Eubios Journal of Asian andInternational Bioethics
EJAIB Vol 18(6) November 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

page

Editorial: Public engagement
161
Causes of Communication Gaps between Science andSociety: Discussion Based on Community Engagementin the Haplotype Mapping Project in Japan162- Eiko Suda
In search of Chinggis Khan's genes: A strange case ofscience-based irreverence in the age ofpolitical correctness
164- Oana Iftime and Alexandru Iftime
The Biocosmology of Konstantin S. Khroutski: A
Philosopher’s Reflections on Biology
168- Georges Chapouthier
Stakeholders in the Energy Debate – Identities,
Responsibilities and the Future170- Emily Price, Stephanie Russo, Kamani Thanakrishnan
Global Warming, Ozone Depletion and Water Politics:
Political Realist and Liberal Institutionalist perspectives
at the state level
174- Nikhil C. Farias
The Ecological Costs of Hydroelectricity
178- Matt Saunders
Energy Equity and Human Security: Where Does the
Solution Lie?
178
- Tamarind Reynolds
The space has been ill – the humans' fault
179- Bing H. Tang
Teaching of bioethics in medical schools in Bangladesh 180- Shamima Parvin Lasker Arif Hossain
To Err is Human: The Need for Patient Safety
181- P. Thirumalaikolundusubramani and A. Uma
Stigmatization of the Mentally Ill and an Ethical
Framework of Cultural Contexts, Psychosocial
Development, and Moral Development
182-Hanzade Dogan
Report of the Asian Bioethics Association (ABA) General
Meeting (2008)
188
Conferences
189
ABA Renewal Information 2009192
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

Editorial: Public engagement
This issue of EJAIB begins with a reflective article on
the process of community engagement by Eiko Suda,
based on experiences gained in the Haplotype Mapping
project in Japan. This has been the subject of several
reflections some years ago in EJAIB. The process ofcommunity engagement, or public engagement, is now
well established as a norm for ethical review andconduct of research projects. Although it has been said
to be in contrast to the current state of lack of public
discussion of scientific research in many countries, it isa natural extension of democratic principles of good
governance. Public discourse in bioethics is also afoundation of the EJAIB as a free online resource.
There follows a review of hyperbole over the genetic
influence of Chinggis Khan, and the fathering ofchildren across Asia. The genetic histories of different
communities are still being discussed. There is also
some interesting reflection on these issues available
on http://gfbr9.hrc.govt.nz/ available as proceedings ofthe Global Forum on Ethics of Health Research, held in
Auckland, New Zealand, 3-5 December, 2008. The
forum focused on ethics for indigenous populations,and there are still many concerns that somecommunities wish to say no to research. I also
convened a UNESCO Ethics Education Workshop 1-2
December, which saw active discussion and sharing of
methods and examples for ethics education.
Also in this issue are contributions on the topic of
ethics of energy technologies from a Joint UNESCOMacQuarie University Conference held in May 2008.
There are several papers looking at medical ethics
issues, from Bangladesh, India, and a substantive
review of ethics of stigmatization of persons and mental
illness. There is also the 2008 annual meeting report of
the ABA, following a successful conference organised
in Indonesia. As we end 2008 I wish all readers a happy
new year, and also a reminder that if you wish toreceive a hard copy of EJAIB renewal of subscription isrequired. The support given by subscribers ensures thecontinuation of this journal. EJAIB is online for all toread, so we also encourage more paper submissions
as EJAIB continues to be one of few freely accessible
online academic journals for cross-cultural bioethics
dialogue – a type of public engagement.
-Darryl Macer

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

Causes of Communication
Gaps between Science andSociety: Discussion Basedon Community Engagementin the Haplotype Mapping
Project in Japan

will examine some of the arguments of how genetic
information should be deal with from the perspective ofprotecting individual human rights, and at the sametime the expectations over the generation of public
value from scientific research as a social activity.
Lessons from a range of efforts for public engagementin science and technology (PE) focusing on inclusion of
citizens’ views, interests, values and issues, and how
they are framed into the social decision making process
regarding science and technology will be discussed forJapan as well as the global society.

- Eiko Suda
Graduate School of Life and Environmental Sciences,
University of Tsukuba, Tsukuba Science City 305-8572,
Japan
Email: fwhv4551@mb.infoweb.ne.jp

2. The International Haplotype Mapping Project1(HapMap Project)
The HapMap Project is an international collaborative
project to determine the common patterns of DNA
sequence variation across the human genome bygenotyping four populations in the world including
Japanese, Han Chinese, Northern and Western
European (CEPH) and Yoruban ancestry 2 . The project
was initiated by the International HapMap Consortium
consisting of organizations and institutions in fivecountries, USA, Japan, United Kingdom, Canada andChina, from October 2002 and mapped the regions of
the genome inherited over the generations (haplotype
blocks represented by the set of SNPs, single
nucleotide polymorphisms) on the human genome(HapMap)This project is positioned as a post Human
Genome Project (1990-2003), and the products of it
have been enthusiastically expected to empower the
progress in life science research in post genome era.
The database including the developed HapMap and thecell bank of collected samples have been made freely
available in the public domain to be utilized for life
science research by researchers in the world.
In the project to determine human haplotypes, thepatterns of common variation in DNA sequence acrossthe human beings in the world, and to map them as
HapMap, genotyping on the above four populations was
conducted. Even if the project is focusing on building
the HapMap on human beings in general rather than
3
particular groups and that no individual information
was collected with the samples, a great amount ofgenetic information regarding involved populations
became apparent through the process to develop andutilize the freely accessible map by anyone in the world.
Also the samples collected for the project are stored in
the central cell bank permanently and have alreadybeen made available for researchers in the world.
Therefore, the impact upon the participating
communities needed to be considered as bothindividuals and as groups, not only before but also after
the project. A community engagement and samplecollection group was organized in every participating
community to work out the best process to respect each

1. Public Engagement in Human Genome Researchin Post Genome Era
After the discovery of the DNA double helix in 1953,
almost every basic system of our life phenomena suchas heredity, ontogenesis, cell proliferation, immune
system and aging, have been reported at molecularlevel. Thanks to the Human Genome Project (19902003) the complete sequence of 3 billion base pairs of
the human genome was determined and made public.
Such developments have made an impact on our viewsof human beings or human life, and now in the post
genome era human beings have become to beconsidered as physical substances which can be
explained from a reductionist perspective. That view ofhuman beings as a technically possible existence to be
subject to future accurate mechanical intervention
means they can be modified as subjects of the naturalsciences. Based on such ideas, advanced medical
technology and biotechnology have achieved significant
status in society.
Meanwhile the growing concerns in society toward
genetic modified (GM) foods developed the recognition
that the loss of social trust for science or advanced
technology might become a significant factor for humangenome research. The understanding of citizens’ social
and bioethical interests has become to be consideredessential recently. Through nationalistic arguments andits consequence regarding projects such as the
Icelandic population database in the year 2000, therecognition that the process to respect the need for
public consultation and social debate involving ordinary
people in the society has become a norm in many
countries. The ethical and social debates are becoming
more heated in human genome research in the post
genome era than they were before.
On the other hand the escalation of global
competition in science and technology and its
application and the high degree of specialization andsegmentation of scientific disciplines have made thestructural outline in which scientific activities areplanned, carried out and evaluated among the experts’communities more solid. The specialized nature ofscience also makes it difficult for people outside of such
communities to understand what is going on in scienceand technology.
Many studies on the human genome are phrased as
probing the nature inside of human beings. This paper1

http://www.hapmap.org/
The International HapMap Consortium. The International
HapMap Project. Nature 2003; 426: 789-796.
3
Foster, Morris W. and Sharp, Richard R. Beyond race:
towards a whole-genome perspective on human populations
and genetic variation. Nature Reviews Genetics 2004; 5: 790796.
2

