Eubios Journal of Asian andInternational Bioethics
EJAIB Vol 18(4) July 2008

ISSN 1173-2571

Copyright ©2008 Eubios Ethics Institute (All rights reserved, for commercial reproductions).
Eubios Ethics Institute World Wide Web: www.eubios.info/index.htm
Official Journal of the Asian Bioethics Association (ABA)

Contents

page97
Biocosmology – Rehabilitating Aristotle’s Realistic
Organicism and Recommencing Russian Universal
Cosmism: Response To Arthur Saniotis
98- Konstantin S. Khroutski
Darwin – Wallace Saga: Ethics in Research
105- K. K. Verma
Bioethical concerns are global, bioethics is Western106- Subrata Chattopadhyay and Raymond De Vries
How can we make the best use of the Universal
Declaration on Bioethics and Human Rights? 110- Miki Fukuyama and Atsushi Asai
The Roman Catholic Church on organ transplantation
112- Paolo Becchi
On Cultural Narratives, Fertility Medicine and
Women’s Agency
118- Frida Simonstein
Ninth Asian Bioethics Conference Draft Program 118
Editorial:

Send papers to the editor in electronic form if possible.
Please use reference style of citations by author’s name in
the article and an alphabetical list at the end of the article, 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
the principles 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@unesco.org

Deadline for the September 2008 issue is 27 August, 2008.

Editorial: Culture and Bioethics
This issue of EJAIB includes 6 papers which are linked
around the theme of culture and bioethics, providing
illustration of the diversity of views of what bioethics is, andwhat principles are important in bioethical discourse.
The first article is a substantive and detailed response toan earlier article published in EJAIB. No doubt in a futureissue we can see the conversation continue, and we welcome
others to the discourse over biocosmology. It is illustrative ofphilosophical diversity.
The second item is a reminder of the debates that
occurred 150 years ago as the theory of evolution was
published in 1858, and the understanding between Darwin
and Wallace that emerged when they had both beendeveloping the same idea. The message of cooperation isimportant today in academic endeavours to develop any field.
The next two articles discuss the universality of bioethics,
and how individuals and communities are both important.
There is a different emphasis in each of the articles, with thefirst calling upon Western bioethics to realize that there areother approaches to bioethics, and the second looking at the
implications of the Universal Declaration of Bioethics andHuman Rights in application. The authors calls for ethics
education at all levels.
The article by Becchi reveals how the discussion of brain
death and organ transplantation that featured so highly in thebioethics agendas of the past 40 years in Japan, Korea, andsome other Asian cultures, is also a matter of debate in papal
policy. The final paper, by Simonstein, reveals how in an
educated community like Israel a pronatalistic policy can
influence the moral choices that people make. We may not beso free as we like to think in determining informed choices. It
reveals anthropological diversity in the way bioethics andlifestyle choices linked to provision of advanced science andmedicine are adopted.
At the end is the draft program of the Ninth Asian
Bioethics Conference, to be held, 3-7 November inIndonesia. It promises to be a significant meeting, with allthemes being discussed and with many original presentations
on research in Asian bioethics. We are still open to more
papers, and there will be associated meetings on ethics ofenergy technologies, among other events.
-Darryl Macer

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Eubios Journal of Asian and International Bioethics 18 (July 2008)

Biocosmology – Rehabilitating
Aristotle’s Realistic Organicism
and Recommencing Russian
Universal Cosmism: Response
To Arthur Saniotis- Konstantin S. Khroutski, Ph.D.
Novgorod State University after Yaroslav-the-Wise
A/B 123, PO-25, Novgorod Velikiy, 173025 Russia
E-mail: hrucki@mail.ru
Philosophy is a science and therefore, like every
other science, it seeks to establish truths that have beenstrictly proved and are therefore binding for every
thinking being and not only for a particular people or
nation. - N.O. Lossky (1951, p. 402).
Introduction
At the very beginning, responding to the article of
Arthur Saniotis (“A Reconnaissance of the Cosmos: A
Critical Response to Konstantin S. Khroutski’s
BioCosmology”; EJAIB 18, March 2008, pp. 52–56) I
would like to thank the author and underline a highquality of his critical analysis of BioCosmology.
Saniotis has carried out really a substantive, interesting,thoughtful and productive analysis that yield the resultsof new original propositions, as well as the elucidationof further possible areas for future discussion in therealm of holistic thinking. At the same time, Saniotis
chiefly concentrates his attention on my first (of theyear 2006) article, published in the section
BioCosmology, of the on-line journal E-Logos:
Electronic
Journalfor
Philosophy(http://nb.vse.cz/kfil/elogos/). The title of this article is“BioCosmology – Science of the Universal Future”
and, of course, it has a basic significance.
However, my second article (also published in thesection BioCosmology) – “Arousing a Dispute over
BioCosmology. A Reply to Stephen Modell” – likewise
should be read carefully, moreover, this is precisely thework that originates the discussion over BioCosmology.
The main peculiarity of this text is that it establishes avector of comparative analysis of BioCosmology withthe philosophy of Aristotle. Crudely speaking, theessence of BioCosmology is the rehabilitation ofAristotelian “bio-” (organic, whole, hierarchical)
cosmos, in which every (living) entity has its inherent
place and destination in the one whole organic selfevolving cosmic world. Substantially, the perspectiveof comparative relation to Aristotle’s philosophy(pertaining to the critical analysis and development of
BioCosmology) was set by Stephen Modell in his
previous critical response (Modell, 2006).
In fact, Modell has grasped the substantial point – thetrue trajectory of the discussion on BioCosmology liesin the realm of rehabilitation and reconsideration (while

addressing to the state-of-the-art empirical andtheoretical achievements of the world scientificprogress) of the realistic philosophy of Aristotle. One
more valuable contribution in this perspective (likewise
published in the E-LOGOS), that ought to bementioned, – is the work by Anna Makolkin“BioCosmology as a New Sign and its Possible
Meanings”, in which she discloses the great value ofAristotle’s ideas in our time. In truth, for instance,
Arthur Saniotis, while exemplifying the basic law of
autopoiesis by Maturana and Varela, brings about theirsubstantial assertion: “Further, the organism is not awhole by itself, rather it results as a whole in therelational space in which it is considered as an
autopoeitic system through its interactions in its niche”(Saniotis, 2008:52). That is clearly the Aristotelian
approach, inasmuch as it relates to the world as aheterogeneously (harmoniously, organically) selfevolving whole, with the natural position of an entity inits(her/his) place (“niche”). This approach categoricallywithstands with a modern dominating scientificstandpoint that divides the world and establishes thedualism of Mind and Matter, as well as treats cosmos as
the material unified (homogenous) space.
Current substantial misinterpretation of Aristotle’s
philosophy
On the whole, in Aristotle’s approach, – a realistic
exploration (physical and metaphysical, scientific andphilosophical) is the integrity of rational and empiricalknowledge, of noumena and phenomena, of aposteriori
and apriori data. He defined philosophy as the scienceof the universal essence of that which is real or actual.
Hence, Aristotelian philosophy has the irreplaceable
significance, inasmuch as the world of our living is
actually universal (which is an aposteriori truth, i.e. isconfirmed and not rejected by natural sciences data).
Instead, in the present reality, we are witnessing thesituation, that “reflections on the meaning of thecomplex dynamical nature of living systems show an
overwhelming multiplicity in approaches, descriptions,definitions and methodologies” (Van de Vijver
2003:101). At the same time, agreeing with the accurate
conclusion by Anna Makolkin: “The post-Christian
man misinterpreted Aristotle, who had come back to
Europe via Byzantium, Moslem Spain and Papal Romeduring the Renaissance. Aristotelian texts had been readin the light of the post-Christian analytical categories,
tinged with Judeo-Christian and Islamic theology.”(Makolkin 2008:5). Hence, the actual task of-today is
the urgent rehabilitation and development (due to thechallenges of the current epoch) of Aristotle’s realistic(universal) philosophy.
First of all, we might confess that Aristotle of-today
is substantially misinterpreted. For example, if to take
into consideration Aristotle's cornerstone notion“form”, which originally signifies those inherent ideasthat substantively determine the origination, existence
and development of any entity, – in contradistinction, aEubios Journal of Asian and International Bioethics 18 (July 2008)
contemporary meaning of “form” has rather the
opposite sense, signifying the external superficial
features of a thing, like its shape (or configuration,
contour, figure, outline, etc.). The same is with
Aristotle’s “cosmos” (not only in astrophysical, but
precisely in ontological meaning) which is substantiallymore than a planetary model and is quite distinct fromthe modern concept of Universe (infinite, quantitativeand homogeneous, where space, time, matter, and cause
are absolute and uniform). On the contrary, Aristotle’s
Cosmos is finite, qualitative, and hierarchicallydifferentiated. In this Cosmos there is no space (onlyplace), and everything is ever the combination of matterand form, while any change is based on the Four
Causes (material, formal, efficient, final). In this order,
causa finalis has the decisive significance – all entities
in the world are basically moved and are (self)evolving
due to their inner immanent (natural) goals. Thus,
Aristotle has made teleological explanation the mostfundamental of the four complementary ways of
explaining nature.
At the present time, however, causa finalis (as theinner universal essence) has been deleted from thesphere of modern science, philosophy and (bio)ethics.
Our actual task is to return it back, thus paving the way
for the universal understanding and interrelation withthe world. In this perspective, the achievements ofRussian philosophy and science (which were and arebadly suppressed or passed over in silence during
nearly the last century) are the matter of great
importance.
Cruel fate of Russian biocosmology"All new is the well forgotten old". In relation to
Russian philosophy and science the formula ispertinent: “All new is the well annihilated «subjected torepression» old”. In other words, the disappearance of
the achievements of Russian philosophers and scientists
from the world scene of cultural evolution has notoccurred due to natural causes (owing to a freecompetition of ideas and their further embodiment inpersonalist and public life), but this historical disasteremerged exclusively because of the “artificial” manmade causes (not programmed by the nature, but whichwere planned and realized by the certain persons andtheir public structures). To put it differently, Russian
philosophers and scientists (as well as writers, poets,
painters, musicians, artists) who formed the so-calledstream of Russian cosmism and analogous currents, andwho just realized and substantially developed
Aristotelian ideas of real perception and universal
cognition of the world (treated as the one common
organic whole, but, now, on the contemporary higher
level and stage of the world evolution) – these cultural
workers have been shot, banished in concentration
camps, or exiled from the country, and their majorachievements have been basically withdrawn from
cultural sphere and up to now totally are not admitted

99

into the processes (in the main cultural spheres) of
public institutes building and development, including
education and science.
To the point, forcible westernization of Russian
civilizational evolution has been carried out since thereign of Peter the Great (i.e., since the beginning of the
XVIII century) and continued during the further
monarchical reigns, and this “general perspective”
seriously reduced possibilities of the realization of
Russian inherent civilizational potential. However, in
the XXth century (since the 1917, during the Bolshevist
dictatorship), the essential conditions have been
worsened dramatically, inasmuch as Russian
civilizational evolution has been broken by the violent
total suppression of its inalienable cultural potentials(as well as by non-admission of the other world-wide
cultural achievements). The suppression of true
inherent Russian culture (and, hence, the breaking of
the world evolutionary development of Aristotle’s basic
philosophical principles) has been fulfilled in favor ofWestern Marxism, executed in the name of MarxismLeninism and within the dogmatic principles of Soviet
Marxist Philosophy (dialectical materialism). To
implement this, there were framed the punitive social
institutions that repressed opposition to Soviet
ideology, including GULAG (the government agency
that administered the penal labor camps), GLAVLIT(Soviet censorship organ), the forcible “psychiatrictreatment” of dissidents (otherwise-minded), etc.
Herein, the conclusion of Nicolei Lossky is relevant(made by a prominent Russian philosopher in the 1951,already in the emigration, for, Lossky was exiled from
Russia): “Dialectical materialism is the only philosophy
allowed by the Soviet Government. A philosopher who
attempted to write a book or an article in a different lineof thought could not have his work published andmoreover would be in danger of being sent to aconcentration camp. As soon as Russia becomes free ofthe communist dictatorship and has freedom of thought,
there will at once appear many different schools ofphilosophy just as in any other free and civilizedcountry” (Lossky 1951:408).
Only since the late 1980s and early 1990s, during theperiods of “Glasnost” and “Perestroyka” and the further“democratic reforms”, – there appeared (in Russia) the
conditions for the free development of philosophicalideas, both Russian and World (chiefly, Western).
However, again the balance has run into theunfavorable condition for the development of Russian
cultural heritage, including the development of Russianscientific achievements, realized in the conceptions ofSechenov, Mendeleev, Danilevsky, Ukhtomsky,
Bogdanov, Vernadsky, Kholodny, Sorokin, Anokhin,
Chizhevsky, Ugolev, Gumilev, Simonov and manyother (which bear the essence of neo-Aristotelism). The
reason is that the current sources of Western philosophy
and science is enormously more influential (in financial
aspect, first of all) than the surviving sources of

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Eubios Journal of Asian and International Bioethics 18 (July 2008)

Russian culture. Therefore, in outcome, in current
Russian reality (cultural life) we have, of course, theoverwhelming predominance of Western civilizational
ideas and dispositions over the natural inherent Russian
position and perspective in the world development. Not
surprisingly, therefore, that Arthur Saniotis, as well as
any other scientist in the world (including a major partof Russian philosophers and scientist themselves), –have not any other chance for the exploration of organic
wholeness of the world but the use of a Western
standpoint (world outlook), inasmuch as theachievements of Russian philosophy and science, whichdevelop Aristotelian ideas of realist and rational(universal) approach to the world (i.e., which deal withand develop Aristotle’s immanent teleologicalessentialism), – these ideas and conceptions still areunavailable for a explorer and, thus, – for the world
cultural development on the whole.
Indeed, for more than 300 years Russian civilization
undergoes the crudely unfavorable conditions for thenatural origin and development of its inherent culturalpotentials, including the horrific period of the
Bolshevist dictatorship in the XXth century, since the1917 (that caused, in brutish manner, the artificial breakof the evolution of Russian civilization and its influenceon the world development). To my strong opinion, thelack of the harmonizing influence of Russian culture on
the world evolution in the XXth century is one of themain factors of the occurrences of two brutal worldwars and the entire world confrontation in the XXthcentury, as well as the appearance of the 11 global
paradoxes (crises), the characterization of which is
given in my previous works (Khroutski, 2007–2008).
The important negative result (in this course of world
affairs) is that still the account of the significance ofRussian civilization for the world culture is realized
exclusively from the Western standpoint that treats
Russian culture as the peculiar (queer) phenomenon(which is chiefly explained by its specific religiosity or
mysticism), but which has strongly emerged in thegeneral way of the world cultural development andmovement to the “omega” point of mature Western
civilization
(with
its
culturalachievements:
technological progress, free market, liberal democracy,etc.) – the “end of history” (“end of philosophy”). Thisis a typical presentist point of view, which is,
metaphorically, – a kind of sleep (of “dream” or“hallucination”).
In reality (in the cycle of‘wakefulness’), we might always remember that ahuman life and human life activity is ever the product(creation) of natural (cosmic) evolution, but not viceversa. In fact, we (every living subject) are theconstituents of the evident (due to the natural sciences
data) one common whole cosmic evolutionary processof the life on Earth (EvoProcess, briefly). Within
EvoProcess, substantially, a man is ever an organ (likea cell in the organism), which naturally has its selfdependent functionalist evolution. Therefore, in therealistic dimension, a human mind (consciousness), as

well as any other living entity is ever a functional
means (but never – the end) and, thus, – ever being (andfunctioning) in the triadic process (micro- and macroevolutionary) of the realization of its/her/his inherent
emergent past, present and the future stages ofautonomous evolution.
Likewise, Russian civilization is a naturalautonomous organ (but which still is artificiallysuppressed) within the one common whole worldorganism (which might be treated as Cosmos, orGodmanhood, or World, or Universe, etc.). The
cornerstone point is that the natural (healthy, selfsufficient) functioning of this organ (of Russian culture)is the essential condition for the universal well-being of
the entire world, for, nobody else at present (in themodern times) is concerned with the rehabilitation andpractical implementation (on the due evolutionary
level) of Aristotle’s true physical and metaphysicalprinciples, aimed at the realistic universal cognition of
the world.
Biocomological unity of Russian philosophy andscience
Substantially, there is no fundamental difference
between Russian religious and secular philosophy. I
defend in my works that Russian culture has basicallythe organicistic (biocosmological) essence, which roots
are taken in the World (Ancient, Eastern) cosmism(holism). In turn, the stem of Russian biocosmology isconstitutedbythefundamental
ontological,
gnoseological and axiological principles: of ontologicalorganicism (cosmism, universalism, holism, pan-unity
or all-unity – of treating any actual entity as the
microcosm in the one common whole universal organic
macrocosmorCosmos);anthropologism
orpersonalism (stating that, at present, every man is the
crucial agent of the one self-evolving world or
Cosmos); and triadic futurologism or three-stage
emergent futurology (of studying the autonomous (intheir organization) Past, Present and the emergent,sought for – naturally required, desired, needed –Future).
Likewise, the gnoseological (core, fundamental)
foundation of Russian biocosmology is the principle of“zhivoznanie” – epistemological realism – in thevarious forms of integral knowledge (“tsel’noe znanie”– the term, for the first time coined by Vl.Solovyov) orof intuitivism (the notion of Lossky) that integrates “thesubrational aspect of the world (sense qualities), itsrational (or ideal) aspect, and the superrational
principles”, thus combining “sensuous, intellectual andmystical intuition” (Lossky 1951:404). (In turn,“zhivoznanie” –‘LifeCognition’ – is the term of
Slavophils who urged that our knowledge of reality isimmediate. “Zhivo-znanie” (‘LifeCognition’) isrepresented in Russian gnoseology in the different
forms, all of which “discard the Western belief thatsense data are subjective mental states of the observer,

Eubios Journal of Asian and International Bioethics 18 (July 2008)
and admitted their transsubjective character” (Lossky
1951:404).
Finally, we have the axiological cornerstone(biocosmological) principle of anthropocosmism (theconception with this name was basically developed in
the middle of the XXth century by N. Kholodny) – a
person is the decisive active-evolutionary functionalist
element of the one actual self-evolving world(Cosmos). This essence was clearly disclosed by aneminent Russian scientist and philosopher Nicolai G.
Kholodny: “A man, despite the essential features of thevital environment created by him himself, continues toremain an integral part of cosmos, completely
subordinated to its laws. A person is not above thenature, but inside the nature.” (Kholodny 1982:44).
This judgment reflects a cornerstone of Aristotelian (aswell as of Russian biocosmological) approach: a person
is within (but not without) the cosmic evolutionary
process of the life on Earth, hence, s/he is really the
microcosm (similarly to the views of Eastern or Ancientphilosophers) but, distinctly, in biocosmological realm,– a man is the personality who is not only integrated,but, likewise, is the decisive (creative) element ofmacrocosm – self-(macro)evolving Evolutionary
Process (EvoProcess).
Hence, having taken roots in the ancient cosmism
and centered over the stem of basic cosmist –ontological, gnoseological and axiological –fundamental principles (of pan-unity, anthropologism(personalism), triadic futurologism, integral knowledge(zhivoznanie) and anthropocosmism) – the branches
and fruits (of the ‘tree’ of Russian biocosmology) havesprung up in the forms of various achievements ofRussian culture, both “religious” and secular. The
former are represented at least by the conception ofSobornost and “zhivoznanie” by Slavophiles (A.
Khomyakov and I. Kireevsky, first of all); “pan-unity”,“Godmanhood” and “integral knowledge” by Vl.
Solovyov; cosmology of N.Pirogov; Sophiology of S.
Bulgakov; “Soil Conservatism” of F. Dostoevsky;
original philosophy of L. Tolstoy; “The common task”
of N. Fedorov; Personalism of N. Berdyaev, L. Shestov,
L. Lopatin, and others; Ontologism of S. Frank;
Intuitivism of N. Lossky; the “metaphysics of all-unity”
of brothers Trubetskoi, L. Karsavin, P. Florensky; andmany others. The latter (biocosmological essence ofRussian secular philosophy) is brightly expressed in the“organicism” of D. Vellansky and A. Galich;“cosmism” of D. Mendeleev and I. Sechenov;“revolutionary-democratic” conceptions of the so-called“westernizers” – A. Herzen and N. Chernyshevskij; the“subjective school in sociology”, created by the socalled “narodniki” (Russian populists) – P. Lavrov andN. Michailovsky; the philosophy and theory of“cultural-historical types” by N. Danilevsky and K.
Leontiev; Anarchism of M. Bakunin and P. Kropotkin;philosophical conceptions of nature – “ortobios” of I.
Mechnikov and “nomogenesis” of L. Berg; “tectology”

101of A. Bogdanov; “cosmic philosophy” of K.
Tsiolkovsky; philosophy of social sciences of P.
Sorokin; L. Gumilev’s “theory of passionarity”;
Biosphere and Noosphere of V. Vernadsky;
Heliobiology of A. Tchizhevsky; ecologicalconceptions of N. Moiseev and others; and, eventually,
the conceptions of modern (Russian, universal,
biocosmological) functionalism – of A. Ukhtomsky, P.
Anokhin, A. Ugolev, P. Simonov – which are thematter of special interest and study from the standpointof author’s BioCosmology (this issue is characterized
below).
The scheme shown in Figure 1 shows similar
positions of Greek universalism (firstly, of Aristotle’s
philosophy) and Russian cosmism (biocosmology) in
relation to “the general ascending – Cosmist – axis
(vector)” of world evolution. At the same time, thesecultural eras (cycles of world cultural development)
clearly have the opposite axiological directions – of“theocosmism” or “cosmobiology” (paving the way
ultimately for the sphere of modern anthropocentrism
or AntiCosmism) and, in turn, – of “biocosmology”,
naturally required for the Future anthropocosmism – theessential foundation of the sphere and era of
RealCosmism.
Figure 1: Positions of Greek universalism(cosmobiology) and Russian cosmism (biocosmology)
in the integral spiral evolution of world culture
Designations:AC –Ancient cosmism(ACosmism)
GU –Greek universalism
AntiC –
AntiCosmism(absolute
anthropocentrism)
RusC –
Russian Cosmism(biocosmology)
RC –RealCosmism

Meanwhile, in the conclusion of this part and withreference to cosmological substantiation, the idea of a(macro)evolutionary spiral (as a metaphor of the one

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Eubios Journal of Asian and International Bioethics 18 (July 2008)

common world cultural process) is advanced.
Substantially, this ‘evolutionary spiral’ transcends(during its ascending movement) the polar cycles ofhuman basic world-viewing and relation to Cosmos –from ancient cosmism (or ACosmism) to modern
anthropocentrism (or AntiCosmism) and, further andagain, to present and future cosmism (RealCosmism).
The given below scheme strives to simplify theperception of this thesis. To the point, herein, thecompression of the turns in the current and future times
reflects the apparent acceleration of cultural processes.
As Ervin Laszlo asserts, “in the past, a more adapted
civilization evolved over several generations; therhythm of change was relatively slow. This is no longer
the case. The critical period for change today iscompressed within a lifetime of a single generation”(Laszlo 2001: 46).
Modern (Russian, biocosmological, universal)
functionalism
Russian psychologist and historian of sciences M.G.
Yaroshevsky substantiated the “Russian way” in theworld science, which brought about the emergence of
behavioral science that is radically different “frompsychology of consciousness, on the one hand, andfrom neurophysiology, on the other hand”(Yaroshevsky 1995, 5). Really, Sechenov had revealed
the phenomenon of “central inhibition” that showed
clearly the integration of central nervous activity(including the qualities of “soul”) into the whole
behavioral activity of a person. Further, I.P. Pavlov
elaborated the theory of conditioned reflexes(“conditioned”, i.e. centrally organized). However, thecornerstone moment is the origination of the notion of“functional organ” by A.A. Ukhtomsky, the forerunnerof his famous theory of dominanta. The Russianscientist gave a strict definition to his concept of amobile, whole functional organ: “we used to bind thenotion «organ» with the representation of amorphologically developed, static and constantformation. It is absolutely not obligatory. Organ can
represent any temporary combination of the forces,
capable to carry out the certain achievement”(Ukhtomsky 1978:95).
The revelation of the physiological mechanisms of“central inhibition” (by I.M. Sechenov) and thefollowing conception of “functional organ” (by A.A.
Ukhtomsky) unraveled the integrated nature of anorganism’s behavior in the environment (world) andworked the way to the other functionalist achievementsin the Russian physiology and psychology (the general
theory of functional systems by P.K. Anokhin, theconception of modern functionalism by A.M. Ugolev,
the need-informational theory of higher nervous
activity by P.V. Simonov and the other). For the
purpose of more detailed characteristic, we are todecide in favor of Petr Anokhin’s scientific work,
inasmuch as his theory, probably, is the most elaborated
conception in the area of modern (biocosmological)

functionalism.
Characterizingadistinguishedcontribution of P.K. Anokhin to the world science,
Professor K.V. Sudakov, a leading specialist in the areaof functional systems approach in contemporary Russia,
highlights “universality, constructivity, and practicalusefulness of the principal scheme of the functional
system… According to this theory, a functional system
is an elementary integrative unit of any activity ending
with a useful result. It makes the functional system an
isomorphic (i.e. – universal. – K.K.) principle forsystems of different classes which end with a useful
result." (Sudakov 1998:171).
The definition of a functional system is thefollowing: “Functional systems are dynamic, selforganizing and autoregulatory central-peripheralorganizations the activity of which is aimed atachieving adaptive results useful for the system and theorganism as a whole.” (Sudakov 1995). A cornerstone
point is that Anokhin’s notion of a functional systemdiffers radically from the notion of a classical system.
In his time, P.K. Anokhin emphasized that“overwhelming majority of researchers do not attempt
to penetrate into the internal architectonics of a system– to make a comparative estimation of the specificproperties of its internal (italics mine. – K.K.)
mechanisms» (Anokhin 1973:31). K.V. Sudakov sets
out the essence of this issue: “Just the being (entity) ofa system-formative factor – the result of activity –radically distinguishes functional systems from thesystem organizations of the classical type formulated by
L. Bertalanffy” (Sudakov 1997:48). It is clear that wehave herein the direct analogy (and the development) of
Aristotle’s conceptions of causa finalis and entelecheia.
(Aristotle’s entelecheia – from en (in), telos (end, or
purpose) and echein (to have) – denotes “having one's
end within” and signifies something’s essential
potential that is capable of and determining its own
spontaneous (but in the due time and condition) fullself-actualization).
Three autonomous, constantly active spheres ofhuman cognitive and practical activity
On the basis of aforementioned conceptions, wemight advance the idea of the three autonomous(emergent) spheres of human cultural activity, which
are forever required and active for a personalist(societal, ethical) cognitive and practical agency. This
metaphor is expressed in the scheme given in Figure 2.
These three spheres likewise designate (in relation to
the fundamental ontological, gnoseological andaxiological bases of Russian biocosmology) the three
evolutionary levels of modern scientific activity. The
First (bottom) level and sphere pertain to Ancient(Eastern) holism (cosmism) that conducts a realistic(treating the world as a universal whole) but irrational
approach (lacking the reduction of knowledge to arational substance). In the expression of Prof.
Sakamoto, the cognitive activity of a man in this sphereis driven by “the Asian ethos and wisdom” (Sakamoto

Eubios Journal of Asian and International Bioethics 18 (July 2008)
2004:489). As regards bioethics, this area is brightly
exemplified by the original conceptions of “bargain
consensus” and the “social tuning technology”, whichwere created by Prof. Sakamoto and presented by him
at the Fifth Asian Bioethics Conference in Tsukuba(2004), and which are aimed at the resolution of
conflicts of any type and realisation of the harmony in(future) global bioethics.
Figure 2: Three spheres

With respect to biomedicine, this is the sphere ofactivity of the so-called ‘organismic’ medicine (in theformsof
Hippocratic,
neohippocratic,
postneohippocratic, and the current forms of alternative
medicine – Homeopathy, Acupuncture, Osteopathy,
Vitamin Supplements, etc.), which treats a patient as awhole (as organism – microcosm, integrated into thegiven environment – macrocosm), whose disease isgenerally considered as the imbalance of her internal
harmony. The humoral theory of Hippocrates himself –Father of medicine – is a bright example of the ‘first –organismic’ medicine. Significantly, Hippocratic
medicine shows general agreement with Traditional
Chinese Medicine. The substantial quality of
Hippocratic medicine (and the derived modern
complementary forms) is its holistic (organismic) andhealth-centric essence, which is realized, however,within the presentist world outlook – within ‘the given’,
thus denying the ‘the evolving’ substance of a person.
Noteworthy, Hippocratic principles in medicine,including biotypology, survived more than 25 centuries(and continue to develop) in the world history, havingpresented the remarkable achievements in integrative
constituting of human organism – from Hippocrates,
Galen, and Paracelsus up to Pavlov, Jung, Kretschmer,
and Sheldon.
At the second level and in the second sphere – of(post)modern philosophy and science activity (whichclearly dominates in the world since the XVIII century)– the cosmology of anthropocentrism (i.e. – ofAntiCosmism) has the absolutely dominating
significance, thus generating the entire spectrum andgrand scale of the current technological progress, which103

is not in a need of extra comments. Substantially, theachievements of Russian functionalists (Sechenov,Ukhtomsky, Bogdanov, Anokhin, Ugolev, Simonov),
as well as the advances of systems and hierarchy
theorists and the progress of complexity scientists,
including the promising position of A. Saniotis himself(of all, who study the non-linear processes of integral
natural and life phenomena, and whose proposals are
based on the theories of chaos, fractals, catastrophes,etc.), – might be treated as marginal and nondeterminative (counting at the best on interdisciplinaryinteraction with the generally recognized – mainstream,
anthropocentric – paradigms and theories), but whichhave the essential transitive character and role (for the
future holistic philosophy and science) in the integral
development of world culture. Substantially, theSecond sphere enables the rational (subdued to theempirical evidence and logical reasonableness), but
unrealistic approaches in philosophical and scientificdomains, inasmuch as it establishes (due to its
fundamental anthropocentrism) the dualistic separationof a man’s mind (consciousness) from the world’s
reality (which is a posteriori holistic – all-in-one) and,thus, legalizing the enormous pluralism of human
idealistic interpretations of the world.
Characterization of the bioethical issues, as concerns
this Second sphere, was given in my previous work for
the EJAIB (Khroutski 2007). As regards biomedicine,the ‘Second – Western’ (‘organic-pathological’),modern scientific medicine is based on the subjectobject exploration of Aristotle's causa materialis, causa
formalis and causa efficiens, and the rejection of causa
finalis, i.e. – on the basic studying of extrinsic factors,
thus being bio- and morpho-centric, as well as socioand environment-centric, and, ultimately, bearing thepathocentric essence in relation to a human being. In
contradistinction (to holistic medicine), a person isviewed here as an average patient – a statistical (bio- orsocial) norm (without any peculiar intrinsic andorganismic peculiarities). The primary significance isplaced on the external factors which cause a disease –infectious, traumatic, other environmental causes.
Hence, this is precisely the medicine of disease (which,of course, is absolutely necessary), but not the medicine
of individual's health, of her/his ontogenetic well-being.
A vivid example, herein, is the definition of blood types
in humans, unnecessary to a healthy person, butabsolutely necessary in the certain pathologicalsituations. Another relevant example is the modern
pharmacogenomics and the knowledge of the genetic
basis (with respect to the diseased person) – her/his
genetic profiles – of a drug response, that allow
specification of drug prescriptions instead of trial anderror.
Ultimately, at the Third level and sphere,
biocosmological fundamentals (the basic ontological,
gnoseological and axiological principles – of pan-unity,
personalism, triadic futurologism, integral (of the unity

104

Eubios Journal of Asian and International Bioethics 18 (July 2008)of empirical, intuitive and rational) knowledge,
anthropocosmism – i.e. of realistic and rational relation
to the world) – take on the status of a central nuclear
core of the entire life (including cognitive and practical)
activity. Henceforth, RealCosmism acquires the ‘legal’
determinative significance, thus opening the colossal
realm (yet unexplored – “white area” in the “map” ofscientific discoveries) and prodigious perspective forthe growth of any cultural trend, including firstly thephilosophical and scientific domains. Naturally, thealready existing functionalist (of integral knowledge)
scientific achievements (methodologies) of Russianscientists (Ukhtomsky, Bogdanov, Anokhin, Ugolev,
Simonov) will take on a special significance, serving as
the primary point of reference.
As well as author's BioCosmology might pretend to
be useful in the realization of this global perspective (ofgeneral turning to the realistic and rational – universal –cognition of the world). Substantially, BioCosmologicalapproach cardinally transforms the ethical preferences.
Indeed, anthropocosmism means the ‘ethics of love’ –the basic significance of “reasonable (judicious, sane)
egoism” (in the term of N.Chernyshevskij – ofsatisfying (accompanied by positive, gratifying
emotions and feelings) realization by a person (during
the entire ontogenesis) of her/his Basic Cosmist
Functionality (‘ontogenetic entelecheia’). This is theradical opposition to current (Kantian) “(bio)ethics ofduty”, which is the reflection to the requirements ‘fromwithout’ (like Kantian “categorical imperative”), whilethe ‘(bio)ethics of love’ is the expression of natural life
impulses ‘from within’ (thus, in turn, we are dealing
herein with the types of transcendent and immanent
essentialism). In this approach, we are to refer andreconsider the significance of Darryl Macer's
conception of the “Bioethics is love of life”, wherein“key to life is love of life” (Macer 1998:5).
As regards biomedicine, the Third (biocosmological)
sphere opens the real perspective for the realization of atrue medicine of individual’s health (personalist
medicine); firstly by bringing forward the fundamental
principle of CosmoBiotypology, another cornerstone of
the
whole
Cosmisttheoreticaledifice.
CosmoBiotypology may be treated as a concrete
biocosmological law, which states that each living
subject on Earth is a natural (more accurately, cosmic)
function of the higher-level congenerous subject andultimately of EvoProcess itself. Therefore, every living
subject on Earth naturally bears the biotypological traitsof this intrinsic basic functionality and naturally relates
to the appropriate ecological-social environment (theanalogy to Aristotle’s notion of “place”). In otherwords, this principle establishes the functionalist
identity and, thus, the universal meaning of the threemacro-orders of man's entire wellness: satisfying
subjective feelings and perceptions; adequate positionin the social-ecological environment; and biologicalconstitution or biotype. The latter precisely serves tothe fulfilment of a person's BCF – basic cosmist

functionality (which is the first basic inherent need –entelecheia, and the self-realization of which is thebasic condition for the entire healthy ontogenesis of aperson). Thus, the CosmoBiotypological principle
aspires to universalize biomedical, social, and humanknowledge – to rationally unite a person’s subjective
knowledge with the objective knowledge about
her/him, hence – to unite previously incompatible
scientific and humanistic paradigms.
Conclusion
The substantial point is that Russian biocosmologicalculture on the whole and author’s BioCosmologicalconception, particularly, – fully correspond (inontological and gnoseological aspects but substantiallydiffer in axiological perspectives) to Aristotle’s realism,
practically carrying out the rehabilitation of his
philosophy that perceives the world (cosmos) as “bio”(organic) whole, and wherein teleological causality(immanent essentialism, fundamental functionalism)occupies the primary positions. Therefore, Russian
biocosmological culture (with its core principles oforganicism, personalism, triadic futurologism, integral
intuitive knowledge and anthropocosmism) represents aworld evolutionary phenomenon and cultural processthat is essential (as author strives to reveal in his works)
for the future well-being evolution of the global world.
The gist of the issue, however, lies not in thenationality, but precisely in the need of effective
rehabilitation (in line with the contemporary
tremendous scientific achievements) of Aristotle’s
universal consideration of the Earth’s world with all its(living) entities and processes.
The author attempted to disclose in this work that thelong epoch of the “westernization” of Russia has
eventually brought about the unfavorable results ofcultural stagnation in Russia (and in the whole world,
accordingly). Hence, nowadays, the task of therehabilitation of Russian inherent civilizational(biocosmological) potential (and, thus, the restorationand development of the evolutionary potential of
Aristotle’s philosophy) becomes the urgent task for the
global culture. At any rate, however, this grand task is amatter for a special – thorough and substantive –exploration (and discussion). Meanwhile, in this
response to A. Saniotis’s interesting contribution to thediscussion over BioCosmology, I chiefly tried to focus
attention on the cosmological bases (primarydispositions – Cosmist and AntiCosmist, that determine
the essence and results of scientific activity), as well as
to shed light on the evolutionary ‘logic’ of their natural
evolutionary emergence. To author’s firm belief, atpresent and henceforward, the exploration andunderstanding of these issues take on special
significance for resolution of the issues of integral(universal, rational) cognition of the living world on
Earth, firstly of a person’s well-being ontogenesis.