Eubios Journal of Asian and International Bioethics 18 (November 2008)
community’s social, cultural or historical background 4 .
The mission of the groups was to provide theinformation about the HapMap Project including
scientific background, ELSI issues regarding such kindsof research, risks and benefits of participating in the
project for both individuals and the community, toprovide opportunities of public debate on thesignificance of the Project to members of thecommunity before being required of participation, and tocollect the responses, questions, concerns or opinionsfrom the community. Also based on the knowledge fromthe community engagement process, the groups
developed
culturally
appropriate
protocol5
modifications . In the HapMap project the term“community engagement” was used instead of “public
engagement” to make a point that the process intended
to involve participating communities rather than entire
public.
In Japanese community engagement the nationwide
preliminary questionnaire survey, various types ofmeetings such as citizens’ forums and explanatory
meetings around the Kanto area in which samples werecollected and the individual interviews were
implemented. Detailed analysis of data from them can
5
be shown in several publications , 6, 7 but in this paper I
focus on discussion of some issues relating to thecommunication between experts’ communities and thecitizens in society which will be the focus of discussion
based on the knowledge from the community
engagement process in the HapMap project in Japan.
3. Experts in Japan lack confidence in public ability
for Community Engagement
In the HapMap project community engagement
particularly in its early stage ordinary people showed
generally positive attitudes toward human genome
research, DNA banking, and scientific or medical
research. As has been found in opinion surveys earlier,the general public in Japan showed their opinion thatscience contributes to the progress of the quality of lifeor health and it has high public value. They were also
willing to be involved in science as a social contribution
8
or for helping others . However, such attitudes changed
gradually through the community engagement process
toward more diversified aspects which are difficult to be
simply classified into “Yes” or “No” categories. People
showed a wide range of perspectives such as
4

The International HapMap Consortium. Integrating ethics
and science in the International HapMap Project. Nature
Reviews Genetics 2004; 5: 467-475.
5Charles Rotimi, et al. and The International HapMap
Consortium. Community Engagement and Informed Consent
in the International HapMap Project. Community Genetics
2007; 10: 186-198.
6
Eiko Suda and Darryl Macer. Policy and Attitudes towards
Collection of Personal DNA in genetic databases in Japan.
Journal of International Biotechnology Law 2007; 04: 89-97.
7
Eiko Suda, Darryl Macer and Ichiro Matsuda. Current
Situation and Challenges in Public Engagement in Scienceand Technology in Japan: Experiences in the HapMap
Project. Genomics, Society and Policy, In Press.
8
Masakazu Inaba and Darryl Macer. Attitudes tobiotechnology in Japan in 2003. Eubios Journal of Asian andInternational Bioethics 2003; 13: 78-90.

163

understanding, interests or sympathy toward science atthe same time as expressing distrust towards thescientific community or scientists, displeasure about
potential utilization of their genetic information forindustrial purposes, mistrust toward private industries,
or concerns that their genetic information and blood
samples should be either regarded as their own orJapanese property, and so on. It seemed that ordinary
peopleparticipatinginJapanese
community
engagement tried to put together the individuals’
opinions in a hesitant way taking such various factors
into their consideration.
In Japanese community engagement meetings in the
HapMap project some experts participated from a broad
range of disciplines such as genetics and medical
science from the natural science field and also fromsocial sciences including law, bioethics, sociology andso on. Some participants also came from clinicalmedical fields or pharmaceutical industries. Regardlessof the discipline it seemed that members of experts’communities had a similar picture that the lay publiclacked the ability to engage in discussion or dialogue on
issues regarding science and technology. That is tosay, they thought lay public are not necessarily capableand not appropriate to be involved in community
engagement since they believed that they are not sointerested in science and technology, and also that theycannot understand technical matter. Also somepersistent concern was recognized among expert
communities that such public discussion might justcreate fear among citizens or society, which might be
an obstacle for research implementation to provide too
detailed or highly technical information to lay public whoare basically untrusting towards scientists or science.
4. What Discourages Communications between
Science and Society?
Recently in Japan disinterest in society towardscience among ordinary citizens, particularly among
young generations, has been seen as a serious
problem in context of science and technology policy
and strategy as well as promoting science andtechnology in society as seen in the government's white9, 10. And apapers repeatedly from 1990s, for instance
lot of effort to progress scientific literacy or developscientific communication in the society have beenmade. One method to develop public acceptance of
science and technology is by providing scientificknowledge to the public, and the efforts to enhance
public understanding are concentrated on providing
expertise information rather than developing mutualcommunication, deliberation or cooperation in thesociety.
9
Ministry of Education, Culture, Sports, Science andTechnology. 1993. White paper on science and technology for
1993.
http://www.mext.go.jp/b_menu/hakusho/html/hpaa199301/ind
ex.html10
Ministry of Education, Culture, Sports, Science andTechnology. 2004. White paper on science and technology for2004.
http://www.mext.go.jp/b_menu/hakusho/html/hpaa200401/ind
ex.html164

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

It will be a significant role of experts from a wide
range of disciplines to activate social deliberation or todiversify public debate by providing information invarious contexts or raising issues regarding topics ofscience and technology at the scenes of PE. Actuallysome experts who participated in the HapMap
community engagement in Japan have contributed
significantly to such a perspective. However, at thesame moment, PE is the opportunity in which everysocial sector including experts’ can learn about views,
attitudes or issue awareness of other sectors throughinteractive activities of debate and/or cooperation. Sucha view point however, might be less represented among
Japanese current PE activities.
For instance, in life science research involving
human subjects, human beings are treated as physicalexistences according to the scientific worldview. In
contrast in society human beings are recognized as
moral and social living existences. There is a significant
distance between these ways to look human beingsand it is not really recognized by people in scientificcommunities that such distance sometimes causes
serious concerns among the lay public toward scientificcommunity.
As was experienced in the HapMap projectcommunity engagement also, the issue framing of lay
public is more widely extended than that of mostexperts. The lay public try to consider about each topic
of science and technology as a broader issue framedby each standpoint, experience and interest, or in a
wider social context. On one hand they show
understanding or sympathy toward the significance andpublic value of research, and on the other hand theyraise various concerns and require the explanations orcorrespondence to experts or decision makers. Thenthey endeavor to put together their opinions andattitudes toward research comprehensively. It might not
be really recognized by experts either that thedifference in the extent of issue framing between
scientific communities and society often causes a sortof communication gap between them.
The above described picture of how the lay public is
recognized among expert communities is based on few
direct or indirect bad experiences or loose assumptions
rather than understandings developed throughcontinual and interactive communication efforts. Suchstereotypes without an entity base, which seem to exist
in every social sector, need to be addressed andresolved by mutual learning through interactive
communication and cooperation in society.
5. Necessity of Broad Public Engagement (PE)Science sometimes makes an impact on society
beyond the further extent that the scientific side forecasted. If scientific activities also can be recognized aspart of social activities, some scientific research
programs involving human beings may become amethod of broader social questioning of various existingvalues in our society. Even if the social introspection is
not in the implementation phase but in just theconceptual phase, we can see discussions of questions
such as the value of life. Especially in big projects forwhich considerable amount of taxpayers’ money will befunded, the questionings may become a real possibility.
At that time previously un-focused fear or vague

discomfort which were developed through images inscience fiction, movies or experts’ alarms can become
substantial issues that suddenly threaten our real life. It
is significant to develop communication and deliberation
before such a reality emerges more in society. Also to
extract, address and adjust various misunderstandings
or variance which comes into existence incommunication will require a lot of efforts and a longtime. For this reason PE from an early stage ofscientific research is significant.
PE may function as a social mechanism to contributefor consensus building and democratization of decision
making regarding social issues of science andtechnology, and for complementing the adequacy or
propriety of law and political decision making by
including a wide range of values and people in social
decision making process. Also PE provides theopportunities in which a range of social sectors interact
each other to learn and share different value anddifferent scope of issue awareness through mutualcommunication or deliberation. Such a process might
be promoted inside sectors or each member to maketheir opinions and attitudes have greater social
consideration. After that manner, PE might function asa mechanism to empower citizens to cooperate withmembers of other sectors as scientific citizens and todevelop social self-determination.
It will be important for future scientific development inJapan and other countries that the scientific community
recognizes the meaning of broad PE as a standard
component mechanism in science and technology, andthat policy makers move PE from specific targetoriented goals to a broader social involvement inscience policy.

In search of Chinggis Khan's
genes: A strange case ofscience-based irreverence inthe age of politicalcorrectness- Oana Iftime1 and Alexandru Iftime2,
National Museum of Natural History "Gr. Antipa"
1
University of Bucharest, Faculty of Biology,
Department of Genetics, Aleea Portocalelor 1-3, s 6,
Bucharest, Romania; e-mail: oiftime@gmail.com(corresponding author)
2"Gr. Antipa" National Museum of Natural History,
Kiseleff Bvd. no. 1, Bucharest, Romania
Genetic investigations at a population scale aim toreveal for various purposes the distribution of certain
determinants in human population. Specialists may lookfor genes responsible for various disease or just foralleles specific to a certain group in order to gather apicture of one or more persons' genealogy.
The usual ethical issue associated with type ofinvestigation is thought to be the risk of discriminationthat might arise for some subjects in certain contexts

Eubios Journal of Asian and International Bioethics 18 (November 2008)
due to the results of genetic analysis. E.g., people
carrying "bad" genes might not be able to get
employment or a health insurance in spite of the factthat the relationship between genes, predisposition
conferred by them and actual manifestations of thecorresponding disease is not that easy to specify as in"you- have- the- gene- that- means- you- will- get- ill".
But, the absence of an algorithm adequate forquantification of the genetic risk might very well leadfrom the perspective of an insurance agent to a refusalof insurance. "Unknown risk" is prudent to be read as"risk" only and insurance agents should be prudent by
nature and training.
Apart from the above, two other classes of potential
negative outcome can be listed - the simple, almostnaïve risk of spending money on irrelevant testing andthe more delicate risk of touching one's or a groups'
cultural sensitivities.
The first category refers to the option of having yourgenealogy traced up to distant ancestors (or at least
this is the claim of the proponents) for a fee. There arequite many such offers on the internet (we will not list
links in order not to tempt anyone). Ignoring the factthat the simple use of certain chromosomal markers
cannot really unveil kinship, the need for an actual DNA
sample collected from the persons supposed to be
one's relatives being decisive some "laboratories" keep
discovering amazing connections between their clientsand historical figures. “[A]s usual, there are those who
simply want to make money out of it, those for whom it
is part of serious science, and those who are extremely
desperate to look for their famous ancestors and who
will do anything to reach their target”. "[There is] a lot of
total rubbish on many of the Y-STR project sites[online], but it seems that those involved are perfectly
happy with what they do”. (Peter de Knijff, a geneticist
at Leiden University, the Netherlands apud Wolinsky,2006).
Of course there's no harm in dreaming but still when
dreams tend to substitute realty we might have a (big)problem. And when, for a small fee, science gets toback on day-dreaming the whole society might have aproblem.
On occasions such investigations leads toembarrassing situations such as the one observed by
11
H. Wolinsky in Genetic genealogy goes global(Wolinsky, 2006) when a person was told that he was adescendant of Chinggis Khan which granted him a
reception in his honour at the Mongol embassy in theUSA. The reception has never been held since anotherlaboratory dismissed those first results. Therefore, thepoor DNA-testing lab confident customer was - as
Wolinsky put it- "booted out of the yurt". But,
"Fortunately errors in paternal ancestry assignment are
not life-threatening, as would be the case in blood
typing prior to transfusion, for instance." (Peter
Underhill, a senior research scientist at Stanford
University, CA, USA, apud Wolinsky, 2006).
Speaking of the Khan's descendants gets us to thesecond category of negative consequences of genetic
11
Title followed by a brief but comprehensive comment:
Although useful in investigating ancestry, the application ofgenetics to traditional genealogy could be abused165

investigations at a population scale in humans.
Chinggisids became subject of many inadequate
speculations and comments. The paper that elicited thewhole mythology of Chinggis' descendants to be foundto say so at every corner in Asia and only at every
eighth corner in the rest of the world is The Genetic
Legacy of the Mongols, by Zerjal et al. (2003).
The authors claim that a certain Y-chromosomal
lineage highly frequent in Asian men originated from
Chinggis Khan or an ancestor of him. The paper
contains more than a few contradictions, illogicalassertions and unfounded speculations that we will
examine in the following.
12"Increased reproductive fitness , transmitted sociallyfrom generation to generation, of males carrying thesame Y chromosome would lead to the increase infrequency of their Y lineage, and this effect would beenhanced by the elimination of unrelated males. Within
the last 1,000 years in this part of the world, these
conditions are met by Genghis (Chinggis) Khan (c.
1162–1227) and his male relatives. He established thelargest land empire in history and often slaughtered theconquered populations, and he and his close male
relatives had many children." (Zerjal et al, 2003).
First (most embarrassing) Chinggisids married andhad legitimate wives but did not walk aroundinseminating women and spreading their chromosomes
as some suggest. To suggest that Chinggis“systematically inseminated the most attractive
13
women” is to go far over the top in such speculations.
From the descriptions in The Secret History of theMongols, he appears to have had far more respect ofwomen than implied by such breeding-machine
behaviour. While the Great Khan had a (should we say,natural) attraction to beautiful women, he was definitely
not enjoying mass-proportion rape parties upon theconquered nations – quite the contrary, often he wasaccompanied in his campaigns by one or a few of his
Mongol wives and concubines. Also, elite Mongol
soldiers (and especially the ruling clan) were extremely
unlikely to have taken part in war-time rape, that was amuch disgraced act given the available testimonies on
the Mongol moral code of the time (see, e.g.,
Khamaganova, 2003).
Second (most logical) the idea is absurd in itself,from a biological point of view. The spread of the Y
12

What does "reproductive fitness" actually mean, in thiscontext?...
13
We will quote here the perplexing affirmations made by
Brian Sykes, an Oxford researcher and professor of Genetics
in an interview to The New York Times "Take Genghis Khan'sY chromosome, which is now found in 16 million men inCentral Asia. It started as a single copy from the man himself
in the 12th century. What drove this? Well, when heconquered a territory, he killed the men and systematicallyinseminated the most attractive women. A thousand years
later, his Y chromosome has survived and proliferated, which
is sexual selection on a very grand scale." (from A
Conversation With Bryan Sykes, Is Genghis Khan an
Ancestor? Mr. DNA Knows, by Claudia Dreifus, The New
York
Times,
June
8,
2004,
also
availabeat http://www.nytimes.com/2004/06/08/science/08conv.html?ex=1402027200&en=0a3548b6503d517e&ei=5007&partner=U
SERLAND).