Eubios Journal of Asian and International Bioethics 18 (July 2008)
References
Anokhin, P.K. 1973. Fundamental issues of the general
theory of functional systems. In: Principles of the systemicorganization of functions. Moscow, Nauka: pp. 5–61. (InRussian).
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BioCosmology. A Reply to Stephen Modell” E-Logos:
Electronic
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Khroutski, K.S. 2007. “BioCosmological Approach in World
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Bioethics
17(6):
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167–171.
(Available
at: http://eubios.info/EJAIB112007.pdf)
Khroutski, K.S. 2008. The Evolutionary Time of Awakening:
Do We Need a Third (neither Eastern, nor Western) Way in
the World Evolution? // Journal of Futures Studies. 12(3):pp.
101–109.
(Available
at: http://www.jfs.tku.edu.tw/sarticles.html)
Laszlo, E. 2001. Macroshift: Navigating the Transformation
to a Sustainable World. San Francisco: Berrett-Koehler
Publishers, Inc.
Lossky, N.O. 1951. History of Russian Philosophy. NewYork, International Universities Press, Inc.
Macer, D. R.J. 1998. Bioethics is Love of Life: An Alternative
Textbook Christchurch, Eubios Ethics Institute.
Makolkin, A. 2008. “BioCosmology as a New Sign and its
Possible Meanings” E-Logos: Electronic Journal for
Philosophy URL: http://nb.vse.cz/kfil/elogos/
Modell, S. 2006. “The Two Arrows of Efficiency: A
Commentary on Konstantin S. Khroutski’s BioCosmology– Science of the Universal Future” E-Logos: Electronic
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Sakamoto, H. 2004. “Globalisation of Bioethics – from the
Asian perspective.” In: Macer, D. R.J., ed. Challenges for
Bioethics in Asia. The Proceedings of the Fifth Asian
Bioethics Conference (ABC5), 13–16 February, 2004, in
Tsukuba Science City, Japan. Christchurch, Eubios Ethics
Institute: pp. 487–493.
Saniotis, A. 2008. “A Reconnaissance of the Cosmos: A
Critical Response to Konstantin S. Khroutski’s
BioCosmology – Science of the Universal Future” Eubios
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56.
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105

Darwin – Wallace Saga: Ethics
in Research- K. K. Verma, Ph.D.,
Retired Professor of Zoology,
HIG 1/327,
Housing Board Colony,
DURG – 491001, India.
Email: kk.sheel@gmail.com

Some significant celebrations are quite close now. In
2009 biologists will be celebrating the bicentennial
anniversary of Charles Darwin’s birth (date of Darwin’s
birth: 12th Feb. 1809) and 150th anniversary of
publication of Darwin’s “Origin of Species” (the book
was published in Nov. 1859). Establishment of thenatural selection theory of evolution as a scientifictheory has proved to be a turning point and arevolutionary step in the history of biology. Hewett
Watson, a noted botanist of that period, wrote to
Darwin soon after the publication of “Origin ofSpecies”, “Your leading idea will assuredly become
recognized as an established truth in science, i.e.
‘Natural Selection’ …You are the greatest revolutionist
in natural history of this century, if not of all centuries”.
The optimism, expressed by Watson, has not only
survived through one and a half centuries, but also it
has been much strengthened by cogently explaining all
biological observations and phenomena. Moreover theconcept of natural selection is entering the realm ofmolecular biology (Yuan et al., 2005; Joyce, 2004;
Paegel et al., 2008).
Recently Beccaloni and Smith (2008) have pointed
out that, when we plan next year Darwin’s
anniversaries, we shall be downplaying Wallace’s rolein formulation of the Natural Selection Principle.
The Darwin-Wallace saga has something very
relevant to the present scenario in the field of research.
Hence it would be useful to recall the history ofdevelopment of the Natural History concept.
When Darwin returned from his famous scientificvoyage on HMS Beagle in 1838, he had a load ofinteresting observations in the various parts of theworld, visited. He got his experiences published in his
book “Journal of Researches” in 1839. After sometimein London he moved to his country residence in 1842.
Escaping the excitement and bustle of London andhaving a restful time in his country home, he ponderedover his recorded observations and reached his Natural
Selection concept. While he was diligently andanalytically arranging evidences supporting the concept
and was preparing a voluminous manuscript of a
proposed book, he received the script of an essay from
Alfred Russell Wallace on his concept of mutability ofform through selection.
Wallace was a zoogeographer, and had extensively
traveled in the Malay Archipelago. When he was lying

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Eubios Journal of Asian and International Bioethics 18 (July 2008)

with fever in an island of the archipelago, he waspondering over his various observations, and suddenly
he realized the role of natural selection in producing thediverse organisms. He prepared a short essay on thisnew concept, and sent the script to Darwin, saying in a
letter that, if he considered his manuscript worthwhile,
he may send it to Lyell for criticism. Charles Lyell wasa leading geologist and Darwin’s lifelong confidant.
Darwin, on going through the Wallace’s essay, atonce realized that his notion of natural selection, on
which he was developing his large proposed book, hadalready been conceived by Wallace. On this realization
Darwin “felt that he ought to withhold his own
publication in favor of Wallace” (Dodson, 1964).
Eiseley (1956) quotes the following words of Darwin,“I would rather burn my whole book than that he or any
other man should think that I had behaved in a paltry
spirit”. Darwin sought advice of the famous botanist
Hooker and his close friend Lyell in this context, whowere well aware of the views of Darwin and of thepains he was taking in preparing his large book. They
advised him to prepare an abstract of his proposed
book, and got Wallace’s paper and Darwin’s abstract
published together by the Linnean Society of London in
Aug. 1858. Though these publications could not catchmuch attention of people, but, as the Natural Selection
Principle was first published in 1858, it would be a
fitting tribute to the event to celebrate the 150th
anniversary of this, one of the greatest discoveries ofscience, in the current year, as suggested by Beccaloni
and Smith (2008).
The magnanimity of heart, shown by Darwin, wasreciprocated by Wallace, who gave the title“Darwinism” to his book on natural selection publishedin 1889.
Both Darwin and Wallace were not only good field
workers and observers, but they were also keen thinkers
and had a well developed capacity to analyze andalignate their observations to see the meaning
underlying them. As Eiseley (1956) has said about thethinking and synthesizing capacity of these founders of
the Natural Selection Theory, “Such synthesis
represents the scientific mind at its highest point ofachievement”.
There is an ethical message in this oft repeated andwell known story of Darwin and Wallace for thepresent workers in the field of scientific research. Most
significant scientific papers are being published underauthorship of two or more names; some have even morethan ten names, e.g. Macaulay et al. (2005) and Sahooet al. (2006). Importance of team work is being
realized. Several workers, working in collaboration, areable to reach valuable results. Besides different aspectsof the research project, chosen, may be worked upon by
specialists of related areas, and thus important results
and inferences may be reached. The generosity andethical attitude, seen in the Darwin-Wallace saga is
indispensable for team work. Every member of theteam should give to every other member his/her due
credit.
References
Beccaloni, G.W., and Smith, V.S., 2008. Celebrations for
Darwin downplay Wallace’s role. Nature, 451: 1050. (doi:
10.1038/4511050d2008).
Dodson, E.O., 1964. Evolution: Process and Product.
Reinhold Publishing Corporation, New York. pp. 352.
Eiseley, L.C., 1956. Charles Darwin. Scientific American,
194: 62 – 72.
Joyce, G.F., 2004. Directed evolution of nucleic acidenzymes. Annual Review of Biochemistry, 73: 791 – 836.
Macaulay, V., Hill, C., Achilli, A., Rengo, C., Clarke, D.,
Meehan, W., Blackburn, J., Semino, O., Scozzari, R.,
Cruciani, F., Taha, A., Shaari, N.K., Raja. J.M., Ismail, P.,
Zainuddin, Z., Goodwin, W., Bulbeck, D., Bandett, H.-J.,
Oppenheimer, S., Torroni, A., and Richards, M., 2005.
Single, rapid coastal settlement of Asia revealed by analysis
of complete mitochondrial genomes. Science, 308: 1034 –1036.
Paegel, B.M., and Joyce, G.F., 2008. Darwinian evolution on
a
chip.
PloS
Biol.,
6(4):
e85.
(doi:
10.1371/journal.pbio.0060085).
Sahoo, S., Singh, A., Himabindu, G., Banerjee, J., Sitalaximi,T., Gaikwad, S., Trivedi, R., Endicott, P., Kivisild, T.,
Metspalu, M., Villems, R., and Kashyap, V.K., 2006. A
pre-history of Indian Y-chromosomes: evaluating demic
diffusion scenarios. PNAS, 103(4): 843 – 848.
Yuan, Y., Karek, I., English, J., and Keenan, R., 2005.
Laboratory directed protein evolution. Microbial Molecular
Biological Reviews, 69: 373 – 392.

Bioethical concerns are global,
bioethics is Western- Subrata Chattopadhyay
Department of Physiology, Kalinga Institute of Medical
Sciences, Bhubaneswar 751024, India
Email: linkdrsc@yahoo.com- Raymond De Vries
Bioethics Program, University of Michigan, School of
Medicine, 300 North Ingalls Street, Rm. 7C27, Ann
Arbor, MI 48109-0429, USA.
Abstract
Modern bioethics was born in the West and thus
reflects, not surprisingly, the traditions of Western
moral philosophy and political and social theory. When
the work of bioethics was confined to the West, thisbackground of socio-political theory and moral
tradition posed few problems, but as bioethics has
moved into other cultures – inside and outside of theWestern world – it has become an agent of moral
imperialism. We describe the moral imperialism ofbioethics, discuss its dangers, and suggest that global
bioethics will succeed only to the extent that it is local.
Keywords: Bioethics, Western bioethics, Medical
Ethics, Culture, Research ethics.

Eubios Journal of Asian and International Bioethics 18 (July 2008)
Is bioethics a Western phenomenon?
The issues that fall under the purview of bioethics –doing good, avoiding harm, respecting people and theircommunities, justice – are of concern to all those whoshare life on the earth, but their articulation – inresearch institutions, health care centers, corporateboardrooms, and governmental policy – has the strong
accent of the West. While a Western-accented bioethics
has its uses – for example, it simplifies theglobalization of medical research and drug
development – it ignores moral traditions whose roots
and ways of thinking lie outside of the Western
philosophy and political and social theory. There is aninteresting irony here: in order to make bioethics
global, it must be local.
Bioethics and diverse moral traditions
After their research trip to China in 1984, Renée Fox
and Judith Swazey returned to the United States anddeclared, ‘Medical morality is not bioethics.’ Theirobservation – that bioethics as developed in the UnitedStates was simply one among many possible
incarnations of medical morality – was not warmly
received (see, e.g., Gorowitz, 1986). In the intervening
years, however, there has been a gradual but growing
recognition that the discipline of bioethics, assembled
in the North American and European cultural context
from the raw materials of Western moral philosophy,
may not fit all of the world’s cultures. And yet today,
most, if not all, of the efforts to make bioethics more
‘culturally appropriate’ amount to little more thanadapting Western bioethics to varied cultural settings.
We are aware of the danger of putting adeterminative adjective ‘Western’ to an area ofsystematic study or knowledge. After all, there isnothing called ‘American anatomy’ or ‘British
biochemistry’ or ‘Western pathology’. Why then should
we, or anyone else, think of bioethics as Western?
Bioethics, as conceived of in most discussions, isWestern not because it originated in the United Statesor has its roots in the West, but because of the way it istheorized, structured, formulated, and practiced. We are
not alone in this view of bioethics. Alora and Lumitao(2001) declared that we should move ‘Beyond Western
Bioethics’ and Myser (2003) described the ‘normativityof whiteness’ present in mainstream bioethics
discourse. Further testimony to the ‘color-blind’ bias inbioethics is found in what Arekapudi and Wynia (2003)
call the ‘unbearable whiteness’ of mainstream bioethics
and in Burton’s (2007) concern that ‘bioethics cannot
figure out what to do with race.’ Taken together, these
critics confirm that the dominant socio-cultural-moral
construct known as bioethics does not encompass thebelief-systems, cultural norms and moral values ofpeople who are located outside of the moral tradition
that evolved in white Western societies.
Diversity is undeniable reality – and an asset – ofcontemporary life. We share the planet with more than

107

6 billion people who speak over 6000 languages, live inabout 200 countries, and belong to a number ofreligious and/or spiritual traditions. The technologies ofcommunication, the global nature of market economy,
and increased opportunity and ability to travel havemade multi-faith, multi-lingual, multi-cultural societies
commonplace. Given that the purview of bioethics
extends from personal issues (e.g., how should one live
ethically as a healthcare professional?) to global
concerns (e.g., what should our governments andinternational organizations do to combat bioterrorism?), one would expect this field to be
characterized by a broad moral vision, extensive
intercultural dialogue, and a rich variety ofperspectives.
This is, however, clearly not the case. For manyscholars, Bioethics is a blinkered discipline, seeing theworld - its issues, problems, and solutions - througheyes coloured by the noble, but limited, philosophicaltraditions of the West. Cases in point are many; a few
may suffice.
Most histories of medical ethics – and especiallythose that are foundational for bioethical thought –begin with the Oath of Hippocrates. How manybioethicists are aware that the Oath in Charaka Samhita
in Ayurveda surpasses the Hippocratic Oath in both
‘eloquence and moral idealism’ (Jonsen, 2000)? Where
are the references to the two most ancient but living
systems of medicine – Hindu medicine of Ayurveda andancient Chinese medicine – and their medical ethics inbioethics discourse? Interestingly, although bioethics
emerged as a check on value-free, objective Western
medical science, it is itself a product of modern
Western medicine and thus pays scant, if any, attention
to other healing traditions. Complimentary andalternative medicine (CAM) or traditional indigenous
systems of medicine are practiced in vast areas of theworld and, to be sure, have gained popular recognitioneven in the West in recent years, but are seldom
discussed in the bioethics literature (Turner, 2004). It is
no surprise then, given this limited worldview, thatmainstream bioethics does not know what to do andhow to deal with Ayurveda or acupuncture or othertraditional systems of medicine, aside from using themas esoteric puzzles. Having no place for these nonWestern traditions, the discourse of bioethics is
impoverished indeed.
Consider too the role of moral, political, and social
philosophy in bioethics. Unless stated otherwise,
philosophy for most scholars means Western
philosophical systems of thought in bioethics. It is not
surprising then, that bioethics discourse is replete with
Socrates, Plato, Aristotle, Augustine, Aquinas, Kant,
Locke, Mills, Bentham, Heidegger, Levinas, Sartre, andFoucault. Most mainstream bioethicists would bebaffled if Buddha, Confucius, Charaka, Sushruta,
Shankara, Ramanuja, Chaitanya, Ramakrishna,
Vivekananda, Gandhi, Gibran, Radhakrishnan, Tagore,108

Eubios Journal of Asian and International Bioethics 18 (July 2008)

Aurobindo, or Sri Anukulachandra were introduced into
the philosophical conversation that grounds bioethics.
Most of these thinkers will, in fact, be unfamiliar toWestern bioethicists.
Putting moral traditions in their place
Please do not misunderstand us: we are not jumping
on the ‘anything-Western-is-evil’ bandwagon. We
deeply value and appreciate the contribution of Western
philosophy to bioethics. Our question is simply: why dobioethicists coming from Western theology,
philosophy, and ethics ignore the significant
religious/spiritual and philosophical systems thatdeveloped in other places and cultures? Is it ignorance
or is it ethnocentrism? Have bioethicists unconsciously
divided the world into the “Western” and the “Oriental”(Said, 1978) or “Western” and “abnormal” (Hern et al.
1998)? Ignoring non-Western moral ideas can perhaps
be justified for those whose work is intended only forothers who sit squarely in the Western tradition, but in
an increasingly pluralized world, this is less and lesscommon. It is an interesting paradox that popular
culture in the West is flooded with literature regarding
Eastern religion and spirituality while the discourse ofmainstream bioethics is conspicuous by its nearexclusion of Eastern worldviews. Furthermore, theeducational programs created to train non-Western
health care workers and researchers in bioethics(‘medical morality’?) rarely make the effort to discover,teach, and integrate these other moral traditions, raising
the question of the ‘colonizing’ nature of otherwise
well-meaning ethics training programs (Coward andRatanakul, 1999).
The Western approach to bioethics gives rise to a‘one-size-fits-all’ set of ‘principles.’ Distinguishedprofessors seek to train the future bioethicists of the(so-called) developing world in the acrobatic art ofbalancing the ‘principles’ (in either their American orEuropean version) to conquer the most troubling of
ethical dilemmas. While the ‘principles’ are often
framed as meta-cultural, they derive from Westernsecular belief-systems that are not responsive to either
the cultural ethos and moral sensibilities of ethnic
minorities of the West or the emotional needs andreligious/spiritual worldviews of people in the nonWestern world. It is important to remember that the
moralities of both Western and non-Western cultures
are born out of the interplay of values, cultural norms,
belief-systems, and moral traditions that evolved in avariety of historical settings. Application of a set of‘principles’ – even when those principles are ‘adjusted’
to the recipient culture - fails to engage with the moral
ideas and with the medical systems in non-Westerncultures (Stonington and Ratanakul, 2006) and thus
fails as a strategy for promoting more ethical care.
Consider autonomy, the dominant principle ofbioethics in the United States (Wolpe 1998). It isdifficult for some Western bioethicists to realize thatthe principle of individual autonomy – even when

tweaked to fit in non-United States settings by
relocating autonomy in the family, or the clan, or anelder – is an assault on the tradition and values of nonWestern societies who believe in the matrix ofrelationships in dynamic equilibrium of the cosmos. Or,
consider the language commonly used in bioethics suchas ‘end-of-life’. This term, so widely accepted in theWest is heard and apprehended much differently by a
traditional Hindu who believes in ‘life after death’. The
complex and rich realities of cross-cultural bioethics
discourse are blurred by uncritical application of thelanguage, methods, and ‘universal principles’ of themodernWesternphilosophicalframework.
Furthermore, it is inappropriate, and yes, unethical toimpose, either consciously or unconsciously, thedominant Western socio-cultural-moral construct toethnic minorities in the West and the vast non-Westernworld. Our criticism may sound exaggerated, but there
are bioethicists who defend their ‘moral imperialism’(Dawson and Garrard 2006), failing to see this cultural
invasion as unethical.
The blindness to the cultural diversity and otherreligious/spiritual/moral/philosophical traditions of theworld extends to the well-intentioned efforts of those
who seek to serve those in the ‘developing’ countries.
The ‘Universal Declaration on Bioethics and Human
Rights’ promulgated by UNESCO offers an example.
One of its articles says, ‘The interests and welfare of
the individual should have priority over the sole interestof science or society’ (UNESCO, 2005). We respect theintent of this proclamation but question its‘universality’. This ‘universal’ declaration could beread to contradict the cultural norms and moral valuesof a major part of the world and question thefoundations of several Eastern religious and spiritual
traditions. From the perspective of billions of people in
the non-Western world, the idea that ‘the interests andwelfare of the individual should have priority over thesole interest of science or society’ is not just absurd, it
is dangerous. Taken at face value, it makes the whole
public health enterprise untenable on ethical grounds.
The Declaration does also include articles on solidarity,and on respect for cultural diversity and pluralism,
which can be read to balance the individual focus. The
elaboration of the framework principles needs a lot offurther work in different cultures and communities.
Part of the problem here is that bioethics – comingfrom the Western humanist tradition - is focused on‘rights.’ Underemphasized in bioethics is the fact that a‘right’ unaccompanied by a ‘duty’ makes little, if any,sense. Moreover, in many non-Western societies, thenotion of duty is historically held in high regard making
rights-based bioethics something distant, alien, anddiscordant with the local ethos. It is interesting that in
the Eastern world-view, there are no segregated, airtightcompartments of religion, philosophy, spirituality,
ethics, politics, and science. Knowledge is whole, Truth
is One, and in the relational nature of life, the goal issynthesis and harmony rather than analysis andEubios Journal of Asian and International Bioethics 18 (July 2008)
division. In the Eastern tradition, there is no divergent
dichotomy between faith and reason in the pursuit ofknowledge and in the quest for truth. The rigid division
between ‘religious’ and ‘secular’ is also artificial: in
Eastern philosophy, human beings are on a continuous
journey of inner realization from a lower level to ahigher level of truth.
Bioethics and justice
Bioethics loves to talk about distributive justice, but
ironically bioethics is part and parcel of the injustices ofthe Western health care industry. At present thebioethics market in the West is so full of different
varieties of colourful ‘cakes’ for its wealthy customers(pre-implantation
genetic
diagnosis,
neuralenhancement, genethics, nanotechnology, etc.), that few
notice the lack of ‘bread’ (i.e., issues of social
inequality in health, poverty, basic health care, AIDS,
violence, etc.) for the vast majority of the poor andneedy. Given its comfort with institutionalized
medicine and its occupation with procedures, rules,
rights, and legal frameworks, armchair bioethics now
faces the danger of being reduced to bio-etiquette withphilosophy as its feel-good companion.
Mainstream Western bioethics is occupied with theobsessive pleasure solving esoteric ethical dilemmas
and conflicts and with categorizing the priority of‘rights’. While deriving solutions to enigmatic puzzles
can be intellectually satisfying, it is an emphasis thatturns the field inward. Bioethics – in the West and theEast, the North and the South – will flourish if it makes
room for the moral traditions of other cultures. Imagine
the possibilities if bioethics could be shaken from its
Western view of reality to consider the perspective on
reality found in dharma. This ideal-centric way of life
focuses on ‘being and becoming’ and sees humanbeings interacting with their environment in a cosmos
guided by the principle of ‘live and let live’. Thisapproach offers a way to get beyond the apparent
irreconcilable rift between the ‘religious’ and the‘secular’ in the West. It describes a harmonious way oflife help where we human beings – all of us driven by asimilar urge to love and be loved – are deeply
embedded in a matrix of interdependent relationshipsthat tie us together.
In an international roundtable meeting on Bioethics,
one of us asked delegates from different Asian andEuropean countries how they felt about the current
Western-model and its limited vision of bioethics. The
response of one Asian delegate still haunts us. She
confided, “You know, they have the power, they havemoney, they set the agenda!” It is time to stop andponder this.
Modern bioethics is largely conceived of as Western,
but bioethical concerns are global, as shown in thediscussions of regional associations such as the Asian
Bioethics Association. It is better to accept this reality
now, rather than deluding ourselves with wishful109