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

haplotypes does not occur in population following somealgorhitm and constantly increasing their frequency unless genealogy is known from records one cannot
make accurate affirmations with respect to the numberof a person's male descendants throughout history. Anysuch affirmation is purely speculative. And, even if
preferred and/or socially advantaged as a mate, a man
cannot control the sex of his offspring, he might very
well have more daughters than sons or even daughters
only (and his Y lineage become extinct because ofthat). In fact, it is the case of one of the Chinggisid
lineages that perished when the last male descendant
had only female offspring – i.e. the Hulagid dynasty in
Iran which became extinct with the death of Abu Said
Baatar Khan (1305-1335); at his death he only left
daughters, two collateral family members remaining in
Iran were killed in a succession struggle and theprosperous Persian khanate collapsed (see Roux,
1993). The Chinggisid lineage in Mongolia itself was at
one time in the late XV century reduced to only one
male child, Batmunkh, the future Dayan Khan (see H.
Howorth, and R. Grousset). This shows that extreme
reduction can follow great expansion in an aristocratic
bloodline, especially in conditions of intense warfare
and competition for the throne, such as were prevalent
in most of Central Asia following the collapse of theMongol empire.
Third (most accurate) the lineage of the Great Khanis very well known up to our time, genealogical records
being very strictly kept so that Mongolians know
precisely who is and who is not a descendant from
14
Chinggis . Other Central Asian peoples which wereruled by Chinggisid lineages (such as the Kazakh andTatar) also have such genealogical records. A very
serious misgiving of the study of Zerjal et al. is that they
did not consult any such Mongol, Kazakh or Tatar
genealogical records (and very little historical data on
the Chinggisid/Borjigid clan) 15 – and in spite of thatclaimed that the Khan and his male relatives had
descendants in a rhythm more adequate to a fast
reproducing small mammal than to humans.
Fourth (most evident) the only scientifically accurate
way of proving genetic relatedness is to compare thegenes of the people supposedly related, namely, in thiscase, the genes of the Khan to those of his presumed
descendants. Zerjal et al admitted that themselves (andalso that they were not able to do it) on a few
occasions. In The Genetic Legacy of the Mongols: "We,therefore, wished to compare Genghis Khan’s Y profile
with the star cluster. It is not possible to examine his
remains directly (…)." And also in an interview of one of
Zerjal's co-authors, Chris Tyler-Smith who declared that"Of course, the ideal evidence would be a direct
14

Communist rule in Mongolia has destroyed many
genealogical records but others have been saved and now
there is renewed interest in these – many coming to light in
the later years, see "In search of sacred names", Mongolia
Today(http://www.mongoliatoday.com/issue/5/names.html)
illustrating a genealogical record of a Chinggisid nobleman.
Sadly most of the Chinggisid nobility perished in the Stalinistera persecutions.
15
The litterature is immense, covering anything from theMongol law (the Yasa) and its provisions about marriage andsex to political marriage practices of the ruling clan – andcountless other topics less interesting in this context.

analysis of DNA from his remains. Unfortunately, thelocation of his tomb is unknown."
Alas Zerjal et al. tried to compensate for the lack ofscientific evidence with folklore: "We, therefore, wished
to compare Genghis Khan’s Y profile with the starcluster. It is not possible to examine his remains directly
but history provides an alternative. The Hazaras ofPakistan have a Mongol origin (Qamar et al. 2002), andmany consider themselves to be direct male-line
descendants of Genghis Khan. A genealogy
documenting these links has been constructed fromtheir oral history (Mousavi 1998). A large proportion of
the Hazara profiles do indeed lie in the star cluster,which is not otherwise seen in Pakistan (fig. 2), thus
supporting their oral tradition and suggesting that
Genghis Khan carried the star-cluster haplotype."
For the beginning, one may easily notice theinconsistence of the reasoning - what was to be
demonstrated (by scientific evidence) namely that theHazara are descending from Chinggis becomes a
premise of the demonstration. The main link - abiological sample from the Khan, or at least from an
uncontested male-line Chinggisid of to-day - is still
missing but folkloric evidence "doubles" scientificevidence that in fact was needed to sustain the same
folkloric claim.
Historically (not folklorically) speaking, the Hazara
people are of a Mongol extraction but by no means of a
Chinggisid one (and by no means a people where
nearly one in three men is a direct descendant of theGreat Khan, as the paper implies). On the contrary,"history provides an alternative" but it does not support
Zerjal et al. In fact, the Hazara were included in the
Mongol empire at Chinggis Khan’s death, and their
origins include Mongols but not of the Chingisid clan –their local rulers, such as Negudar (from him theMongols in Afghanistan were also called Nikudari), or
military commanders such as Sali noyon, were not
Chinggisids. Some descendants of Chinggis Khan
(through the line of Chaghatai) were only appointed asgovernors of the Nikudari (future Hazara) area but
apparently they all returned to the core areas of the
Chaghatai khanate, most becoming khans (Morgan,
1986; Roux, 1993). All of this is quite unsuggestive ofsuch a proportion of putatively Chinggisid blood in the
Hazaras (a proportion larger than that in Mongolia, after
Zerjal et al.), but of the contrary. To whoever might thatancestral Y chromosome have belonged, that malecertainly was not Chinggis Khan.
Actually, male-line Chinggisid descendants, eventhose coming from concubines and not from legitimate
wives, were not numerous in Central Asia. Many rulinggroups (some Mongol in origin, such as the Timurids
and the Oirat ruling families, of which the mostimportant were the Choros, some of other ethnic origins
16
such as the Manchus ) tried hard to acquire theprestige associated with Chinggisid filiation, but to no16
Manchus were sampled by Zerjal et al., but it is not stated if
any persons from the ruling Aisin Gioro clan (i.e. the imperialfamily of the Qing dynasty) were included; if yes, there would
have been the certitude of a witness line that definitly does
not have male-line Chinggisid origin; if they have the Y
haplotype, then the assumption of its association with
Chinggisids is wrong.

Eubios Journal of Asian and International Bioethics 18 (November 2008)
avail. They married Chinggisid princesses but of course
the male line (and most prestigious) Chinggisid filiation
was out of their league.
The problem should be considered solved given theobservations above but we will continue analizying
some more elements as the analysis pertains toresearch ethics (How can such unfounded claims be
published by a major science journal? might very well
be one of the main questions here).
Circular logic with the conclusion serving as apremise for its own demonstration occurs again in The
Genetic Legacy of the Mongols: "(…) group selection
has been much discussed (Wilson and Sober 1994)
and is distinguished by the property that the increased
fitness of the group is not reducible to the increased
fitness of the individuals. It is unclear whether this is thecase here. Our findings nevertheless demonstrate anovel form of selection in human populations on thebasis of social prestige." In fact, the authors noticed thehigh incidence of a certain Y- haplotype among a
number of sampled subjects and they supposed thatthe ancestral Y- chromosomes belonged to Chinggis
Khan and his male relatives, having no uncontestableevidence for their claim.
As for the male dominance effect on Y- haplotypes
propagation, this is another SF (with the initial standingfor "science" and "folklore") scenario that has recently
been deconstructed. Working on 12 short tandem
repeats (Y-STRs) and on a battery of SNPs on the Y
chromosomes with samples collected from 1269
subjects belonging to 41 Indonesian communities
Lansing et al (2008) concluded that "patrilines seldom
are dominant for more than a few generations, and thus
traits or behaviors that are strictly paternally inheritedare unlikely to be under strong cultural selection." Theauthors underline that "A central tenet of evolutionarysocial science holds that behaviors, such as those
associated with social dominance, produce fitness
effects that are subject to cultural selection. However,evidence for such selection is inconclusive because it isbased on short-term statistical associations between
behavior and fertility." They also provide an explanation
for the "rarely skews" part from the title of the paper:"Even our non-neutral Indonesian communities may notnecessarily reflect the action of male reproductive skew
but rather the signature of a very recent or nonneutral
founding group."
In spite of its scientific and historical inconsistence
The Genetic Legacy of the Mongols served as adeparture element for a long series of writing
17
productions of a doubtful taste . If their presence insome obscure publications should not be of concern,
when such things get to be published by National
17

Visit for reference: http://www.encyclopedia.com/doc/1G1163653180.html (Genghis Khan has 16 million offspring);
http://findarticles.com/p/articles/mi_m1200/is_6_163/ai_97997
816 (Genghis Khan's legacy? The Mongol warlord may haveleft his imprint on the world's DNA);
http://www.freerepublic.com/focus/f-news/1158027/posts(Genghis Khan: Father to Millions?);
http://www.digitaljournal.com/article/216355/One_in_200_me
n_alive_today_is_a_relative_of_Genghis_Khan (One in 200 men
alive today is a relative of Genghis Khan)