thinking and exporting a modern Western philosophicalframework to fit in all non-Western cultures. Our view,a voice from the margins of the main stage of bioethics,
is shared with the hope that some day bioethics will
come out of its self-imposed confinement of ‘theWestern-view-is-the-only-credible-one’ mind-set to see
the much bigger, more colourful and rich global arena
where global bioethics must first be local.
Bioethics needs to expand its vision and to open its
way of thinking to the whole of humanity. Only thencan we face the challenge of finding the common
ground of morality across different cultures that
acknowledges and respects other faiths and otherphilosophical and moral traditions.
Are we prepared to face this challenge?
References
Alora, A. T. and J.M. Lumitao, (eds.): 2001, Beyonda Western Bioethics: Voices from the Developing
World. Washington: Georgetown University Press.
Arekapudi S, Wynia MK: 2003, ‘The unbearable
whiteness of the mainstream: should we eliminate, orcelebrate, bias in bioethics?’ American Journal of
Bioethics 3:18-9.
Coward, H. and P. Ratanakul, (eds.): 1999, Crosscultural dialogue on health care ethics. Ontario:
Wilfrid Laurier University Press.
Dawson A, Garrard E: 2006, ‘In defence of moral
imperialism: four equal and universal prima facie
principles’ Journal of Medical Ethics 32: 200 - 204.
Gorovitz S: 1986, ‘Baiting Bioethicists’ Ethics 96:
356-374.
Hern, H.E. Jr., B.A. Koenig, L.J. Moore, and P.A.
Marshall: 1998, ‘The difference that culture can makein end-of-life decisionmaking’, Cambridge Quaterly of
Healthcare Ethics 7: 27-40.
Jonsen A.R.: 2000, A Short History of Medical
Ethics. Oxford: Oxford University Press.
Myser, C.: 2003, ‘Differences from somewhere: thenormativity of whiteness in bioethics in the UnitedStates’, American Journal of Bioethics 3: 1-11.
Said, E.: 1978, Orientalism. New York: Vintage.
Stonington, S. Ratanakul P. ‘Is there a global
bioethics? End-of-life in Thailand and the case for local
difference’, PLoS Medicine Oct; 3(10): e439.
Turner, L.: 2004, ‘Bioethics in pluralistic societies,’
Medicine, Health Care and Philosophy 7: 201-8.
UNESCO, 2005, Universal Declaration on Bioethics
and Human Rights. Paris: UNESCO.
Wolpe. P.: 1998, “The Triumph of Autonomy in
American Bioethics: A Sociological Perspective”, in R.
De Vries and J. Subedi, (eds.) Bioethics and Society:
Constructing the Ethical Enterprise. Englewood Cliffs,
NJ: Prentice Hall.

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How can we make the best useof the Universal Declaration on
Bioethics and Human Rights?
- Miki Fukuyama
Department of Bioethics, Kumamoto University
Graduate School of Medical Science and theDepartment of Nursing, School of Health Sciences,
School of Medicine, Kumamoto University,
Kumamoto, Japan- Atsushi Asai (corresponding author)
Department of Bioethics, Department of Bioethics,
Kumamoto University Graduate School of Medical
Science, Kumamoto, 1-1-1 Honjo, Kumamoto, 8608556, Japan
Email: aasai@kumamoto-u.ac.jp
Our world today must undergo dramatic changes if
we are to put an end to the unacceptable living
conditions and tragic events experienced byhumankind. We should not complacently accept thecurrent state of the world we have created. A quick
glance around the world reveals many wars of
aggression, territorial disputes, acts of discrimination
against the weak, crimes that bring suffering toinnocent people, and evasions of social responsibility(1). For instance, British journalist Jessica Williams
reports in her book, 50 Facts That Should Change theWorld, that 2 million girls and women are subjected tofemale genital mutilation each year. Furthermore, shereports that there are 27 million slaves in the world
today and there have been more than 120,000 acts ofviolence and disruption at abortion clinics throughout
the United States. In more than 70 countries, same-sex
relationships are considered illegal and even punishable
by death in 9 of these countries (2). Many factors havecontributed to these grave realities, including local andreligious traditions, ignorance, misunderstandings,
authoritarian attitudes, and intolerance, which have all
played a significant role in allowing these tragic events
to continue.
In the modern history of our nation, tragic events
have continued to repeat themselves. For over 90 years,
many Japanese living with Hansen’s disease,commonly known as leprosy, were quarantined without
justifiable medical or scientific reasons. Sterilization
operations, forced abortions, and solitary confinement
as punishment for attempted escape from detention
hospitals were not uncommon. At the same time, theleprosy prevention law has engendered harsh prejudiceagainst these patients and “legal” isolation has further
aggravated social discrimination against them (3).
Furthermore, clinical research on chemotherapy forovarian cancer was conducted in the late 1990’s in oneof the national university-affiliated hospitals without
participants’ consent and some patients were not eveninformed of their diagnosis (4). Even today, truthtelling has yet to become the norm and unwanted lifesustaining treatments continue to be imposed on manydying patients. It is nearly impossible for many of theelderly to die with dignity and peace in Japanesehospitals.
Under these conditions, Japan and the rest of theworld need a set of guidelines with which to educate
people from an ethical point of view. We believe that
the Universal Declaration on Bioethics and Human
Rights (UDBHR) should be considered the most up-todate and comprehensive compendium of bioethicalknowledge in the world today. The Declaration draws
attention to all points of moral worth – ethically
preferable attitudes, behaviors, and states of things –that must be considered for humans to take into accountthe bioethical point of view (1).
There are many valuable things worth protecting
around us, including human rights, freedom, dignity,
solidarity, tradition, cultural diversity, respect forfamily life, and moral development. Different people
have different ideas about what is a matter of thegreatest importance. It may be unrealistic for us topursue a perfect set of ethical guidelines that can satisfy
everyone and that is free of any internal inconsistency.
However, disparaging the UDBHR because of its
limitations may be short-sided. For those who regard
the UDBHR as incomplete, we recommend that they
think of it as a starting point for further discussion andrevision. Instead of dismissing the UDBHR, theyshould, instead, attempt to improve it.
Article 12 of the UDBHR clearly declares that theimportance of cultural diversity and pluralism should begiven due regard, but that such considerations are not to
be invoked to infringe upon human dignity, humanrights and fundamental freedoms, nor upon theprinciples set out in this Declaration, nor to limit theirscope. The authors agree with this position without
reservation, with the understanding that the reliance on
individual human rights may be criticized as
inappropriate. Those who do not recognize theuniversality of human rights, including certain culturesthat do not perceive human beings as individuals but
rather as part of a larger social fabric, as well as thosecommunities in which the majority of people do notrecognize the existence of human rights as such, willundoubtedly reject the Declaration (1).
Nevertheless, the authors believe that protecting
human rights should always be prioritized over thepreservation of traditional cultural practices when the
two are in conflict. We are strongly convinced that noone should suffer for the sake of cultural traditions,such as female genital mutilation and infanticide offemale babies. Attempting to preserve cultural or
religious traditions at the sacrifice of individual
happiness mistakes the means for the end and gets theirpriorities wrong. Cultural practices requiring humansacrifice must be abolished immediately.

Eubios Journal of Asian and International Bioethics 18 (July 2008)
A philosopher and writer, Umberto Eco argues that
respecting individual human rights should be a norm of
human society. Eco argues that there certainly are
notions common to all cultures and writes:“(E)very human being has notions about the meaningof perceiving, recalling, feeling desire, fear, sorrow,relief, pleasure or pain, and of emitting sounds that
express these things. Therefore (and we are already inthe sphere of rights) there are universal concepts
regarding constriction: we do not want anyone toprevent us from talking, seeing, listening, sleeping,swallowing, or excreting, or from going where we wish;
we suffer if someone binds or segregate us, beats,wounds, or kills us, or subjects us to physical or
psychological torture that diminishes or annuls ourcapacity to think (5).”He quickly goes on adding sexual relations, thepleasure of dialogue, love for his offspring, or the painof losing a loved one to the list of things of which wewould seriously suffer if someone deprive andcontinues:“(F)irst and foremost we respect the rights of thecorporeality of others, which also include the right totalk and think. If our fellows had respect these “rightsof the body,” we would never have had the Slaughter of
the Innocents, the Christians I the circus, Saint
Bartholomew’s Night, the burning of heretics, the deathcamps, censorship, child labor in mines, or the rapes in
Bosnia (5)”.
In his argument, Eco outlines why we must respectindividual human rights, fundamental freedoms, andhuman dignity and that, in our opinion, further
justification from philosophy, religion, or psychology is
not needed.
Up to here we believe that the UDBHR represents acomprehensive and meaningful set of moral values thatshould be understood as a whole (Article 26). There are
no serious problems with the Declaration, nor any
statements that need to be removed. The moral
authority of any guideline or declaration is determinedby its content and not by its authors, as we are mostconcerned with the impact of its message. For example,
the Declaration of Helsinki has a strong moral authority
not because it was created by the World Medical
Association, but because it contains a comprehensive
set of ethical statements concerning clinical research.
Article 23 of the UDBHR explicitly states that “inorder to promote the principles set out in thisDeclaration and to achieve a better understanding of the
ethical implications of scientific and technologicaldevelopments, in particular for young people, Statesshould endeavour to foster bioethics education andtraining at all levels as well as to encourage informationand knowledge dissemination programmes aboutbioethics.” We believe that this article is particularly
important and both bioethics educators and scholars

111should deliberate on what must be accomplished interms of bioethics education worldwide. Our belief isthat the UDBHR can be used as an educational tool andthat education must be the very first task to beundertaken to help people comprehend the significanceof the UDBHR. In spite of its importance, laws andregulations have made limited impact. People might try
to elude the watchful eyes of the police and law and weneed internal spontaneous motivation to be ethicalinside ourselves. Only through education will we beable to change the deeply entrenched social attitudes
and nurture both tolerance and patience toward otherswith different values, ideologies, and religious
backgrounds.
We are most concerned with how best to use the
UDBHR and how to prevent repeating tragic events inhistory. Specifically, we seek to successfully utilize the
UDBHR as a tool in bioethics education for healthcare
students and professionals because of the fact that theauthors are both health care professionals who engage
ourselves in educating bioethics, nursing and medicine
for healthcare students/professionals. In order to help
healthcare learners develop ethical sensitivity and toappreciate the implications of the UDBHR, bioethics
education must strike a chord with this group.
Knowledge and reasoning are not enough, as healthcare
students and professionals are not either easily
influenced or impressed by guidelines, philosophicalworks, or bioethics textbooks. Therefore, it is importantthat the ethical issues resonate deeply within thehealthcare learner to spur them into action. In order toproduce ethical healthcare practitioners, we must
present issues using intellectually and emotionallystimulating materials and foster opportunities for
productive discussions (6).
One plan is to present the UDBHR together with acase book, such as Williams’ aforementioned text,
which successfully describes the ongoing infringementsof fundamental human rights throughout the world andwhat must be changed. Personal encounters with humanrights victims may also help healthcare learners to think
about what can and should be done locally. In addition,
both fiction and nonfiction films can provide realistic
materials that can supplement bioethics teaching. Thesefilms include Nuit et Brouillard (1955, France), One
Flew Over the Cuckoo’s Nest (1975, USA),
Philadelphia (1993, USA), Southern Comfort (2000,
USA), No man’s Land (2001, France, Italy, Belgium,and Slovakia), Rabbit-Proof Fence (2002, Australia),
Vera Drake (2004, France, UK, and New Zealand),
Moolaade (2004, France and Senegal), Hotel Rwanda(2004, South Africa, UK, and Italy), and Das Leben
Der Anderen (2006, Germany), to name only a few.
Furthermore, bioethics education using the UDBHR
should begin in elementary school and continue intohigh school. Children must be taught about the content
and implications of the UDBHR starting at a youngage, so that they do not learn to discriminate based on

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Eubios Journal of Asian and International Bioethics 18 (July 2008)

race, sex, culture, religion, sexual orientation, or
ideology. Complicated textbooks on bioethics or humanrights will not be useful and, instead, we need to devise
a special plan, such as the use of videos and picture
books.
In conclusion, the ultimate aim of bioethics is toprotect human rights and, thereby, reduce humansuffering and tragedy throughout the world. Utilizing
the UDBHR in bioethics education may help people,
including healthcare professionals, become moresensitive to ethical problems and work towards making
the world a better place to live for everyone. If we were
wise enough, bioethics education with the UDBHR
would work to realize the world where no one will bekilled or suffered.
References
1 Asai and Oe. A valuable up-to-date compendiumof bioethical knowledge. Developing World Bioethics
2005; 5: 216-220.
2 Jessica Williams, 50 facts that should change theworld. Revised and updated edition. Icon Books Ltd.,2007.
3 Fumiyo Hataya, Discrimination and Hansen’sdisease. Heubonsha, 2006, Tokyo, in Japanese.
4 Masaki Nakamasa, Kiyoshi Uchide, Tsuneo Niki,“Human Experiments” and Patient’s Jinkaku-Ken,
Ochanomizu Shobou, 2003, Tokyo. in Japanese.
5 Umberto Eco, When the other appears on thescene. In Five moral piece. Translated from the Italianby Alastair McEwen, Harcourt, INC, San Diego, 1997,
19-30.
6 Atsushi Asai and Miki Fukuyama, Toward
Successful Bioethics Education. In Darryl Macer editor,
Asia-Pacific Perspectives on Bioethics Education.
UNESCO Bangkok, 2008, in press.

The Roman Catholic Church onorgan transplantation
1- Paolo Becchi, Ph.D.
Professor, Hofstrasse 9, CH-6003 Luzern
Switzerland
Email: paolo.becchi@unilu.ch
In Italy some of the most authoritative Roman
Catholic thinkers 2 seem – in my opinion – not well
1

Translated by Drs. Lenny Pittaluga e Rosangela Barcaro:
firstly published in the Italian theological review Asprenas,
vol. 52, 2005, p.389-401.
2
We consider for example Cardinal Tettamanzi andMonsignor Sgreccia. Dionigi Tettamanzi identifies deathwith come depassé “in which there is no more hope of arestart of social and conscious life (even if the organic
functions, like breathing and heart-beat, still going)” see:
D.TETTAMANZI, Nuova bioetica cristiana, Casale

informed on the notion of brain death, and theyencourage the organ donation in the name of theChristian charity. There are opposition groups to thisway of thinking above all among associations with a“traditional” background like Famiglia Domani and
Fiducia or with a dated background like the Centre forStudies “San Pius X”, which is referred to thefortnightly si si no no or, again, to catholic associations
like Famiglia e civiltà 3
The most authoritative opinion, opposite to theacceptance of a cerebral criterion of death, is the one by
Joachim Meisner, Cardinal of Cologne (Germany),
who, both on official pronouncements to the press, andon an article published on an important German
newspaper declares his opposition to the equivalence
between brain death and human death. 4 These arewithout a doubt minority opinions, which seem to be in
Monferrato (Alessandria) 2000, p.496; this definition itself isquite audacious, even though it can be realized from thecontext that Tettamanzi confines himself to adopt the total
brain death one. He reminds Elio Sgreccia, who, even if
aware of the voices of dissent regarding that definition, goeson declaring that the subject whose cerebral activity
definitively stopped, is clinically dead, even though „theintroduction of methods of reanimation let breathing andcardiac activity go on working for a while.“ see:E.SGRECCIA, Manuale di bioetica, Milano 2000, vol. I, p.
692.
3
It’s not accidental that just the associations Famiglia
Domani e Fiducia have organized an international
convention - I was invited to attend with a communication which has been held in Rome on the 25th -26th October 2002,
on the subject Ai confini della vita: scienza, morale e diritto
a confronto. Among the speakers there were Robert
Spaemann and Joseph Seifert. Spaemann’s paper has been
published and is entitled La morte della persona e la mortedell’essere umano, in Lepanto 162/2002. The catholic“antimodern” fortnightly of the Center Study “San Pius X”
has recently published one of my tributes on the subject see
P:BECCHI, I morti cerebrali sono veramente morti quando
preleviamo i loro organi ?, in si si no no, XXX (June 2004)
p. 1-6 (for the same newspaper the tribute has been publishedin Spanish, Portuguese and in French). An English edition ofthis article has been published with the title Are the deadreally departed when we remove their Organs?, in: EJAIB,
15, 2005, p.25-29. In Italy the most documented criticism onequivalence between brain death and actual death from
catholic point is in the book of the Benedictine oblate
U.TOZZINI, Mors tua vita mea. Espianto di organi umani:la morte è un’ opinione?, Napoli, 2000. The paper by Don G.
ROTTOLI, La predazione di organi e le ambiguità diGiovanni Paolo II, in La tradizione cattolica, p. 34-41. The
text has been recently published in French in a little volume
which moves from the same point: F KNITTEL, G.
ROTTOLI, MARIE-DOMINIQUE, Que penser des donsorgans ? La “morte cérébrale”. Les prélèvment d’ organs,
Avrillè 2005.
4
See: J. MEISNER, Erklärung des Erzbischofs von Köln zum
beabsichtigen Transplantationsgesetz, Presseamt desErzbistums Köln, n. 316, 27 September 1996, see also: Wann
trennen sich Seele und Leib?, in Frankfurter Allgemeine
Zeitung, on 25th January 1997.

Eubios Journal of Asian and International Bioethics 18 (July 2008)
hard conflict with the official ones. However, if some,besides quite limited, documents of Magisterium areexamined, the position of Roman Catholic Church ismuch more complicated than it appears at first sight.
This is what I am trying to demonstrate with this paper.
It’s impossible not to begin with the famous Pope Pius
XII’s speech:“The natural reason and the Christian morality showthat man (and anyone who has the function to help theothers) have the right and the obligation, in case of aserious illness, to resort to the essential treatments topreserve life and health. This obligation, that he has
towards himself, towards God and the human society,and more often than not, towards certain persons,derives from a good ordered charity, from thesubmission to the Creator, from the social justice andfrom the justice in the strict sense of the word, and also
from the pity towards his family. But generally it
doesn’t oblige to use extraordinary treatments(according to the circumstances of persons, places, age
and culture) and this is to say those remedies that don’t
impose extraordinary obligation towards themselves
and the others.” 5
Essentially this means that in a situation where, on
the basis of medical knowledge, any recovery of thepatient to conscious life is definitively impossible, (theproblem of the persistent vegetative state didn’t yet
occur), the physician can “remove the ventilation
appliance to let the patient, already practically dead, diein peace.” 6“Practically dead” means that in fact the patient isn’t
actually dead, but the physician can remove therespirator because it’s an extraordinary mean.
I’m not going to expand on the widely discussed andcriticizeddifference
betweenordinary
andextraordinary treatments, (it’s however indicative that
ordinary means are not defined once and for all, butthey depend on place, time and culture).
I would like to draw the attention to another aspectthat seems to remain completely unprepared. Amongthe questions put to Pope, the most important one is thefollowing one: when the ventilation is still on, might
the patient be considered already dead? It’s a crucial
question, because thereafter the Roman Catholic
Church has legitimated organ transplantation on thebasis of the assumption that they are removed fromcorpses. But the Pope then, regardless of the subject oftransplantation, seems to have a completely different
opinion. By answering the question, he states: “wegenerally believe that human life goes on till its vitalfunctions – unlike the simple life of organs – show
itself spontaneously or with the help of artificial
5

See PIUS XII, Risposte ad alcuni importanti quesiti sulla“rianimazione” , in Discorsi ai medici, Roma, 1959, p. 608618. quotation on p. 612. I quote from the Italian translation
reported in smaller body at the foot of the page.
6
Ibidem, p.611.