167

Geographic or Science then perhaps it is the time forscience ethicists to explicitly disapprove such attitudes.
As a bioethicist paying attention to cultural sensitivities
and also as a woman being married into a family having
distant Mongol origins 18 and as a person having
Mongol roots 19 , respectively we would say that titles
such as Genghis Khan, a prolific lover, DNA data
implies(see http://news.nationalgeographic.com/news/2003/02/
0214_030214_genghis.html) or Mongolian Big Daddy(from Science, 2003, vol 299, no 5610, p 1179) show
very bad taste, as well as the journalistic fabrication
published in GEO (No. 323, Jan 2006) in the paper
entitled Les fils afghans de Gengis Khan ("The Afghan
Sons of Chinggis Khan"). The last was a photographwith Afghan men holding next to their own face
reproductions of an ancient portrait of the Khan so thatthe reader may notice some “resemblance”. Indeed, for
the Caucasian public the Afghans and the Khan mightvery well look alike and besides them at least half of
Asia. What is the big (educative in sciences) idea here,
besides another inadequate (not at all educative)
appendix to things that certain populations (theMongols) hold as almost sacred - i.e. the memory of theGreat Khan? Note may be also taken that in Mongolia
itself there has been much talk lately of abuse and20
overuse of the name of the great conqueror . We thinkthat such titles as published in the above-mentioned
sources (and based on shaky, speculative, conjecturalclaims) may be felt as a not-so-proper use of the nameof Chinggis Khan.
A few issues can be extracted from the above
analysis. We started wondering about possible abuseor inadequate use of population genetics in humans
and observed the classical topics - problems with healthinsurance and employment as well as the issue of
spending money on useless (and worthless from ascientific viewpoint) genetic analysis. Then we moved
to meta-personal abuse i.e. to the topic of offending
cultural sensitivities.
In the course of analysis we discovered that otheraspects of science ethics are also involved - concern
about the scientific quality of published papers arises.
Perhaps when human genealogy makes the subject
historians should also get to review papers in human
genetics as it seems geneticists are not able to assure
the coalescence (to use a term in Genetics) of the twodomains - genetics and history. After all it is theuniversal problem of multidisciplinary issues, there is no
shame and no guilt in a human geneticists asking ahistorian's opinion on his or her speculations on
genealogies. Objectively speaking, those speculations
fall in fact in the attention of history, not biology.
We also saw unfounded scientific claims getting tofeed the sensational in media with this taste for cheap
thrills contaminating pop science publications (see the18

Oana Iftime
Alexandru Iftime
20
See,e.g., http://www.foxnews.com/story/0,2933,202695,00.html –where the discussion on „frivolous exploitation” of the Khan’slegacy comes right after the mention of DNA studies,presumably based upon Zerjal et al., once again.
19

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

case of the title in National Geographic or thephotograph in GEO) and this is the most painful, as
science should not become popular in the sense ofvulgar.
What can and/or should be done? Educating
scientists, educating lay people? This is one of the mostcommon and easiest answers to give and one of themost difficult enterprises to conduct in real life. Still, it ispart of the bioethicist's vocation.
References
1) Grousset R., L’Empire des Steppes, Paris, ed. Payot,
1939.
2) Howorth H., History of the Mongols from the 9th to the19th Century. Part 1, Elibron Classics, 2001.
3) Khamaganova, E., 2003, Original institutions of selforganization among Mongols: cosmological foundations,continuity and change. Presented at the Institutionalrd
Analysis and Development Mini-Conference, May 3 andth
5 , 2003, Workshop in Political Theory and Policy Analysis,
Indiana University, Bloomington, Indiana, USA (available
at http://www.indiana.edu/~workshop/seminars/papers/y673_spring_2003_khamaganova.pdf)
4) Lansing J. S., Watkins J. C., Hallmark B., Cox M. P.,
Karafet T. M., H. Sudoyo, Hammer M. F., 2008, Male
dominance rarely skews the frequency distribution of Y
chromosome haplotypes in human populations, Proc Natl
Acad Sci, 105 (33), p. 11645–11650.
5) Morgan, D., The Mongols, Basil Blackwell, London, 1986
6) Roux, J.-P., Histoire de l’empire mongol, ed. Payot,
Paris, 1993.
7) Sailer S. (interviewing Chris Tyler- Smith), Genes ofHistory's Greatest Lover Found, United Press International,
February
5,
2003,
availableat:
http://www.isteve.com/2003_Genes_of_History_Greatest_Lo
ver_Found.htm
8) Wolinsky H, 2006, Genetic genealogy goes global,
EMBO reports, 7 (11), p. 1072 – 1074.
9) Zerjal T, Xue Y, Bertorelle G., Wells R S, Bao W, Zhu S,
Qamar R, Ayub Q, Mohyuddin A, Fu S, Li P, Yuldasheva N,
Ruzibakiev R, Xu J, Shu Q, Du R, Yang H, Hurles M E,
Robinson E, Gerelsaikhan T, Dashnyam B, Mehdi S Q,
Tyler-Smith C, 2003, The Genetic Legacy of the Mongols,
Am J Hum Genet, 72, p. 717–721.

The Biocosmology ofKonstantin S. Khroutski:
A Philosopher’s Reflections
on Biology- Georges Chapouthier
UMR CNRS 8590, IHPST, and, UMR CNRS 7593,
Paris, France
Email: georges.chapouthier@upmc.fr
No scientific or philosophical view of the universe
can be all-encompassing.
In different domains,
physical sciences have made major contributions
improving the life of human beings and increasing theirunderstanding of the functioning of the universe, butscience cannot answer any questions of a metaphysicalnature. One of the rare thinkers to develop an allembracing view of the cosmos is Konstantin Khroutski
whose biocosmology is founded on the Aristotelianconcept of “immanent teleological essentialism”(Khroutski, 2008, A and B) set in a single and concrete
context.
A single concept can embrace shared and generalevolutionary mechanisms – Khroutski’s pan-unity, ororganicism, cosmism or holism – which can be found in
the cosmos at a physical or organic level, and also at
an intellectual level, and both can coexist in a cosmic
continuum. This is the approach which I, as a biologist
and philosopher of biology, have been working on(Chapouthier, 2001), and have applied to the selectedarea of living beings, as will be reported here in asummarised version.
1. Complexity in living organisms: Mosaic
structures
The challenge is to explain the developmental trend
to greater complexity in the evolution of species,
although there are cases where complexity has been
simplified in the course of evolution; see, for example,
S.J. Gould (1980). The thesis presented here iscompatible with Darwin’s theory of evolution, but seeks
to include explanations that are not purely Darwinian.
The working hypothesis is that there are two mainprinciples operating in any evolutionary development
towards complexity: “juxtaposition” and “integration”(Chapouthier, 2001).
Juxtaposition is the accumulation of identicalentities, e.g. beads on a necklace. Integration is theaction which alters these original entities, producing
other entities that are specialised and/or on a higher
level, while still containing the original component
entities as units (e.g. a string of “beads” may be shaped
to become a container, or form a sheet, which is thenmore complex in structure). And so the process can goon, juxtaposing and then integrating new identicalentities at a higher level (e.g. starting with beads,
moving to a single string necklace, and then a multiple
rope necklace).
The repeated exercising of these two principles cangradually produce complex structures, over various
levels, each one using the initial components as units
which still maintain their autonomous functioning. In
metaphorical terms, the mosaic structure can provide apractical model to depict both the result and theprocess. A mosaic is a work of art that portrays a figure
made to appear by juxtaposing and integrating small
ceramic elements which retain their individual features(size, shape, colour and texture). In philosophicalterms, a mosaic has properties as a whole, yet leaves adegree of intrinsic autonomy to the properties of thecomponent parts. A living organism, whether relatively
simple or with the complexity of a human being, can besaid to comply with this mosaic process.
Unity – genetic, anatomical and on higher levels
Genetic expression entails silent duplication of
introns which can be seen as identical units being
juxtaposed. It has been argued (Ohno, 1970) that
juxtaposed introns undergo a large number ofmutations over long periods of time, forming organised
patterns that integrate the original units, developing
exons and coding for new organs and functions. Such a
process might be presented as a genetic hypothesis
explaining the complexity of organs.