113

treatments, too.” 7 So it could be concluded that thepatient is still alive (or at least he might be) when his
vital functions are kept still long by life support
system. 8 However, switching it off doesn’t mean to kill
him, as with this act it is only avoided delaying
patient’s death. “On this case there is no direct
arrangement of patient’s life, and neither euthanasia
which could never be legitimate, even though it causes
the end of blood circulation; the stoppage of thereanimation attempts is only the indirect cause of theceasing of life, and in that case double acting principle
must be applied.” 9We can omit here to debate even though there isn’t(for sure) direct disposition for life, there is not eveneuthanasia, (it depends on the idea of euthanasia wewant to take); and we don’t want to dwell on double
effect doctrine (widely discussed as the previous one
regarding the difference between ordinary andextraordinary means). The crucial passage in Pope’s
speech is another one: the patients, whose brain stopped
completely working (or as Pius XII says patients thatare “in a deep unconsciousness” 10 ) are still alive, but
it’s possible to disconnect them from the respirator,even before the definitive stoppage of circulation
voluntarily occurs, when the physician can exclude
their recovery to conscious life. The Pope is perfectly
aware that just the removal of the life support-machine
will provoke on this case the ceasing of blood
circulation and then death within few minutes, however
he thinks that it’s not opposed to the principles ofcatholic Church, when the physician is sure of the fatal
prognosis of his patient. In a doubtful case, the Popewrote: “In the event that an insoluble doubt occurs, you
can resort to presumptions of law and fact. Generally,
we’ll have to dwell on the vital permanence one,because it’s a fundamental right received by the Creator
whose non-existence has to be proved.” 11 In a doubtful
case, then, we have to be inclined to presumptive life:
in dubio pro vita.
The Pope’s answer seems, apparently, clear; however
it is open to quite different interpretations. The“insoluble doubt” refers only to those cases when the
diagnosis is uncertain and a return to conscious life may
not be completely excluded, or does it concern the

7

Ibidem p. 617-618.
To prove this interpretation it can be mentioned that Pope,with respect to the validity of administration of extreme
anointing, declares: “if extreme anointing hasn’t been given,
it must be tried to protract the respiration in order to confer
the sacraments”. As the sacraments can only be conferred onliving human being, obviously, what the Pope declares,
means implicitly that till the ventilation is on, the person isstill alive.
9
See PIUS XII, Risposte ad alcuni importanti quesiti sulla“rianimazione”, p. 615-616.
10
Ibidem, p. 609.
11
Ibidem, p. 614.
8

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simple and pure continuance of human life also
irreversible conscious?
In order that the basic right to life isn’t brought into
question it must be certainly demonstrated that did
conscious human life or human life as such faint? Now,
it seems clear that the whole papal speech turns towards
the first choice, however there is a chance also for thesecond one, when – after recalling that we can’t leaveout that patients who subjected to ventilation, eventhough completely unconscious, go on living – just in
the conclusion of the speech he declares: “A great dealof such cases shape the object of an insoluble doubt andthey have to be considered on the basis of those
presumptions of law and fact we talked about”. 12 That
is to say, also on this case, in favour of life. Here, infact, the “insoluble doubt” is clearly concerned withthose individuals, who connected to a ventilator, evenbeing in an irreversible coma, we can’t manifestly
declare them already dead. And for them also theprinciple in dubio pro vita seems to be valid, and then,in doubt, in defence of that life, too. Such a conclusion
is contrasting the whole previous argument, which is
not established on the need to prove undoubtedly theend of human life before switching the ventilator off.
Quite the contrary, it is based on the legitimacy toswitch it off, regardless of this proof exists.
Nevertheless, a gap had been opened and then, whenmany years later the attention wasn’t drawn by thequestion about the legitimacy of ventilation ceasing any
more but by the problem regarding organs
transplantation, that gap turned into a completely
opened door: the transplantations could be consideredlegitimate, on the condition that it could be for suredemonstrated that organs transplant was done fromcorpses.
In December 1989, the Pontifical Academy of
Sciences called a working party, already founded in1985 13 , to approach just this matter. If you read theaddress referred to it by John Paul II, you can soon
realize how the change of emphasis - from the problemof legitimacy of ventilation stoppage, in each casewhere it wasn’t useful to keep it on according to thephysician, to the organ transplantation one – hasradically changed the viewpoint adopted by Pius XII in
his famous speech. Critical it’s no more what we haveto do with patients, who, connected to the ventilation,
are not excluded to be still alive, but whose fate is,however, irremediably decided, on the contrary wehave to establish in which precise moment their death12

Ibidem, p. 618.
Already in 1985, the Working Group gathered by the
Pontifical Academy of Sciences had reached the acceptanceof the new definition of death, declaring – with a incredible
argument – that “brain death is the actual criterion of death,as the complete stopping of cardio-respiratory functions leadsvery rapidly to brain death.” The Declaration held by thescientists, and from where the quoted passage is taken, isentirely quoted by L’ Osservatore romano, 31 October 1985,
p. 5.

occurs, so as the removal of their organs post mortem
can be allowed. “In which moment does it happen what
people call death? Here is the key of the speech.” 14
Only if patients are corpses their organs can beremoved, however are they already dead when the life
support machine is still on?
According to Pius XII, we can’t be sure they aredead; but what did John Paul II say about? The answer
isn’t clear. In his speech, above all, John Paul II
underlines the fact that, in a doubtful case, it’snecessary to stop the transplantation programme
because life as such must be protected from its
beginning to the end: “this apparently promising track
must be left, when you go through human being
destruction or the voluntarily stoppage of his earthly
existence.” 15John Paul II remembers the tragic dilemma opened
by technical possibility of organ transplantation; heexplains it an exemplary way:
“On the one hand there is the urgent need to findsubstitutive organs for ill people, who, in the absence of
these, would die or at least they wouldn’t heal. That is
to say, it’s believable that in order to escape certainand forthcoming death, an ill person needs to get anorgan that could be provided by another ill person,
perhaps his neighbour at the hospital. In this situation
there is the chance to put an end to a human life, tobreak the person’s psychosomatic unit definitively.
More exactly, there is the real possibility that the life,
whose continuance is made impossible by the removalof a vital organ, is a human being’s life. On thecontrary, the respect due to human life prohibits us
completely to sacrifice it in a direct and positive way,even though it would happen for the benefit of anotherhuman being that he is with good reason considered to
be privileged.” 16
How to find a solution to the quandary? According toJohn Paul II, there is no other way but “to determine asexactly as possible the precise moment and the hopelesssign of death. Once got this, the seeming conflict
between the duty to respect the person’s life and to heal
or even to save another person’s life disappears.” 17 The
problem, however, is if it will be possible to define thatmoment as exactly as possible. John Paul II seems tothink this way. Death “turns up when the spirituality
which governs the unity of the individual can’t any
more carry on its functions in the living body and on it,
whose elements, left alone, dissociate themselves.” 18
To note, it’s not a case that in the whole speech, thePope doesn’t talk about brain as that spiritual principle,
but just the Working Group of the Pontifical Academy

13

14

We are quoting the text of pope’s speech published withthe title In quale momento avviene la morte?, in La Traccia,
X, (1989), 11, p. 1349-1350 (1349).
15
Ibidem.
16
Ibidem, p. 1350.
17
Ibidem.
18
Ibidem, p. 1349.

Eubios Journal of Asian and International Bioethics 18 (July 2008)of Sciences came to the conclusions that spirituality,
responsible for the integration of different bodily parts,
couldn’t be other than brain and that the new definitionof death at a brain level could be accepted. 19 The
patients with the ventilation still on, but who didn’t
show any sign of recovery, weren’t any more patients
whose fate was decided, but corpses. On this way, theRoman Catholic Church went as far as to legitimatetransplantation on the basis of the death of the humanbeing.
Certainly, even in the future voices of dissent within
the Roman Catholic Church would rise, but the line wasjust drawn. Among the voices of dissent (other than the
one by Cardinal of Cologne, already mentioned) themost important one is Cardinal Joseph Ratzinger’s,already vicar of the assembly for doctrine of faith andnowadays Pontiff under the name of Benedetto XVI.
On the occasion of extraordinary consistory works on
1991, dedicated to the subject La Chiesa di fronte alle
attuali minacce contro la vita, in his speech cardinalRatzinger approached also the question of organtransplantation in hard words:
We are now witness of a real war between the potent
and the weak, a war which aims to erase the disabled,
those who bother and even those who are simply poorand “not useful”, in every moment of their life. In
concert with the nations, huge means are used against
persons at the dawn of their life, or when their life
becomes vulnerable by an illness or when it’s going todie down. 20
After condemning abortion, the usage of additional
embryos and the prenatal diagnosis, he says:“Afterwards, those whom the illness or an accident willcause an irreversible coma will be often led to death tocome up to the requests for organ transplantation or
they will be also used for the medical research (“warmcorpses”)”, 21
These words instead of causing a second thought on
Roman Catholic Church, or at least a pause forreflection, would operate as a fire. In conclusion, muchado about nothing. As much as still “warm”, the brain
dead was already a corpse and this was enough to
exclude him from that defence of human life from the
beginning till its natural end stated by the encyclical
Evangelium vitae. In front of the “new threats to humanlife” the Magisterium of the Church intensifies its

19

The only voice of dissent of Papal Academy of Science
was represented by Josef Seifert, already at the time he wascritical towards the definition of brain death. The results of
Academy’ s works are published on the book R.J. WHITE
H.ANGSTWURM, - I.CARRASCO, DE PAULA (eds.),
Working Group on the Determination of Brain Death and its
Relationship to Human Death, Città del Vaticano, 1992.
20
J. RATZINGER, Il problema delle minacce alla vita
umana, in L’Osservatore Romano, April 5th, 1991, p. 1 and
4 (quotation at p. 4).
21
Ibidem, p. 4.

115

actions in defence of sanctity and inviolability ofhuman life:
Today this proclamation is especially pressing
because of the extraordinary increase and gravity of
threats to the life of individuals and peoples, especiallywhere life is weak and defenceless. In addition to theancient scourges of poverty, hunger, endemic diseases,
violence and war, new threats are emerging on an
alarmingly vast scale. 22
The Pope refers clearly to the case of erasing ofseveral infant human lives or of lives on the way out,
the question of transplantation is not mentioned.
Afterwards, however, the Pope perceives the danger
that could be “when, in order to increase the availabilityof organs for transplants, organs are removed without
respecting objective and adequate criteria which verify
the death of the donor.” 23 and afterwards he reminds:“the direct and voluntary killing of an innocent humanbeing is always gravely immoral”. 24 Certainly, the Popeconfirms, but if the brain dead patients are alreadycorpses there’s no problem: a person already dead can’t
be killed. So the battle in defence of human life could
be led without bringing into question the removal oforgans from brain dead individuals. 25
In his discourse to the Transplantation Society, heldin Rome on August 29th 2000 in occasion of its XVIIIInternational Congress, John Paul II demonstrates thisposition and he even comes to a clear legitimating of
brain death. Talking expressly about the “neurological”
criterion of death, the Pontiff confirms that the Church
does not make technical decisions. She limits herself to
the Gospel duty of comparing the data offered by
medical science with the Christian understanding of theunity of the person, bringing out the similarities and thepossible conflicts capable of endangering respect forhuman dignity. 26 .
From the speech, however, it might be concluded
that John Paul II considers that prospect compatible
with new definition of death:
Here it can be said that the criterion adopted in more
recent times for ascertaining the fact of death, namely
the complete and irreversible cessation of all brain
22

See JOHN PAUL II; Encyclical letter, Evangelium vitae(25-3-1995), n. 3: EV 14, 2173. (English translation can be
found
at:
http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents/hf_jp-ii_enc_25031995_evangeliumvitae_en.html)
23
Ibidem, n. 15.
24
Ibidem, n. 57.
25
And rather, afterwards, the Pope could underline that “thedonation of organs, performed in an ethically acceptablemanner, with a view to offering a chance of health and evenof life itself to the sick who sometimes have no other hope.”
26
The
English
text
may
be
found
at:
http://www.vatican.va/holy_father/john_paul_ii/speeches/200
0/jul-sep/documents/hf_jpii_spe_20000829_transplants_en.html

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Eubios Journal of Asian and International Bioethics 18 (July 2008)

activity, if rigorously applied, does not seem to conflictwith the essential elements of a sound anthropology.
Therefore a health-worker is professionally responsible
for ascertaining death can use these criteria in eachindividual case as the basis for arriving at that degree of
assurance in ethical judgement which moral teachingdescribes as "moral certainty". This moral certainty is
considered the necessary and sufficient basis for an
ethically correct course of action. 27
This speech represented that clear legitimacy of the
new concept of death that the transplant surgeons had
been expecting for a long time. 28
John Paul II, in a speech held on March 22nd 2004,
confirmed the position of Roman Catholic Church withreference to the “persistent vegetative state” reverting
once again to the ethical principle in dubio pro vita:“The moral principle is well known, according to whicheven the simple doubt of being in the presence of aliving person already imposes the obligation of fullrespect and of abstaining from any act that aims at
anticipating the person's death.
Considerations about the “quality of life”, often
actually dictated by psychological, social and economic
pressures, cannot take precedence over generalprinciples.
First of all, no evaluation of costs can outweigh thevalue of the fundamental good which we are trying toprotect, that of human life. Moreover, to admit thatdecisions regarding man's life can be based on theexternal acknowledgment of its quality, is the same as
acknowledging that increasing and decreasing levels of
quality of life, and therefore of human dignity, can be
attributed from an external perspective to any subject,thus introducing into social relations a discriminatory
and eugenic principle.” 29
27

Ibidem.
Ibidem. If nothing else, Pope besides, on that occasion,underlined a very important point regarding “the need for
informed consent”: “The human "authenticity" of such a
decisive gesture requires that individuals be properly
informed about the processes involved, in order to be in aposition to consent or decline in a free and conscientious
manner. The consent of relatives has its own ethical validity
in the absence of a decision on the part of the donor.” This
statement states an opinion opposing not only to the criterionof silent-assent (even though informed), adopted as a rule by
the Italian law on organ transplantation (even though not yet
applied in the transient phase, see on the subject P. BECCHI,
La morte nell’età della tecnica. Lineamenti di tanatologia
etica e giuridica, Genova 2002, pp. 99-149), but also to thedirect defence of that criterion expressed by the cardinal
Tettamanzi in Nuova bioetica cristiana, p. 503: “The removalof organs is tolerated by Italian law, if the individual hasn’t
expressed an opposite opinion. We agree with how the state
has acted.“
29
See JOHN PAUL II, Un uomo, anche se gravemente
impedito non diventerà mai un “vegetale”, in L’Osservatore
Romano, 20-21 March 2004, p. 5. The speech has been heldon the occasion of the audience for the participants to theCongress promoted by the International Federation of the28

The Pope’s considerations refer directly to theclinical condition of so called “permanent vegetative
state”, which is different from brain death, but eventhough this final clinical condition is such that we can’t
exclude that when the artificial ventilation is still on,
there is still a remaining of life, then for analogy thoseconsiderations should be valid also for the brain dead.
In conclusion, the acceptance by Roman Catholic
Church of removal of organs from brain dead subjects,
even in presence of a whole and absolute defence ofhuman life, revolves itself about the scientific certainty
that they are actually corpses.
Perhaps a reconsideration process has begun: thePontifical Academy of Sciences has newly decided toreconsider the whole matter: on February 3-4, 2005 an
international meeting on “The Signs of Death” was heldin Vatican City. On that occasion John Paul II sent a
letter to the participants, one of his last writings. In thisdocument the Pope doesn’t consider the neurologicalcriteria of death as a fact any more – in opposition bywhat it resulted from the speech held on August 29th,
2000. 30 Pope appeals to the physicians – recalling Pius
XII’s learning - asking them to provide a certainty
about death moment that, even though prudently in
2000, the pope himself identified death with the “total
and irreversible stoppage of each brain activity”. It’s
not possible to state what results are emerged from the2005 meeting, as official declarations weren’t issued. 31
We think, however, that already the pure doubt in thatregard and the fact that Roman Catholic Church
considered to have to approach the question once again,
is at least symptom of uneasiness. It should let the
principle of respect for human life intervene and,
consequently, the need to stop of organ transplantation,or it should make us think carefully of the message thecardinal Meisner would give.
A fact is hardly disputable today: there exists morethan one simple doubt regarding the scientificallyfoundation of the determination of death by
neurological criteria. Some scholar has thus proposed toCatholic Medical Doctors’ Association and the PontificalAcademy for Life; the English translation may be found at:
http://www.vatican.va/holy_father/john_paul_ii/speeches/200
4/march/documents/hf_jp-ii_spe_20040320_congressfiamc_en.html.
30
The English text, with the Italian translation of Pope’s
letter, is published by L’ Osservatore Romano, February 4th
2005,
p.4
(See
also
http://www.vatican.va/holy_father/john_paul_ii/speeches/200
5/february/documents/hf_jp-ii_spe_20050201_p-acadsciences_en.html). We quote a meaningful sentence: “Fromthe clinical point of view, however, the only correct way and also the only possible way - to address the problem ofascertaining the death of a human being is by devoting
attention and research to the individuation of adequate “signsof death”, known through their physical manifestation in theindividual subject.”
31
Some important (and critical) contributions from thementioned symposium are in the book: Finis Vitae. Is Brain
Death Still Life?, R. de Mattei (ed.), Soveria Manelli 2006.