Eubios Journal of Asian and International Bioethics 18 (November 2008)
In unicellular organisms, the anatomical expressionof the two principles is seen with “juxtaposedorganisms” such as the Gonium, and “integrated
With increasingorganisms” such as the Volvox.
complexity, for example in didermic species, colonies ofpolyps are formed from juxtaposed identical polyps
which, when integrated, develop into complex colonies
containing
non-identicalorganismssuch
assiphonophores, with defensive, floating, digestive andreproductive polyps. One step further, in tridermicorganisms, metamers, when juxtaposed, will develop
into animals such as the earthworm, and withintegration, the developmental path leads to animals
such as the bee, octopus or chimpanzee.
But
integration is not always a neat and complete process:vestiges of prior juxtaposition may sometimes be foundin the integrated organisms: segments in the bee
abdomen, and the segmentation of ribs and vertebrae
in the chimpanzee are vestiges of prior stages ofjuxtaposition.
With complexity greater than in an individualorganism, or even groups of organisms, there isinvariably autonomy of movement, as with animals,
which is then an obstacle to development by
juxtaposition alone (although it does not completely
disappear, as can be seen, for example, with Siamese
twins).
Looking beyond physical development, juxtaposition
and integration have social manifestations: identicalindividuals gather together, forming crowds andcommunities. Identical animals can then acquire explicit
social duties, e.g. in colonies of bees and societies ofprimates, and it is integration which endows specialisedfunctions on some of these identical animals.
Regardless of the structure and the level, integration
at a given level does not eradicate the state ofautonomy of the lower level units: genes have a certain
autonomy within the genome, and the cell within theorganism; bees have a degree autonomy within thecolony, and so on. The integrity of the whole and its
characteristics do not require the autonomy of thecomponent parts to be sacrificed. The mosaic metaphor
as defined (Chapouthier, 2001) can offer a parallel
here. In human societies, the individual has autonomy
while being a component part of that society, and thisindependence of the individual components, theirautonomy in relation to society as a whole, is free will.
Brain and Mind
The most complex structure known to science is thehuman brain/mind (the distinction and/or equivalence
being accepted but not discussed here) and similar
processes can be observed in it. The human brain has
a number of organs that are definitely mosaic inconstruction: the brain is comprised of five encephalicvesicles, juxtaposed in the course of embryonicdevelopment, then integrated, producing the complex
adult brain. The neocortex contains many mosaic
structures forming different areas, and with more than
one in control of any given function; for example,
sensory perception, motor function and language (in all
forms, oral and written, passive comprehension andactive speech). Each area features functional specificity

169

and a degree of autonomy while operating concordantly
as an integral part of the neocortex. The twohemispheres of the brain form a simple two-partmosaic, but each with different functions: analytical anddiscrete functions in the left hemisphere (for righthanded persons), and inclusive, holistic functions in theright hemisphere. Each hemisphere is both functionallyspecific and simultaneously autonomous, being part ofthe congruent and concordant functioning of the wholebrain, with no conflict arising from the autonomy of theparts (except for rare spilt-brain patients).
Looking beyond the physical level, into thefunctioning of the mind, investigations studying
consciousness have shown that while consciousness
may appear to be a whole, it is, in fact, a mosaic ofdiverse states of consciousness. In “split-brain”
subjects, two conscious decision centres co-exist andmay come into conflict; a similar situation can occur
when dream states distort normal consciousness innormal subjects.
The study of language shows that ordered semantic
units, arranged as the component parts of a sentence,
combine to express meaning – an idea formulated as awhole and perceived as such by the end of thesentence. One example is the haiku by the French poet
Jean Monod (Antonini, 2003) : The absent of all /bouquets here she is / says the appearing dawn. The
first line, when read without any further context,
suggests that the subject is a person (in French, thefeminine gender suggests a woman). The second line
then leads the reader to conclude that it is a flower (theflower being a feminine noun). Then the final verse
provides the key, presenting the meaning (the whole) –the subject is sunrise – yet also includes, retroactively,
the separate allusions to a woman and a flower.
Human memory is often considered to be a single
entity, but it too is a mosaic of different memories (e.g.
habituation, conditioning, spatial memory and cognitive
memory), each having been developed throughdifferent evolutionary stages, and each retaining a
degree of autonomy within the whole.
Consciousness, language and memory are separate
psychological functions that also combine as mosaics,
forming a whole and with their own features in thatwhole which cannot cancel the autonomy of thecomponent parts.
Genetic and anatomical observations, together withdescriptions of the brain and mental processes support
the hypothesis that complex living beings are basicallymosaic structures, as shaped through and by theirdevelopment in the course of evolution through theiterative and incremental exercise of two principles –juxtaposition and integration.
Conclusion: The Mosaic Model and Konstantin
Khroutski’s Biocosmology
The proposed model of complexity, based on thetwo principles of juxtaposition and integration, is
consistent with the model proposed by Konstantin
Khroutski. In the field of biology, Khroutski speaks of“fundamental universalism”, as illustrated by DNA,
discovered by Watson and Crick, which “proved theoneness of basic physical-chemical elements and170

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

demonstrated the psychosomatic unity of any
organism” (Khroutski, 2008 B). Khroutski further argues
for fundamental self-(macro)evolutionism whereby
every subject of life is in the self-(macro)evolutionary
process (including all biological evolution and social
history) and every subject’s ontogenesis is a selfdependent emergent development (Khroutski, 2008 B).
The mosaic model proposed here has two generalprinciples suited to such “emergent evolution”, covering
all levels of complexity, from genes to brain andthought, and could therefore offer an approach tofundamental universalism in the specific area of biology
and an example of Konstantin Khroutski’s hypothesis inpractice.
Finally, and perhaps most importantly, both
Khroutski’s model and mine are careful to exclude any
options for evolution focused solely on humans only,
arguments such as the notorious “anthropic principle”(Carter, 1974), an approach which would restrict thefield of complexity to humans only, in their humanworld.
Bothmodelsrefer
touniversal“anthropocosmism” and categorically refute the“anthropic
principle”,
dismissedasbeing
anthropocentric instead of “cosmocentric”.
References
Antonini J (Dir.) (2003), Anthologie du haïku en France.
(Aleas, Lyon, France, 2003), p 45.
Carter, B. (1974). Large number coincidences and theanthropic principle in cosmology. In D. a. R. Longair (Ed.),
Confrontation of cosmological theories with observational
data (pp. 291-298): International astronomical union.
Chapouthier G (2001) , L’homme, ce singe en mosaïque
(Odile Jacob, Paris, 2001).
Gould S (1980), Ever Since Darwin: Reflections in Natural
History (Penguin, New York, 1980).
Khroutski KS (2008 A), Biocosmology – Rehabilitating
Aristotle’s Realistic Organicism and Recommencing Russian
Universal Cosmism: Response To Arthur Saniotis, Eubios
Journal of Asian and International Bioethics, 2008, 18: 98105.
Khroutski KS (2008 B), Biocosmology – a Substantive Origin
for the Ethics of Energy Technologies, Communication at
the Seoul, Korea, August 2008.
Ohno S (1970), Evolution by Gene Duplication (Springer
Verlag, Munich, Germany, 1970).

Contributions are encouraged to the
UNESCO
EthicsofEnergyTechnologies in Asia-Pacific project– updated report outlines and otherdetails are on:
http://www.unescobkk.org/rushsap/energyethics/

Stakeholders in the Energy
Debate – Identities,
Responsibilities and the
Future- Emily Price, Stephanie Russo, Kamani Thanakrishnan
Department of Environmental Law, Macquarie
University, Sydney, NSW 2109, Australia
Emails: emilycarinaprice@gmail.com,
ktjude23@gmail.com,
stephanie.russo@students.mq.edu.au
Abstract
The issue of energy has become a controversial
topic of economic, scientific and policy debate amongst
the Australian public. Rapid population increase,particularly in coastal areas, is putting increasingpressure on the natural environment through habitat
loss, waste disposal and excessive wastage. This has
led to the acceptance that all dimensions of society areaffected by decisions pertaining to the environment andnatural resources. This paper will address the identities
of some of the major stakeholders, including thegovernment, the public, and vulnerable groups such as
indigenous groups and future generations.
Serious discussion around the energy debate
requires a balancing act between the competinginterests of various stakeholders and varied interest
groups. On one hand there is the desire to reverse theimpact of environmental damage caused by energy
consumption and production; on the other hand, thisinterest must be weighed up against the strong
economic growth needed to maintain living standards
and reduce poverty.
The Role of Government
The problems associated with the creation and useof energy are not going to be handled or affectively
addressed through one single stakeholder but involvethe cooperation and coordination of multiple
stakeholders driven by strong governmental leadership(Pittock, 2003). This is the common thread through allindividual stakeholder discussions. The public will lookto the government to prepare our economy for a futurewith a finite level of fossil fuel and to invest inalternative fuel sources. This will involve a commitment
to getting the new energy mix right; reducing theburning of fossil fuels, and increasing the production of
non-renewable energy sources at an economicallysensitive rate (Allen Consulting Group, 2005). Central
governments need to provide the legal decision-making
tools to assist local government, the private sector andhouseholds to integrate climate risks into key decisions.
Local council and state governments in particular havea pivotal role in overseeing public infrastructure, healthpolicy and land use planning and control. During the2005 G8 Climate Conference held in London it was
acknowledged that:“Major investment is needed in energy infrastructure
to meet energy needs and to tackle climate change.
The majority of this investment will come from theEubios Journal of Asian and International Bioethics 18 (November 2008)private sector. Clear policy signals are needed tochannel it towards lower carbon technologies. The
challenge is to create the incentives for the private
sector investment, including through market-based
instruments and carbon finance.”
Statements such as the above reflect the global
desire for governments to steer the energy debate andpressure the private sector to engage inmacroeconomic management, monitor climate risk andappreciate the seriousness of this issue (Weiss, 2002).
Much of the private sector is subject to price regulation.
It is not clear whether regulators are sensitive to thepressures placed on infrastructure by climate change.
Despite a number of initiatives, governments are
generally not seen to be doing enough to monitor theprivate sector and rally the major firms to beaccountable for their contributions to global emissions.
Support for research and development is anestablished function of government, primarily
associated with ‘spin off’ benefits of new knowledge
creation and dissemination’ (Allen’s Consulting Group,2002). For example, in Australia a range of rural
research and development corporations have been
established to begin to address the production
technology needs for a range of agriculture activities.
These agencies can play an important role in assisting
the adaptation response and flexibility of agricultural
producers through the development of drought andimproved production methods. An example of this was
The Managing Climate Variability Program (MCVP)
which ran between 2002 and 2006. It was a joint
initiative between Land and Water Australia, Rural
Industries RDC, Sugar RDC, Grains RDC, Meat andLivestock Australia, Australian Wool Innovation andseveral non-rural RDC agencies. The objective of the
program was to create new tools for improving climate
risk management for farmers and resource
management in long term seasonal forecasts. As aresult seasonal climate forecasts are now taken into
account by half of Australian primary producers. It is still
too early to state decisive results; however, there areindicators that the results of the program have captured
an increase in medium to long-term farm cash incomes.
Climate change will have a serious impact onAustralia’s economy and international competitivenessaffecting in particular Australia’s leading export earners,
agriculture and tourism. This will have flow-on effects
for the whole economy particularly affecting future
generations and those closest to the poverty line. In thereport Deep Cuts in Greenhouse Gas Emissions:
Economic, Social and Environmental Impacts forAustralia two trajectories were presented as alternate
pathways; an early action scenario with a carbon signal
introduced in 2013, and a delayed action scenario
which assumed that the carbon signal would bedelayed until 2022. The result was 2050 greenhousegas emission levels in Australia being 80% higher thancurrent levels.
The government – at international, national, stateand local scales – and business and industry are major
stakeholders on the environmental stage and in theenergy debate. However, faced with resource
limitations, short-term politically motivated planning171

and/or the dominance of commercial and financial
interests, the public and private sectors cannot
adequately address environmental issues as they can
not and are often unwilling to, meet all demands
necessary. Therefore, the emergence of nongovernment organisations has created a new form of‘check and balance’ on both the public and private
sectors, and can also work in partnership with these
sectors to ensure that decision-making accounts more
effectively for environmental concerns.
The Role of Non-Government Organisations
Non-government organisations (NGOs) are generally
motivated by and pursue public interests agendas
rather than individual or commercial interests. Further,
they are often independent of government, free frompolitical affiliation and have a high degree of publictrust. Considering their relative freedom, public support,
and specialist knowledge, NGOs may be better placed
to identify, and redress, remedy threats to theenvironment than government groups. NGOs also may
better articulate the needs of groups marginalised inenvironmental decision-making processes and thosemost adversely affected by environmental degradation;such as, generally local community members(particularly
those
who
are
non-experts
inenvironmental issues are those of low socio-economic
status); or ethnic minorities including indigenous
populations. With this capacity and ability comes anobligation and responsibility. NGOs have a
responsibility to play an intermediary role between
government and the private sector. NGOs take a variety
of forms they may be large or small with agendas
ranging from local to transnational issues and may beprivate, corporate, religious, Indigenous, community orinternational institutions. Some are highly sophisticatedwith a well established public image such as ‘Friends ofthe Earth’ (FOE) while others are grassroots collectives
which are unlikely to become household names but
provide critical support at a local level. NGOs canperform a number of functions critical in theenvironmental arena. Their diversity in experiences,
expertise and capacity makes NGOs a valuable
national and international stakeholder on theenvironmental stage.
Historically, the greatest influence of NGOs has beenonregionalandinternational
environmental
cooperation: playing a major role in influencing
international policy and agreement formulation andpushing for sustainable development as a key agenda
at the international level. Many environmental treaties
formed within the last 20 years demonstrate amovement towards NGO participation in internationallaw, for example, The Convention on International
Trade in Endangered Species, The Montreal Protocol
and The Framework Convention on Climate Change.
NGOs have also served as a watchdog monitoring thecompliance and behaviour of States against theirinternational obligations (Hunter, 2002).
In recent years the range of activities of NGOs has
expanded significantly and they have a wider role thansimply raising environmental awareness or acting aspressure groups. Activities also include environmental