Eubios Journal of Asian and International Bioethics 18 (July 2008)
leave that notion of death. 32 At this point you canwonder as long as Roman Catholic Church will be able
to sustain the sacred value of human life from the first
beginning till its natural end, and at the same time, tolegitimate the removal of organs from brain deadindividuals.
In the end I’d like to show some statements in the
different versions of Catechism of Roman Catholic
Church. 33 In the Italian text, published in 1992, therelating article is formulated in a very unsatisfying way.
Here is the whole text:“The organ transplantation is morally unacceptable if
the donor or those who have claims on haven’t given
their explicit assent. Organ transplantation conforms to
moral law and it can be well-deserving if the physicaland psychic damages the donor incurs is proportionate
to the sake that you are seeking for the receiver. It’s
ethically unacceptable to cause directly the disabling
mutilation or a human being’s death, even though todelay other persons’ decease.”
Apart from the first phrase – completely formulated
in the negative – that, however, even though implicitly
it refers to transplantation from cadaver, the following
phrases refers to, in an implicit as much as clear way, tothe organ donation from leaving people. With reference
to organ transplantation from corpses the position
seems quite defensive and misleading: it’s accepted byputting as principle the expressed consent-assent one,but the clinical condition as from which the removal islegitimate is never mentioned. The Latin version of thequoted article is of some years later, of 1997 precisely,
but it’s not the literal translation of the Italian text:“Organorum transplanatio legi morali est conformis,
si pericula et discrimina physica atque psychica quae
donans subit, bono sunt proportionate quod pro eo
quaeritur cui illa destinatur. Donatio organorum post
mortem est actus nobilis et meritorious atque allicendus
tamquam generosae solidarietatis manifestation.
Moraliter acceptabilis non est, si donnas vel eius
propinqui ius ad id admitti, mutilationem, quae
invalidum reddit, vel mortem directe provocare, etiamsi
id fiat pro aliarum personarum retardanda morte.” 34
32

See on this respect the collection of studies edited by us incooperation with R. BARCARO, Questioni mortali.
L’attuale dibattito sulla morte cerebrale e il problema dei
trapianti, Napoli 2004.
33
The following quotations are taken from Catechismo della
Chiesa Cattolica, Città del Vaticano 1992, p. 586;
Catechismo della Chiesa Cattolica, Città del Vaticano 2005,
p. 129.
34
Cathechismus Catholicae Ecclesiae, Vatican 1997, p. 586:
“Organ transplants are in conformity with the moral law if
the physical and psychological dangers and risks incurred by
the donor are proportionate to the good sought for therecipient. Donation of organs after death is a noble andmeritorious act and is to be encouraged as a manifestation ofgenerous solidarity. It is not morally acceptable if the donor
or those who legitimately speak for him have not given their117

As you can see the reasoning concerning the removalof organs from corpses is surely more complex: therecall to the expressed consent criterion remains, but
it’s preceded by a sentence, whose scrap is not present
in the Italian version at all, where organs donation after
death is represented as a noble and honourable action,
to encourage. The recent summary, prepared by Pope
Ratzinger, is much shorter but in some ways surprising:
the removal of organs is ethically acceptable with thedonor’s permission and without excessive risks for
him/her. For the noble action of organ donation after
death, the donor’s actual death must be completely
determined. The donation post mortem is still a noble
action, but however, for the first time, the concept thatit occurs as from the donor’s actual (and not clinical)
death, is introduced. And as nowadays there are goodmatters to challenge the equivalence between brain
death and actual death; the consequences could bereally disruptive and you could wonder why the Pope
has made an anonymous attack.
Annex: Declaration of Cologne Archbishop regarding
the predicted law on transplantation
Press office of Cologne Archbishop, September 27th,
2006. ∗
Who knows the need of the persons that are waitingfor organ donation will accept with favour the efforts toincrease the disposition to donation. We hope that also
the predicted law on transplantation helps, increasing
the certainty of the right and preventing abuses.
Without expanding here on the details of the projectof law - this is mostly politicians’ particular duty –because of the debates held till now, and considering
the deep discussion of the last years, whose results gobeyond the corresponding declaration of churches of1990 ∗∗ , I have to declare with serious worry and on thegiven occasion as follows:
At the present state of debate the identification ofbrain death with the individual’s death is no more
acceptable from a Christian point. The human being
can’t be reduced to its brain functions. It can’t be said
explicit consent. It is furthermore morally inadmissible
directly to bring about the disabling mutilation or death of ahuman being, even in order to delay the death of otherpersons.”∗
This declarations refers to the discussions regarding theGerman law on the transplantations, which went into effecton 1st December, 1997 (Gesetzt über die Spende, Entnahmeund Übertragung von Organe – Transplantationsgesetz). As
it’s known, the German law, even subordinating the removalof organs to the ascertainment of total brain death, doesn’t
incorporate a definition of death; For comment cp.
Transplantationsgesetz, W. Höfling (ed.), Berlin 2003.
∗∗
Here the cardinal refers to the joined declaration made by
the catholic and the evangelic churches in Germany in 1990:
Organstransplantationen.
ErklärungderDeutschen
Bischofskonferenz und des Rates der Evangelischen Kirche
in Deutschland, 2nd July, 1990.

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Eubios Journal of Asian and International Bioethics 18 (July 2008)

that brain death means death, neither that it’s a deathsign. It is not even the moment of death.
All the considerations regarding the donation oforgans have to move from the idea that a human being,
for whom brain death only has been determinedaccording to the medicine rules, is still alive. However– and this is basically important for a further valuation– the brain dead individual is a dying person in an
irreversible way, that for sure won’t return conscious
any more and he won’t breathe by himself any more.
For this reason it’s not compulsory to prolong
artificially this dying with all technician means - unlessthe interested person expressed the will that organs
would be removed even before switching the ventilators
off. Death as consequence of brain death takes overlate. At no moment then here someone is killed. Organ
donations is possible and it can be an act of supreme
Christian love towards fellow men. If you asked on
which conditions organs can be removed, it must be
considered that a brain death isn’t a corpse.
Defining by law brain death like individual deathwould prevent form joining the efforts to increase thedisposition to donation. Such a law would be counterproductive.

On Cultural Narratives,
Fertility Medicine and
Women’s Agency- Frida Simonstein, Ph.D.
Center for Women's Health and Promotion, Ben Gurion
University, Beer Sheva, Israel.
Dept. of Health Systems Management, Yezreel Valley
College, Israel.
Contact address: Moshav Maor, 38830, Israel
Email: fridafux@netvision.net.il; fridas@yvc.ac.il
Abstract
A recent article, explores the issues of choice, agency
and gender as they relate to assisted reproductive
technologies (RTs). The author of that article claims
that counter-stories as ‘narratives of resistance’ mayhelp see how women can reconcile a strong desire tohave children with the desire ‘to remain authentic andwhole’. While the narratives proposal may help tounderstand women’s choices, this approach becomes
unhelpful where there is one cultural perception of
women – the view of pro-natalism or mandatory
motherhood – that reigns absolute; where all narratives
influencing a woman’s decisions are exclusively‘narratives of hope’; and where a pro-natalist culture
has fully embraced IVF and has further entrenched it bylegislation. In this setting, the societal and medicalpressure on women is so high that resistance becomesalmost impossible. In this context, it would be more

effective to challenge present pro-natalist reproductive
policies and medical reproductive advice.
Key words: assisted reproduction, cultural perceptionsof women, medical counselling, reproductive policies.
In a recent article, Aline Kalbian explores the issuesof choice, agency and gender as they relate to assisted
reproductive technologies (RTs). She observes that thepowerful desires and expectations common to
encounters with fertility medicine, combined with theambivalence about the proper characterization ofinfertility, make questions regarding choice, agency andgender difficult to answer. She proposes, therefore, twobroad narrative categories that help capture theexperience of encounters with fertility medicine:‘narratives of hope’ and ‘narratives of resistance’.
Kalbian believes that counter-stories as narratives ofresistance may help us see how women can reconcile
the experience of a strong desire to have children withthe desire to remain 'authentic and whole’ (Kalbian2005). This paper examines this proposal from theperspective of Israeli policies in reproductive matters;
and from the perspective of a patriarchal society thathas fully embraced and promoted these policies.
Listening To Narratives I: A Catholic Scenario
Freedom of choice is a phrase commonly invoked indebates about reproductive ethics. Some argue thatwomen are freely choosing what they desperately want
– a baby. Others argue that this desire is sociallyconstructed – and therefore this is not exactly a choice.
Since social influences may affect and shape ourdesires and values, Kalbian suggests using a narrative
framework in order to understand the complexity ofchoices concerning the RTs. She describes a scenario ofa devoutly Catholic woman:
After undergoing a battery of tests, [a woman] is toldby her doctor that in vitro fertilization (IVF) is the best
option available if she wants to get pregnant. She isfamiliar with her tradition’s narrative about the inherent
evils associated with ARTs; she knows that IVF isabsolutely prohibited by the Church. The pull of her
faith is powerful; yet there is a conflict between her
strong desire to have a child (narrative a) and the
Catholic narrative that prohibits ART (narrative b).
Nevertheless, her desire for children emerges from her
deep grounding in Catholic tradition and its very
powerful narrative (narrative c) about gender roles,
feminine fulfilment, and maternity. According to thisnarrative the desire to have children is natural, and awoman who does not have children will not experience
her essential womanhood as fully as a woman who does
have children. A fourth narrative (narrative d) mightalso exert some influence on this woman. It is the storyof scientific progress and the wide array of technologies
that can enable almost any woman who wants children
to have them (Kalbian 2005, 94).

Eubios Journal of Asian and International Bioethics 18 (July 2008)
Kalbian points out that in this environment rejecting
these technologies when they are so readily available isequivalent to choosing not to have children; or it can beseen as equivalent to refusing medical treatment. In
order to advance the focus on particularity, Kalbian
proposes two narrative categories that may help capture
the experiences of encounters with fertility medicine:‘narratives of hope’ and ‘narratives of resistance’. Bothhope and resistance, she observes, require an exerciseof agency; and the agency required for resistance in theRTs often entails redefinition of one’s self and one’s
goals, and requires a reliance and trust in one’s ability
to make an informed decision.
Listening To Narratives Ii: A Jewish Scenario
Kalbian’s proposal clarifies problems concerning
autonomous choice in fertility medicine when different
narratives conflict one with the other. However, her
proposal does not cover the difficulties for redefining
one’s self and one’s goals when all narratives coincide.
Suppose now that the woman in Kalbian’s story is
Jewish. Are the narratives of the Jewish woman
equivalent to those of the Catholic woman? There are
no inherent evils associated with RTs in the Jewish
tradition; on the contrary, IVF (and RTs generally) havebeen fully embraced by the Jewish faith. For thiswoman there are no conflicts between a strong desire tohave a child (narrative a in Kalbian’s story) and theJewish narrative that generally encourages the use of
RTs (narrative b). Moreover, the Jewish woman’s
desire for children emerges from her deep grounding in
Jewish tradition, which has a very powerful narrative
about gender roles, feminine fulfilment and maternity.
Equally, according to the Jewish narrative, the desire tohave children is natural, and a woman who does nothave children will not experience her essential
womanhood as fully as a woman who does havechildren (narrative c). It follows that the fourth
narrative (narrative d), which is the story of scientificprogress and the wide array of technologies that canenable almost any woman who wants children to havethem, and which may exert some influence on the
Catholic woman, exerts huge influence on the Jewish
woman. For the Jewish woman, all narratives – without
exemption – favour the RTs; it follows that Jewish
women’s consent to the RTs is consistent with theiridentity. Unlike the case of the Catholic woman above,for a Jewish woman all narratives coincide; they reflect
the same goal: reproduction, which is also considered asacred goal that transcends all other goals any woman
may have. Where in these narratives do one’s self andone’s goals end and the goals of others begin? Kalbiansuggests listening to women’s narratives in order tounderstand the complexity of their choices; it follows
from her proposal, however, that when counter-stories
are non-existent, women’s choice of RTs isunambiguous.

119

IVF in Israel
The situation for women regarding fertility treatment
could be said to be 'ideal' in Israel. To begin with, thequestion of justice does not exist, since assisted
reproduction in Israel is subsidized as a standard part ofthe basic basket of health services by the Israeli
national insurance. Every Israeli (regardless of religion
and marital status) is eligible for unlimited rounds of
IVF treatment free of charge, up to the birth of twochildren – even if the woman already has children.
These exceptional regulations for IVF in Israel permit
us to focus on the question of whether women in Israel
are necessarily better off, because of this generositywith regard to RTs. Since women consent
autonomously to the treatment, and since all women’s
narratives coincide, to ask this question seems
unnecessary in the first place. Moreover, since thepolicy for the RTs in Israel is presented as protecting
women’s rights to become mothers, this generosity
towards women’s rights might be seen as an exemplary
policy.
A closer examination, however, reveals that incontrast to the extraordinary situation of support forassisted reproduction, treatments that limit family sizein Israel remain unsubsidized. Family planning services
do not receive state support and are funded only on acharitable basis. Contraceptives are generally not partof the basic basket of medical services covered byIsraeli health insurance, and abortion is illegal (Unlessthe pregnancy threatens the woman’s life, it resultsfrom rape or adultery, the mother is under age or the
foetus has a major malformation or illness). These
policies reflect a strong pro-natalist society. As in othersuch societies, the dominant social discourse in Israel isessentialist, thus presenting motherhood as imminent,
natural and universally expected of all women(Remennick 2000).
Every Israeli schoolchild learns from the age of six
that barrenness is a tragic condition for a woman;childbirth is a woman’s way of achieving success.
Childlessness is also considered tragic for a Jewish man
who is commanded to procreate according to Jewish
tradition (Kahn 2000). The norm and expectation fromwomen in Israel is to get married and/or to havechildren. Jewish women are under extraordinarypressure to reproduce, whether they are married or not,since in Israeli society not to have children is largely
repudiated by societal conventions and punished by
exclusion and other means (this is true also for other
women in Israel, but I am focusing here particularly on
the Jewish population ). Most infertile women in Israel
fully internalize the dominant ideology. Rejecting
assisted reproduction when it is available andcompletely free of charge is considered as refusing
treatment; and it is equivalent to choosing not to havechildren. Women in IVF emphasize that rejecting theavailable treatment is not a viable option for an infertile
woman. In Israel, neither a non-familial lifestyle in120

Eubios Journal of Asian and International Bioethics 18 (July 2008)

general, nor a rejection of parenthood in particular, isan acceptable option and women may regard IVF
treatment as the only moral choice (Remennick 2000).
It follows that while a woman’s choice for the RTs in
Israel is certainly for herself, we can hardly regard thischoice as completely free.
Other Narratives
Listening to narratives is not unproblematic, sincethese may be highly influenced by subjectivity - yetstories may let us see an additional dimension of aproblem. This is the case with a study in Israel that
focuses on women who did not succeed in having
babies with IVF. In this study, a senior surgical nurse
who had to stop working because of the treatments
observes that she is paying dearly for her ‘desperate
wish to mother’. Firstly, she had to abandon her career,so that her 10 years of study and experience were awaste; and secondly, she is only ‘half-alive’ since she
became ‘a slave’ of her bodys reactions to fertility
drugs. She continues, 'no one ever explained to me (orto other women under treatment) what we were up
against and what the costs will be’ (Remennick 2000,
834).
Women in this study remark that their expectations
from the treatment were unrealistic from the outset, butthey also share the feeling that their doctors induced
false hopes. As another woman comments, if she had tostart all over again, she would press her doc to give her
the full picture in advance, including the success rates,
the costs and the risks involved. She claims that no one
explained her the whole truth. She continues, ‘they justshow you the pictures of the IVF babies “produced” inthe Unit and their happy mothers’. Most women after
years of IVF treatment may find themselves worse off.
As a third woman in that study reflects, 'I havewasted six years of my life on these treatments, andlook where I am now. Unemployed, disfigured and stillchildless. My husband stays with me purely out of
habit; our relationship was lost to these treatments too’(Remenick 2000, 835).
Are the narratives of these women narratives ofresistance? Hardly. These are more likely narratives ofchaos. Women feel confused, defeated, lost. Yet they
still think it is a woman’s moral duty to do whatever ittakes to have a child. This narrative correlates with theFranklin’s observation that ‘IVF is something women
would recommend but wish they had not undergone;that IVF is described as a wonderful opportunity, but asmaking life more difficult’ (1997, 192). What becomes
clear from these narratives is that the price these
women paid in personal losses was higher than they
thought; and, most worryingly, that this eventuality washidden from them. Since these women were not treatedspecifically in one clinic, this indicates a pattern of
disinformation concerning RTs.

Narratives of Hope or Innacurate Information?
There would be little disagreement that autonomouschoice is based primarily on informed choice(Beauchamp& Childress 2001) i.e. fully
acknowledging the risks that a medical procedureentails. We do respect women’s autonomy whenchoosing the RTs, but we seem reluctant to admit thatthe information women get might be manipulative. We
would say that physicians use narratives of hope, andthat hope is an important component for the recovery ofhealth in general. Yet where do narratives of hope end,
and where does inaccurate information begin? The lackof accurate information reflects common feelings
amongst women who did not succeed in having babies
with IVF. Women say that their expectations from thetreatment were unrealistic from the outset, and blame
their doctors for inducing false hopes. Some mayunderestimate and/or override these feelings, whileothers would say that women are taking revenge on
their doctors because of their frustrations. This might be
the case, yet a scene recorded in an ethnography on IVF
clinics in Israel reflects a strong paternalistic
atmosphere:
On one slow Friday, Dr Benjamin brought a patient
clad in her surgical gown into the lab before the embryotransfer and said, ‘Devorah wants to see her children.’
So one of the lab workers opened up the incubator,
pulled out a few Petri dishes with the patient’s name onthem, and showed them to her. Then Devorah walked
into the operation room, lay down on the operatingtable, and waited to have her ‘children’ inserted into her
uterus (Kahn 2000, 84).
Certainly, Dr Benjamin is condescendingly nice to
Devorah; but he also clearly misleads her. Whileembryos may have the ‘potentiality’ of becoming
children, this potentiality, even in nature, is low; with
IVF it is even lower. Dr Benjamin knows that the
chance Devorah has for getting a ‘take-home baby’
from these embryos is a tiny 14 per cent. Making her
believe that these embryos are already her ‘children’ isoutrageous. By this account, instead of lamenting a lost
pregnancy (which happens in 86 per cent of the IVF
cycles!) a woman will mourn a dead child. The
difference might be subtle but it is very significant; thismay explain why women in IVF live in permanentmourning. This is not an isolated case; the potentialityof embryos to become children is inherent in IVF. For
instance, Prof. Shlomo Mashiah, (considered ‘thefather’ of IVF in Israel), defends present IVF policies
with the argument that ‘every child who has not beenbrought to life is a child who has been killed.’ 35 This isalso the ideology of anti-abortionists, but regressed tothe potentiality of gametes.

35

Prof. Shlomo Mashiach advising the Israeli Committee for
the Promotion of Women. Protocol 48 of Israeli Knesset, 18
September 2003.

Eubios Journal of Asian and International Bioethics 18 (July 2008)
Informed Consent To What?
Assisted reproduction has been paternalistic and has
hidden information from women from the outset. Leslie
Brown did not know she was the first women ever tobecome pregnant with IVF until she understood thisfrom the interest journalists showed in her pregnancy(Marantz Henig 2004). Today, many believe this isunlikely to happen since women sign a document of
informed consent for IVF. This is, many would say, thebest proof of women’s agency and autonomous choice.
But is it? Kalbian rightly asserts that judging women’s
approach to IVF by means of this document is notenough - hence, her proposals of a narrative frameworkthat may better understand women’s choices.
Still, I believe, the document of informed consent
deserves some more attention. Firstly, it is remarkable
how the redaction of this document is open tointerpretation. Secondly, there are issues the document
does not mention. I have translated the document for
IVF informed consent in Israel at some length for thesake of discussion. One paragraph of this document
reads as follows: The chances of success of thehormonal treatment are different and depend on the ageof the couple, the conditions of the ovaries, thefallopian tubes, pathology of the womb and/or thepelvis pathologies, the quality of the sperm and otherfactors. This is true, but then it means that IVF clinics
and physicians are not responsible for any possible
failure of IVF! The document also explains that the
chances of getting pregnant from one cycle of treatment
are up to 20 per cent. This means that ‘success’ of IVF
in Israel is still rated by a pregnancy and not by a takehome baby. The logic behind this is that miscarriages
occur normally; so if it happens after a successful
implant this would not be considered the clinic’s fault.
Yet, because women seek to get pregnant, many may
not notice the huge difference between what they
expect (a baby) and what they are actually offered (apregnancy). The rate of success of a take-home baby inIsrael is only 14 per cent. However, the real percentage
of success per each cycle of IVF (i.e. the rate of live
births) is not mentioned in the document; and anywhere
else: one must deduct this from other (disperse)
sources.
The 'Culture of Perseverance'
Several studies have also observed that a culture ofperseverance develops in IVF clinics; women become‘addicted’ to the treatments. Yet this ‘culture’ isencouraged by the way IVF clinics promote theirtreatments. If we return to the informed consent
document in Israel, it remarks that ‘the chance ofgetting pregnant after a set of 3–6 cycles of treatments
is up to 50–60 percent.’ Statistically, however, this isuntrue, since each cycle starts from the same starting
point (i.e. the second cycle and the third – as any – hasexactly the same probabilities as the first!), unlesssomething has been changed in the procedures. But

121

then, if this is a different procedure, it cannot becounted as part of the same statistical batch. Somewould say that trying again and again would do thetrick, since IVF treatment becomes more personalised.
This is also true, but then the statistics would apply
only for some women. For most, these numbers are far
from reality. Moreover, IVF medicine still works
mostly in the dark (i.e. the cause of failure – or success– in most cases remain unknown). Some women may
conceive spontaneously; others may conceive morethan once with IVF; but most women, will neverconceive, regardless of any statistics. It follows that theculture of perseverance, so warmly advocated in IVF
clinics, may work for some women; but it won't work
for most. As a result, many women may get trapped in
IVF fertility clinics for too many years. Reportedly, thishappens worldwide; however, in Israel, because thenumber of IVF cycles covered by the Health Funds is
unlimited, there are no financial disincentives affecting
the continuation of treatment, and this further deepens
the trap of endless infertility treatments.
Health Risks
Long-term effects do not appear in the informed
consent document. This is not because there are none,
but because of the lack of research in this area (Check
2004). However, this is not mentioned either.
Moreover, IVF is considered routine and safe. Yet
short-term side effects may include allergy tochemicals: disruption or bleeding of the ovaries,
ovarian cysts, ovary cancer, stomach pain, swollen
ovaries, and accumulation of liquid in the stomach.
Medium and high over-stimuli of the ovaries may
occur. This includes accumulation of liquid in thestomach cavity and in the chest, over-concentration of
the blood, while other complications might be heart
and/or kidney failure, amputation of limbs and in somecases even death. 36
What can we learn from this document? Firstly, one
should be really ‘desperate’ to sign it. The possible side
effects of IVF are bad enough to make a rational,
healthy person stay away from this treatment. Of
course, not all women will undergo the entire ordeal:
some will feel better than others. Yet a woman signing
this document does not know where she might end up.
Side effects exist in almost every medical treatment, but
in this case even the consequences of low stimuli of theovaries are not particularly encouraging. Secondly, apregnancy has always been dangerous for women (inthe developing world, pregnancies are still a major
cause of women’s natural death), but the RTs make anotherwise healthy woman ill. Moreover, a modest
estimate of one million women may have suffered fromcomplications that require hospitalization. Why would
any healthy person agree to sign such a document? It is
36

Informed consent form: Hormonal treatment due toinfertility. November 2004/OBYGYN (Hebrew).

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Eubios Journal of Asian and International Bioethics 18 (July 2008)

impossible to understand this - unless we recognize that
there is a forceful ideology, which considers that theperson in question is very sick. Since almost all womenfacing infertility in Israel sign this document
voluntarily, we must conclude that childless women in
Israel (and other places) regard themselves as being
very ill.
A Resistance Narrative of Refusal In Israel?
To be a childless woman in Israel (and many othercountries) is still regarded as a social stigma that needs
massive medical intervention. Will more education
resolve the stigma of childlessness in Israel, as some
optimistically want to believe? This depends on thecontents of this education. At present, pro-natalist
education conditions women towards motherhood andsocietal punishments further educate women towards
believing that their main task in life, with or withouthigher education, is to have children. Moreover, if arenowned fertility specialist in Israel declares straightfaced that ‘women who do not want to have children
are subnormal’ (Mashiach 2003), 37 it is hardly
surprising that in Israel, many women who do not havechildren of their own do feel like ‘a failure’, ‘notcomplete’, and ‘less women’. In this atmosphere,
women who do not want to become mothers hide thispreference from friends, family and employers. They
would choose to say that they cannot have children,
rather than that they do not want to mother (Shalitah2005).
Some believe that narratives of resistance may allow
oppressed people to refuse the identities imposed onthem and to re-identify themselves in more respectableterms. Yet pro-natalist narratives in Israel are unlikely
to change, unless other narratives, aiming at educating
women towards voluntary, intentional and fully
informed motherhood, emerge. Only a few cases thathave led women to refuse have been reported, and theseare based on other convictions such as religion’s moral
arguments against RTs (Cussings 1998). In this context,
Matty Häyry's proposal in a recent article is timely.
Häyry suggests that those who seek help before
conceiving could be advised that it is acceptable not tohave children. As he puts it, ‘if prospective parents are
told that it would be all right not to reproduce at all, this
could empower people to make the rational choice toremain childless’ (Häyry 2004, 378). 38 His proposal
has not been particularly popular (Bennet 2004, Aksoy
2004, Holm 2004); however, as I have noted elsewhere(Simonstein 2005), I find Häyry’s suggestion
appropriate (and refreshing!) in view of the Israeli pro37

Prof Mashiach adds in an interview for an Israeli
newspaper: ‘nine out of ten women who may not want tohave a child are “distorted”, “narcissists”, “extremely selfish”
and something is certainly “wrong” with them’ LevyBarzilay, V. 2005. ‘Have six, have seven, have eight kids.’
Haaretz Newspaper (Hebrew), 25 January.

natality narratives and policies now strongly enforcedby the advent of RTs.
Some Conclusions
While the narratives proposal may help to understandwomen’s choices, this approach becomes unhelpful
where there is one cultural perception of women – theview of pro-natalism or mandatory motherhood – that
reigns absolute; where all narratives influencing awoman’s decisions are exclusively narratives of hope.
Where a pro-natalist culture has fully embraced IVF
and has further entrenched it by legislation, the societal
and medical pressure on women is so high that
resistance becomes almost impossible. It follows thatwhile assisted reproduction may be a valuable asset,
IVF in a pro-natalist society is not genuinely a freechoice.
Moreover, self-worth and self-trust are qualities
central to authentic autonomy; yet, infertility in thesesocieties undermines the self-worth and self-trust of
women. This clearly limits the choices available in thecontext of women’s narratives, obstructs the activity ofchoosing and the act of resisting. Is higher education
the solution for women’s self-worth and self-trust? Yes,in principle. Currently, however, the educational statusof women in Israel is high, but this does not correlatewith narratives of resistance to RTs, since pro-natalism
is fully integrated into the education of women.
It would seem more effective to challenge the pronatalist reproductive policies and the medical
reproductive advice currently offered in Israel. Thismeans that IVF should be presented to couples as one
option amongst others; and the advice to remainchildless should be incorporated as part of reproductive
counselling. Real choice can be achieved only whenother options are presented to couples; thus, trying toempower people to remain childless should be on a parwith convincing people to reproduce. Presenting bothalternatives as valid options would ensure that women’s
right to become mothers in Israel and their choice toreproduce – or not – are fully protected.
References
Aksoy, S. 2004. ‘Response to: A rational cure for prereproductive stress syndrome.’ J Med Ethics, 30:382–3.
Beauchamp, T. & Childress, J. 2001. Principles of Medical
Ethics. New York: Oxford University Press.
Bennet, R. 2004. ‘Human reproduction: Irrational but in mostcases morally defensible.’ J Med Ethics, 30:379–80.
Check, E. 2004. ‘Ethics Council calls for probe into assisted
reproduction.’ Nature 428:580.
Cussings C. 1998. ‘Producing reproduction: Techniques ofnormalization and naturalization in infertility clinics.’ In
Franklin, S. & Ragone, H (eds), Reproducing
Reproduction: Kinship, Power and TechnologicalInnovation. Philadelphia: University of Pennsylvania Press.
Franklin, S. 1997. Embodied Progress: A Cultural Accountof Assisted Conception. London: Routledge, pp. 192.
Häyry, M. 2004. ‘A rational cure for pre-reproductive stresssyndrome.’ J Med Ethics 30:377–8.

Eubios Journal of Asian and International Bioethics 18 (July 2008)
Holm, S. 2004. ‘Why it is not strongly irrational to havechildren.’ J Med Ethics, 30:381.
Ibid.
Kahn, S.M. 2000. Reproducing Jews: A Cultural Account ofAssisted Conception in Israel. Durham, NC: Duke
University Press.
Kalbian, A. 2005. ‘Narrative ARTifice and women’s
agency.’ Bioethics 19:93–111.
Marantz Henig, R. 2004, Pandora’s Baby. New York:
Houghton Mifflin.
Levy-Barzilay, V. 2005. ‘Have six, have seven, have eight
kids.’ Haaretz Newspaper (Hebrew), 25 January.
Remennick, L. 2000 Childless in the Land of Imperative
Motherhood: Stigma and Coping Among Infertile Israeli
Women. Sex Roles 43:821-841.
Shalitah, H. 2005. ‘Children are happiness, but not for me.’Seven Days Yedihot Hahronot Newspaper (Hebrew), 19
August, pp. 50–44.
Simonstein F. 2005 ‘A rational cure for pre-reproductive
stress syndrome - A perspective from Israel. A rejoinder to
Häyry, Bennet, Holm and Aksoy J Med Ethics 2004,
30:377-83’ J Med Ethics 31 557.
---Protocol 48 of Israeli Knesset, 18 September 2003.
http://www.kenesset.gov.il/AllSite/mark02/h0201390.html(Hebrew).
---Informed consent form: Hormonal treatment due toinfertility. November 2004/OBYGYN (Hebrew).

Asian Bioethics Association (ABA)
The website for ABA is <eubios.info/ABA.htm>
Please note that membership for 2008 is now due, andmembers of ABA will receive a discount to register for ABC9.

The time or day of the General Meeting of Asian Bioethics
Association has not been decided yet.

Please register to ABC2008 now to: Dr. Amru
Nazif, amru96@cbn.net.id

Ninth Asian Bioethics Conference
Draft Program (as of 15 July 2008)
To be held on 3 - 7 November 2008
in Yogyakarta, Indonesia
Request for speakers replies
This agenda does not imply financial support for thepresenters of the papers, nor does it preclude submission offurther papers for any session. It is for information purposes
only. All speakers are asked to confirm their attendance tothe conference as early as possible and revised programs will
be developed. Because we could not provide financial
assistance to a number of applicants who applied, we would
especially like them to confirm their willingness toparticipate at their own expenses. We also will maintain thegeneral ABA policy that one person gives only one formal
presentation at the conference, although they may be a
coauthor on more than one paper.
This agenda does not include social events.

123

Day 1
Monday, 3 November 2008
1. Opening Session
08.50 - 09.00
Opening Remarks
Umar A. Jenie, PhD, Chairman, Indonesian Institute of
Sciences cum Chairman, Indonesian National Bioethics
Commission
09.00 – 09.10
Welcome to the Ninth Asian Bioethics Conference
Jayapaul Azariah, PhD, President, Asian Bioethics
Association
09.10 - 09.20
Message from Founding President, Asian Bioethics
Association
Hyakudai Sakamoto, Founding President, Asian Bioethics
Association
09.20 - 09.30
Welcome to the Third UNESCO Asia-Pacific School of
Ethics Bioethics Roundtable
Darryl Macer, PhD, Regional Adviser in Social and Human
Sciences in Asia and the Pacific, UNESCO
Session 2. Bioethics and Global Policy
Chair: Umar A. Jenie, Chairman, Indonesian Institute of
Sciences cum Chairman, Indonesian National Bioethics
Commission
09.30 - 09.50
Bioethics in Asia: healthy and productive life in harmony
with nature
Sahin Aksoy, PhD, MD, Harran University, Turkey
10.20 - 10.50
Bioethics in Science and Technology Development
Minister of Research and Technology of Indonesia
10.50 - 11.15 General discussion
11.15 - 11.30 BreakSession 3. Bioethics and inclusion of moral agents
Chair: Prof. Darryl Macer and Prof. Amin Abdullah
11.30 - 11.45
1 The bioethical imperative: responsible harmony with allforms of life
Hans-Martin Sass, Ph.D; Kennedy Institute of Ethics,
Georgetown University, Washington DC, 20057, USA;
Institute of Philosophy, Ruhr University, 44780 Bochum,
Germany; Research Center for Bioethics, Peking Union
Medical College, Beijing 100005,
11.45 – 12.00
2 Healthy and productive life in harmony with Cosmos
Konstantin S. Khroutski, PhD; Institute of Medical
Education, Novgorod State University after Yaroslav-theWise, Novgorod Velikiy, Russia
12.00 - 13.00 Lunch
13.00 – 13.15
3 Bioethical concerns are global, bioethics is Western
Subrata Chattopadhyay1 MD, PhD, and Raymond De
Vries2, PhD

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Eubios Journal of Asian and International Bioethics 18 (July 2008)

1

Department of Physiology, Kalinga Institute of Medical
Sciences, Orissa, India, and 2Bioethics Program, Universityof Michigan, USA,13.15 - 13.30
4 Bioethics … the Shepherd of life
Evangeline Joy U. Ramos, PhD; Philippines
13.30 - 13.45
5 Is Bio-Ethics Possible Without The Morality of Right?:
The Priority of De-Ontologism and the Limits of BioEthics Discourse
Abdul Wahab Suri, MD, Asst. Prof., Dept. of Philosophy,
University Of Karachi, Pakistan
13.45 – 14.00
6. Positioning Asian Bioethics in Transnational EcoAdvocacies Networking: Any Learning From Animal
Rights Movement?
On-Kwok Lai, PhD, Professor, School of Policy Studies,
Kwansei Gakuin University, Japan
14.00 - 14.15
6 Ethics of Common Good
D. Nesy, PhD, University of Kerala, India
14.15 – 14.30
7 Wu Wei of Tao and Buddhist Ethics to Save Nature in
the 21st Century
Chutatip Umavijani, PhD, Thailand
14.30 - 14.45 General Discussion
14.45 - 15.00 BreakSession 4. Enhancement and Neuroethics
Chair: ...
15.00 - 15.15
1 The Significance and Possibility of Teaching Virtues
V. Balambal, M.A.B.T., PhD FRAS (London), Professor(Retd) of History, University of Madras, India
15.15 - 15.30
2 Human enhancement and body re-construction:
prospects from the East
Natallia Aniskovich, Interdisciplinary Center BRAIN,
Department of Physiology and Pathology, University ofTrieste, Via Fleming 22 -34127 Trieste, Italy;
Oleg Artemenko, Department of Japanese and KoreanStudies, Faculty of Foreign Relations, Belarusian State
University , Belarus
15.30 - 15.45
3. Neuroethics of deep brain stimulation
Mihoko Takagi-Okada, PhD, Japan15.45 - 16.00
4 Neuroethics: A Welfarist Perspective On BrainMachine Interfaces In The Context Of Japanese HealthCare CultureMichio Miyasaka, MD, Associate Professor at School of
Health Sciences, Faculty of Medicine, Niigata University,Japan
16.00 - 16.15
5 Neuroethics: The Pros and ConsPriya Chatterjee, Vellore Institute of Technology, Vellore,
Tamil Nadu, India
16.15 - 16.30
6 Assessing the impact of brain enhancement technologies
on the concept of self
Shuhei Taguchi, Kumamoto University, Japan
16.30 - 16.45 General Discussion

Session 5. Descriptive Bioethics Research
Chair: ...
16.45 - 17.00 Discussion
1 Knowledge, Attitude and Safety Practices ofParamedical Staff about Modes of Transmission of
HIV/AIDS in a Public Sector Teaching Hospital of
KarachiNabila Khan, MBBS, DCPS (Health Care Systems
Management)
17.00 - 17.15
2 Survey Research and Ethics
Noriko Kataoka, Kumamoto University, Japan
17.15 - 17.30
3 The ethical aspect in distance learning: how to to assure
quality
T. Basarudin, Faculty of Computer Sciences, University ofIndonesia
17.30 - 17.45
To be decided later
17.45 – 18.00 General Discussion

Day 2
Tuesday, November 4, 2008
Session 6. Public health ethics
Chair: ...
08.30 - 08.45
1. Mass Public Health Interventions in the Developing
World: Some Ethical Issues
Angus Dawson, Keele University, UK and University ofToronto, Canada
08.45 - 09.00
2. Public Health can not be Integrated in the ClassicalApproaches to Medicine
Elangovan Thiruvalluvan, health researcher(HIV/AIDS/TB ) in Tuberculosis Research Centre, Chennai,
India, Elangovan Thiruvalluvan, 40/5, Vignesh Avenue,
Karupayoorani, Madurai-625020, India
09.00 - 09.15
3. The Causes of China’s Abnormal Sex Ratio andImproved Approaches
Yanguang Wang, Ph.D, Professor, Center for Applied
Ethics, Chinese Academy of Social Sciences, Beijing, China
09.15 – 09.30
4. Ethics in Indian Health care for all Systems – an microlevel analysis.
N. Lakshmanan, Programme Coordinator ARFI, and
P. Ilango, PhD, Reader in Social work.
09.30 - 09.45 General Discussion
Session 7. Stored Samples and Patients Informational Self
Determination
09.45 - 10.45
Panel on Stored Samples and Patients Informational Self
Determination
Convenor and Chairs: Brigitte Jansen, University of Madras(India), Bioethicslaw e.V./;
Jürgen Simon, Professor, Leuphana University of Lueneburg,
Bioethicslaw e.V.
10.45 - 11.00 BreakEubios Journal of Asian and International Bioethics 18 (July 2008)

125

Session 8. Health and Bioethics
Chair: Prof. Agus Purwadianto
11.00 - 11.30
Keynote speech by the Minister of Health of Indonesia
11.30 - 12.00 Discussion

4. Trade in kidneys and human dignity
Nir Eyal, Division of Medical Ethics, Harvard Medical
School, Harvard University, USA
15.15 - 15.30 General Discussion
15.30 - 15.45 Break

12.00 - 13.00 Lunch

15.45 - 16.45
Session 11. Panel on Regulating Organ Transplantation:
Experiences from Pakistan
Contact persons: Anant Bhan, MD, Independent Researcher,
Bioethics & Public Health, Pune, India; and Aamir Jafarey,
MD, PhD, Centre for Biomedical Ethics & Culture, Sindh
Institute of Urology & Transplantation, Karachi, Pakistan

Session 9. Protection of Women and Vulnerable Persons
Chair: Yanguang Wang, China
13.00 - 13.15
1. The Legal and Ethical Aspects of Human
Experimentation in Malaysia
Anisah Che Ngah, PhD, Faculty of Law, Universiti
Kebangsaan Malaysia 43600, Bangi Selangor, Darul Ehsan,
Malaysia; andYuhanif Yusof, Kolej Undang-undang, Kerajaan &Pengajian Antarabangsa, Universiti Utara Malaysia, Sintok
06010 Kedah, Darul Aman, Malaysia
13.15 - 13.30
2. How to Safeguard Vulnerable Patients in Biomedical
Research in Case of Lacking of Funding in Developing
Countries
Di Xiao1*, Institute of Pharmacology, Institutes ofBiomedicine, Tsinghua University, Beijing 100084, China;
and;Paola Arslan2 Department of Medical-diagnostic Scienceand Special Therapies，University of Padua, Italy
13.30 - 13.45
3. Factors For Gender Discrepancy in Kidney
Transplantation and Ethical Issues
Shamima Parvin Lasker, Professor of Anatomy, Associate
Professor, Moulana Bhasani Medical College, Dhaka,Bangladesh
13.45 - 14.00
4. Gender Discrepancy in Kidney Donation vs Reception
Globally
Shamima Parvin Lasker, Associate Professor of Anatomy,
Moulana Bhasani Medical College, Bangladesh; andRishad Raihan, Junior Research Assistant, World
University, Bangladesh.
14.00 - 14.15 General Discussion
Session 10. Organ Transplant Ethics
Chair: ...
14.15 - 14.30
1. Womb Transplants: The Next Radical Breakthrough in
the Arena Of Artificial Reproductive Technologies?
Amel Alghrani, Centre for Social Ethics and Policy,
University of Manchester, UK.
14.30 - 14.45
2. Kidney Transplantation in Bangladesh: Opportunities
and Challenges
Chanda Sanchoy Kumar, Institute of Social Science andPublic Health, Dhaka, Bangladesh, and Chowdhury Sajeda,
Holy Family Red Crescent Medical College, Dhaka,Bangladesh; Molla Musaraf Husain, Rajshahi University,
Rajshahi
14.45 - 15.00
3. Global Efforts Against Organ Trafficking
Alireza Bagheri MD, PhD, Medical Ethics Center, Tehran,Iran
15.00 - 15.15

Session 12. Ethics, Energy and Environment
Chair: ...
16.45 – 17.00
1. Ethics of Energy Technologies
Darryl Macer, PhD, UNESCO Bangkok
17.00 - 17.15
2. Environment and Health: From Ethical Perspective
Xiao Wei, PhD, Professor, Philosophy Department, Schoolof Humanities and Social Sciences, Tsinghua University,
Beijing 100084, China
17.15 – 17.30
3. Universaliam and Ethical Values Affecting theEnvironment
Jasdev Rai, MD, Sikh Human Rights Group, UK
17.30 - 17.45
4. Updates by Chairs of Working Groups of the Project onreport progress
Working group chairs who are present
17.45 – 18.00 General Discussion of UNESCO Project on
Ethics of Energy Technologies

Day 3
Wednesday, 5 November 2008
Session 13. Environmental Ethics
Chair: ...
08.30 - 08.45
1. Arsenic contamination of groundwater in Asia: health
implications and ethical perspectives
Abhik Gupta, PhD, Dept. of Ecology & Environmental
Science, Assam University, Silchar – 788011, India
08.35 – 09.00
2. Saving endangered species: who owes a duty to whom
and why?
Sarah Chan, Institute for Science, Ethics and Innovation,
School of Law, University of Manchester, United Kingdom;and Daniela Cutas, Department of Philosophy, University ofGothenburg, Sweden
09.00 - 09.15
3. Environmental ethics – a foundation for sustainable
development
Endang Sukara, Indonesian Institute of Sciences (LIPI),
Jakarta, Indonesia
09.15 - 09.30
4. Spiritual dimension for Indonesian inland water
management: case from resolution of conflict in Lake
Maninjau

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Eubios Journal of Asian and International Bioethics 18 (July 2008)

Dede Irving Hartoto, Research Center for Limnology,
LIPI,LIPI Life Science Center, Indonesia
09.30 – 09.45
5. Building Environmental Ethics for School Students
with an Economical Life-Style
Ngo Thi Tuyen, PhD, Deputy-Director, Centre for Education
Technology, Hanoi, Vietnam
09.45 – 10.00 General Discussion
Session 14. Ethics of using animals
Chair: ...
10.00 - 10.15
1. Ethical Issues in Biomedical Research: The Primate
Research Center - IPB Experiences.
Joko Pamungkas and Yasmina A. Paramastri, Primate
Research Center at Bogor Agricultural University, Indonesia
10.15 - 10.30
2. Ethics in animal production
Kusumo Diwyanto
10.30 - 10.45
3. Ethics in animal trade
Tjeppy D. Soedjana, Indonesia
10.45 - 11.00
4. Constructing “Humans” and “Animals”: anethnographic study of meaning creation in biomedical
ethics and law
W. Calvin Ho, JSD Candidate, Cornell University (USA),
Senior Research Association, Secretariat of the Singapore
Bioethics Advisory Committee
11.00 - 11.15
5. Ethical Considerations in the use of Laboratory
Animals for Biomedical and Bioscience ResearchDondin Sajuthi, Ikin Mansjoer, Primate Research Center ofBogor Agricultural University
11.15 - 11.30 BreakSession 15. Agriculture and Ethics
Chair: Endang Sukara
11.30 – 12.00
Keynote speech by the Minister of Agriculture ofIndonesia
12.00 - 12.30 Discussion
12.30 - 13.30 Lunch
13.30 - 14.30
Session 16. Panel on The Implementation of ELSI Policyin Biobank Development and Ethical Governance ofInnovative Medical Research
Chairs: Prof. Fan, Chien Te and Prof. Tsai, Duu Jian
Session 17. Ethics and biotechnology
Chair: ...
14.30 - 14.45
1. Ethical Concerns and Risk Perception Associated withDifferent Applications of Modern Biotechnology
Applications in Malaysia
Latifah Amin1, Jamaluddin Md. Jahi2, Abd Rahim Md.
Nor2, Mohamad Osman3 and Nor Muhammad Mahadi4
1
Centre for General Studies, 2Faculty of Social Sciences &Humanities, 3Faculty of Science and Technology, Universiti
Kebangsaan Malaysi, 43600 UKM, Bangi, Selangor Darul
Ehsan, Malaysia, 4Malaysia Genome Institute, Heliks Emas
Block, UKM-MTDC, Smart Technology Centre, 43600
UKM, Bangi, Selangor Darul Ehsan, Malaysia

14.45 - 15.00
2. Intellectual Property Rights in Biotechnology: Iranian
Scholars’ Viewpoints
Mansooreh Sanieia*, and Ladan Naz Zahedia, Saeed
Shahraza, Ala Melati Rada, Elnaz Jafari Mehra, Saye
Sayara, Roya Sherafat Kazemzadea, Ahmad Shekarchib,and Mohammad Reza Zalia
a. Shaheed Beheshti University of Medical Sciences, Iranb. Department of Sociology, Shaheed Beheshti University,
Iran
15.00 - 15.15
3. Ethics of commercialisation of individualism andpublic health in genomics: some reflections on
nutrigenomics
Mina Bhardwaj, Cesagen, Cardiff University, UK
15.15 - 15.30
4. Waste Disposal as Environmental Problem: Different
methods of Composting Bio-degradable Waste
P. Malligeswari, S.R.M. University, Kattankolathur,
Chennai, India
15.30 – 15.45
6. Technology and Culture
S. Panneerselvam, PhD, Professor, Department of
Philosophy, University of Madras, Chennai 600 005, INDIA
15.45 – 16.00 General Discussion
16.00 – 16.15 BreakSession 18. Ethics and Disasters
Chair: ...
16.15 – 17.15
1. Panel on Ethical Issues in Post Disaster Research:
Taking the Agenda Forwards
The Working Group on Disaster Research and Ethics(WGDRE) for the Asian Bioethics Conference 2008: Aasim
Ahmad, Aamir Jafarey, Darryl Macer, Sandya Srinivasan,
Nandini Kumar, Sriyakanthi Beneragama, Chandrani
Jayasekera, Saratha Edirisingha, Dananjaya Waidyaratne,
Sisira Siribaddana, Leonardo Catro, Sleman Sutaryo, Athula
Sumathipala
17.15 - 17.30
2. Ethical Issues In Disaster Research and Management
Konstantin G. Gurevich, MD, PhD, DrSci, Prof; andEkaterina G. Fabrikant, MD, Moscow State University of
Medicine and Dentistry (MSUMD), Russia
17.30 – 17.45
3. Post-tsunami rehabilitation in Aceh: Issues in barrack
health management
Zinatul Hidayat, MD, Faculty of Medicine, University ofSyah Kuala, Banda Aceh, Indonesia
17:45 – 18.00 General Discussion

Day 4
Thursday, 6 November 2008
Session 19. Bioethics Education
Chair: Prof. Darryl Macer
08.00 - 08.15
1. Tengrianism as basis for bioethical education in
Kyrgyz Republic
Tamara Kudaibergenova, PhD, Center of Bioethics andRights, Kyrgyz-Russian Slavic University, Kyrgyzstan
08.15 - 08.30
2. Bioethical education in Kyrgyz RepublicEubios Journal of Asian and International Bioethics 18 (July 2008)
Altynai Karasaeva, PhD, Institute of Equal Rights andOpportunities, Kyrgyz-Russian Slavic University,
Kyrgyzstan
08.30 - 08.45
3. A Faculty Development program in Bioethics toencourage infusion of ethical thinking into teachingactivities
Dena Hsin-Chen Hsin andChao-Yu Chen; Center of Faculty Development, China
Medical University
09.00 - 09.15
4. Bioethics Goes To School: module design for highschool students in Indonesia
Sherly Kurnia Dewi (Third year student), Biotechnology
Faculty, Atma Jaya Indonesia Catholic University, Jalan
Jenderal Sudirman 51 Jakarta 12930 Indonesia, andElizabeth Citra Wening Prasanti (fourth year student),
English Department Faculty of Education, Atma Jaya
Indonesia Catholic University, Jalan Jenderal Sudirman 51
Jakarta 12930 Indonesia,
09.15 - 09.30
5. Blogs: alternative media to teach bioethics
Eka Sulistiyowati, MA, lecturer, Faculty of Science andTechnology, Islamic State University Sunan Kalijaga (UINSunan Kalijaga), Jogjakarta
09.30 - 09.45
6. UNESCO Bioethics Education Efforts and Core
Curriculum on Bioethics
09.45 - 10.15 General Discussion
10.15 - 10.30 BreakSession 20. Panel on Islamic Bioethics (1)Chair: M. K. Tadjudin.
10.30 - 11.30
Islamic bioethics and its dilemma
Ahmed Binsumeit Khitamy Badawy, Chief Biomedical
Technologist, Dept. of Microbiology, College of Medicine &Health Sciences, Sultan Qaboos University, Oman
[title not available]
Muhammad Nizam Awang, Faculty of Syariah and Law;
Universiti Sains Islam Malaysia
Ethical issues in health: an Islamic bioethics view
Author to be confirmed
General discussion
Session 21. Panel on Islamic Bioethics (2)Chair:
11.30 - 12.30
Animals in Islamic Bioethics
F. B. Sekaleshfar, MBBS
Muslim responses to HIV/AIDS
Author to be confirmed
Muslim responses to overpopulation andoverconsumption
Author to be confirmed
General discussion
12.30 - 13.15 Lunch
Session 22. Panel on Comparative Religious Ethics onLife and Death
Chair: Zainal Abidin Bagir
13.15 - 14.30

127

1. Panel on Comparative Religious Ethics on Life andDeath‐ Cases of euthanasia, abortion, stem-cell research:
Hinduism, Buddhism, Christianity, Islam‐ Religious studies and disaster studies: need for
dialogue‐ Religion and medicine during disaster‐ Religious communities before and after disaster(focus on particular religious communities inIndonesia)‐ General discussion
Session 23. Panel on Ethical and Legal Aspects of
Xenotransplantation
14.30 - 15.30
Convenors: Brigitte Jansen, University of Madras (India),
Bioethicslaw e.V.; and:
Jürgen Simon, Leuphana University of Lueneburg,
Bioethicslaw e.V.
15.30 - 16.00 BreakSession 24. Ethics Review Committees
Chair: ...
16.00 – 16.15
1. Exploring the Structure, Processes and Principles of
Ethics Review Committees
Sriyakanthi Beneragama and Yin Thet Nu Oo
16.15 - 16.30
2. Developing a Capacity-building Approach to Ethical
Review in Central Asia
Bakhyt Sarymsakova, MD, Central Asian Centre on HealthResearch for Development, National Research Center for
Mother and Child Health, Astana, Kazakhstan
16.30 – 16.45
3. Uzbeki doctors and confidentiality issues
Feruza Zagirtdinova, DSc, Associate Professor Ethics andAesthetics Department, National University of Republic of
Uzbekistan.
16.45 - 17.00
4. National Bioethics Committee in Tajikistan
Nasyrova Firuza, Bioethics Committee under Tajik
Academy of Sciences (BC TAS), Professor, Institute of Plant
Physiology and Genetics of the Tajik Academy of Sciences(IPPG TAS), 299/2 Aini St., Dushanbe, 734063, Tajikistan
17.00 - 17.15
5. Ethical Review of Research: Experience of a“National” Review Committee
Anoja I. Fernando, BA, MBBS, FRCP, Faculty of
Medicine, University of Ruhuna, Sri Lanka
17.15 - 17.30
6. Institutional Review Boards, Worldwide
Jayapaul Azariah, PhD, President, Asian Bioethics
Association
17.30 - 17.45
7. Guidelines For Embryonic Stem Cell Research at
Sindh Institute of Urology and Transplantation (SIUT)
Tashmeem Razzaki. Professor Molecular
Biology/Biotechnology, Sindh Institute of Urology andTransplantation (SIUT), Karachi-74200, Pakistan
17.45 - 18.00 General Discussion

128

Eubios Journal of Asian and International Bioethics 18 (July 2008)

Day 5
Friday, 7 November 2008
Session 25. Health and Ethics
Chair: ...
08.30 - 08.45
1. Ethics and Obesity: Am I my Obese Brother’s Keeper?
Leonardo D. de Castro, PhD, University of the Philippines
08.45 - 09.00
2. Cerebral Palsy - The Social Problems.
N . S. Manjusha, MBBS student, Calicut Medical College,
Kerala, India
09.00 - 09.15
3. Ethics Controversy of Death Choice in Chinese Hospice
Lifang Zhaolili, China Capital Medical University
09.15 – 09.30
4. Principles of Patients Autonomy from Malaysian
Perspectives
A. A. Rosniza , MD, J Rogayah MHPEd, AMH Zabidi Hussin FRCPCH, School of Medical Sciences, Universiti
Sains Malaysia, Kelantan, Malaysia
09.30 - 09.45 General Discussion
10.00 – 10.15 BreakSession 26. Medical Ethics Education
Chair: ...
10.15 - 10.30
1. Teaching Biomedical Ethics to the Undergaduates at a
Medical University in Pakistan – A One Year Experience
Faisal Ghani Siddiqui, MBBS, FCPS, PGD-Bioethics,
Assistant Professor of Surgery, Liaquat University of
Medical & Health Sciences, Jamshoro, Pakistan
10.30 - 10.45
2. Reform in Medical Ethics Curriculum ofUndergraduate Medical Education in TUMS School of
Medicine
Fariba AsghariÅ, Azim Mirzazadeh, and Seyed Hasan
Emami Razavi Medical Ethics Research Center of Tehran
University of Medical Science
10.45 - 11.00
3. Prima-faciism in problem-based learning for medical
students in Indonesia
Agus Purwadianto, Faculty of Medicine, University ofIndonesia
11.00 - 11.15
4. Bioethics Education in Indonesia
Soenarto Sastrowijoto, MD, Center for Bioethics andMedical Humanities, School of Medicine UGM; Member ofIndonesian National Bioethics Commission; Member ofInternational Bioethics Committee (UNESCO)
11.15 – 11.30
5. Teaching Virtue through Role Models in Medical
SchoolSintak Gunawan, M.D., MA in Applied Ethics, India
11.30 - 13.00 Friday noon prayer and lunch
Session 27. Medical Genetics and Ethics
Chair: ...
13.00 – 13.15
1. Bioethical Aspect in Medical Genetics Research andServices
Sultana M. H. Faradz, MD, PhD; Professor, Division of
Human Genetics; Center for Biomedical Research(CEBIOR); Faculty of Medicine, Diponegoro University,
Indonesia
13.15 – 13.30
2. Prenatal screening and counselling in Iran and ethicaldilemmas
Mansooreh Sanieia*, Elnaz Jafari Mehra, Saeed Shahraza,
Ladan Naz Zahedia, Ala Melati Rada,
Saye Sayara, Roya Sherafat Kazemzadea, Ahmad Shekarchib,and Mohammad Reza Zalia
a. Shaheed Beheshti University of Medical Sciences; b.
Department of Sociology, Shaheed Beheshti University;
Shiraz, Iran
14.00 – 14.15 General Discussion
Session 28. Nurturing Bioethics: Education
Chair: ...
14.15 – 15.15
1. Panel on Nurturing Bioethics: Educational Initiatives
from Pakistan
Aamir Jafarey, Natasha Anwar, Moin Siddiqui, Samina
Mansoor, Azra Amerjee, Salahuddin, Bushra Khzar,
Ashraf Hussain, Ali Lanewala and Bushra Shirazi
15.15 - 15.30
2. Teaching bioethics to clinical research students in
India: challenges & opportunities
Anant Bhan, MD, Flat 405, Building A-11, Planet
Millennium, Aundh Camp, Pune-411027, Maharashtra, India
15.30-15.45
3. Knowledge and attitudes towards plagiarism: Views
from Karachi
Bushra Shirazi, MD, Ziauddin Medical University, Karachi
and Aamir Jafarey, MD, Centre of Biomedical Ethics andCulture, SIUT, Pakistan
15.45 – 16.00
4. Field work and bioethics learning
Dayar Arbain, PhD, University of Andalas, Padang,Indonesia
16.00 – 16.15 Break
29. Closing Session
Chair: Jayapaul Azariah, Darryl Macer, and Umar A.
Jenie
16.15 – 16.45
Bioethics, Human Rights, Science and Technology, andAlleviation of Poverty in the World
Pierre Sane, PhD, Assistant Director-General of UNESCO
for Social and Human Sciences
16.45 – 17.45
Open Discussion and Recommendations for the Future(Also award of best student presentation)
17.45 Closing of Conference
The program is open to further submissions, andmodification.
More will be provided in the September 2008 issue of
EJAIB, and updates will be posted on the web.

Eubios Journal of Asian and International Bioethics 18 (July 2008)

129

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Shaping Genes: Ethics, Law and Science of Using Genetic Technology in Medicine and Agriculture
Cost: US$20 UK£10 NZ$30 A$25 C$22 ¥2500 Others or credit card NZ$30
by Darryl Macer, Oct. 1990, 421pp.
Equitable Patent Protection in the Developing World
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Attitudes to Genetic Engineering: Japanese and International Comparisons (Bilingual)by Darryl Macer, May 1992 330pp.
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Intractable Neurological Disorders, Human Genome Research and Society Eds: N. Fujiki & D. Macer
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Bioethics for the People by the People
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Bioethics in High Schools in Australia, Japan and New Zealand,
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Protection of the Human Genome and Scientific Responsibility (Bilingual)
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Bioethics in India (includes 115 papers from Jan.1997 conference)
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June 1998 ISBN 0-908897-10-3, 403 pp.
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Bioethics is Love of Life: An alternative textbook
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Ethical Challenges as we approach the end of the Human Genome Project
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Bioethics Education in Japanese High Schools (in Japanese only)
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Bioethics and the Impact of Human Genome Research in the 21st Century
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Bioethics in Asia in the 21st Century
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Challenges for Bioethics from Asia
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