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

monitoring, environmental education, training andcapacity-building,practical
managementofconservation areas, the promotion of community andindividual action and campaigning for greater
accountability on the part of the government, businessand industry (UNESCP, 2001). The role and activities
of NGOs at national and community levels are
increasingly being realised. NGOs work on two levels:
at a national level, they focus primarily on policy andlegal frameworks and play a vital role in identifying
weaknesses and gaps in policy and legal frameworks,
information gathering and education of the public andprivate sectors. At a community level they take on
responsibility for identifying issues, raising awarenessand providing grass roots information.
NGOs are becoming increasingly prominent in
1
environmental affairs and as the world’s environmental
issues increase and become more complex, NGOs willplay a stronger more influential role and will offer a
global network which should be tapped into to facilitateand support environmental efforts. The importance ofNGOs as a stakeholder on the environmental stage andtheir ever increasing role is recognised in International
Agreements such as Agenda 21 which outlines the roleof NGOs as key partners for sustainable development.
The Role of the Public
The public is obviously one of the key stakeholders
on the environmental stage and crucial in the energy
debate. Although the government is involved in thesystemic causes of climate change or the emissions
from business and industry; individual action is certainly
a contributing factor (Weiss, 2002). A report releasedon April 14, 2008, by the Climate Institute, found that
94% of Australians now accept they need to makechanges in their own lives to prevent further detrimental
effects of climate change (Weiss, 2002). Increased
public awareness and concern about environmental
issues means the public now have the knowledge andmotivation to demand greater participation inenvironmental decision-making. Collectively, the publicalso constitutes the largest stakeholder group involvedin the energy debate, and therefore has great potential
to make an impact on the management ofenvironmental issues, especially as consumers.
The energy-ethics debate contains two key
components which are interrelated: the ethicalproduction of energy and the ethical consumption ofenergy. Individuals are important stakeholders with a
responsibility as consumers. Individual action can help
instigate widespread awareness of the depth ofenvironmental issues and is crucial to a paradigmaticchange in our environmental consciousness. Given theinterconnected dependency of natural resources withhuman society, environmental issues have implications
that affect all dimensions and members of society
including future generations.
Our ethical responsibility as individuals inenvironmental issues involves a number of elements:
first we have a responsibility to examine and reflect on
our personal commitment to sustainability, we also
have an expectation of other stakeholders in the energy
debate, in particular the Government, to addresspressing environmental concerns. Individuals must also
take responsibility for their actions particularly indemocracies where political pressure can have a goodreaction (Kaplan, 2000). Further, if citizens are to
support administrative decisions affecting theenvironment, then they need to know that thesedecisions are based on reliable information, havecanvassed all the issues and have been the product of
to a methodical, transparent and accountable decisionmaking process (EDOSA, 2006). Attempting tounderstand the impacts of our resource use and curb
unnecessary consumption is a personal obligation weeach have.
As consumers we also have a responsibility whicharises from the powerful level of influence the public
has in environmental issues and the energy debate
which arises from people exercising the power ofchoice in the products and services they use and buy.
By using this purchasing power, individuals can greatly
influence business and industry behaviour (World
Business Council, 2007). The influence of this can beseen in the rise of the ‘green market’. The range of
products and services that identify themselves assustainably produced has rapidly expanded since the1990s when the sustainable development mantra was
gaining significant traction; choosing goods which arerecycled, organic and/or environmentally sensitive is
now easier. We can see these trends in the rise ofenergy efficient labeling on electrical appliances,
biodegradable and recyclable products, even green
beers such as the Cascade Green Carbon Neutral Beerare being marketed. Technological adaptation is only
one solution. As consumption of material goods andenergy is one of the largest pressures we exert on theenvironment, the best response environmentallyremains to reduced consumption.
Stakeholders and Intra-Generational Equity
Under the principle of intra-generational equity, theinterests of people affected in the current generationfrom a range of socio-economic backgrounds must be
considered, with relative equality to be encouraged
across backgrounds, within the same generation.
In environmental decision-making, indigenous people
have often been marginalised from decisions that
impact on their livelihood and traditional way of life, thus
violating the principle of inter-generational equity.
Indigenous groups are also stakeholders in theenergy debate, and are often directly impacted bydecisions regarding energy. A key example is theincreasing pressure on traditional owners andindigenous groups in Australia in isolated rural areas
regarding the discovery of valuable minerals orpressure for the use of land for dumping nuclear waste.
The role of indigenous people in relation to theenvironment is extremely important, as they retain not
only stakeholder interests, but significant stakeholder
responsibilities. Indigenous people often havestakeholder responsibilities as custodians of theenvironment, wherein educating future generations
about the land, protecting and caring for the land, and‘speaking for’ – advocating for – the land, ensure its
protection for future generations. This custodian role
therefore incorporates responsibilities that haveendured for generations, and thousands of years.
Indigenous people are also unique stakeholders inenvironmental decision-making, as they have incredibleEubios Journal of Asian and International Bioethics 18 (November 2008)
knowledge of the intricate nature of ecosystems, andhave been able to live in a sustainable relationship withthe environment for centuries. They are valuable in thebattle for sustainable development, as they focus on theirreplaceable value of the environment itself in its
entirety. Yet there have been inadequate measures toensure that the indigenous stakeholder voice is heard in
the debate. For example, the Nam Theun II Dam in
Laos, currently under construction, held information
meetings with indigenous groups after the project had
been approved, to show them what the impact of the
project would be, rather than involving them innegotiations prior to creation of the concept plan, or
prior to approval. Despite the lack of electricity in Laos,the dam will provide electricity to Thailand. The Laopeople will therefore bear the social and environmental
burden of the energy project, while enlivening the Thai
economy. The abuse of such power inequalities inenergy decisions is against the principle of intragenerational equity.
Although there has been progress made; particularly,
with the World Bank’s adoption of a formal policy
relating to indigenous people, and the Declaration on
the Rights of Indigenous People in 2007, whichconnected the rights of indigenous people with theenvironment, it is clear that this progress needs to be
more than aspirational. Indigenous groups should not
bear the burden of energy, and their vulnerability should
not become a magnet for exploitation, but instead, acause to amplify their voice, as advocates for theprotection of the environment.
Inter-Generational Equity and Stakeholders
The
principleofinter-generational
equityencapsulates the idea that future generations retain an
equitable interest in decision-making today; it implies
that they are stakeholders today.
Future generations are substantial stakeholders inenergy debates and decisions, as the implications fromthese decisions will fully resound on future generations.
However, this interest in energy decisions is not legally
enforceable, and future generations do not have a legal
personality by which they may be represented or sue.
The exception to this appeared to be the Minors Oposacase, which was hailed internationally as a success forthe enforceability of intergenerational equity in theFilipino courts. In this case, a lawyer, Oposa, filed aclaim for his children on behalf of the future
generations,againstthe
fast-paced
loggingcommissioned by the Filipino government. While hailed
as a success, this case has been ‘critiqued not as ahallmark case of intergenerational rights, but instead amere application of already progressive Philippine law’(Yeh, 2007).
The principle of inter-generational equity is often
referred to in legislation. This is evidenced in theEnvironment Protection and Biodiversity Conservation
Act 1999 (Commonwealth), which states one of theobjects of the act is to ‘to promote ecologicallysustainable development’. The explicit incorporation ofthese equitable principles into Australian law represents
a step forward; however it is clear that these principles
retain only aspirational significance. New frameworks

173

need to be developed wherein the interests of future
generations in decision-making regarding energy areproperly regarded.
Conclusion
We are beginning to understand environmental
issues and energy concerns as transcending
geographical and institutional boundaries. Each sectorof society has a valuable and necessary contribution to
make and environmental concerns can only be
addressed through a holistic, multi-disciplinary andmulti-divisional approach. This is where thetransdisciplinary subject bioscience ethics can assist as
it bridges the gap between applied science and applied
ethics and plays an important educational role inmaking people appreciate the scientific issues such as
climate change. The portal http://www.biosciencebioethics.org/ provides free access to publications andeducational materials in the area of bioscience ethics
and bioethics.
Future generations are continuing to bear the burdenof the impacts of decision-making today in regards tothe environment, and in regards to energy. While there
has been much discussion about sustainable
development, and the potential for major stakeholders,such as government, business, NGOs and the public towork together towards sustainable development, moreaction is needed to ensure that this actually occurs inpractice. As yet, vulnerable groups such as indigenous
people are enduring the burden of energy decisions,and future generations, with their fragile, unenforceableinterests will simply have to work with the fractured
environment we are currently leaving behind for them.
Acknowledgements
This paper is based on a presentation at the Joint
UNESCO-MacQuarie University Forum on the Ethics ofEnergy Technologies, held 4 May 2008 in Sydney, Australia.

We wish to thank Professor Darryl Macer (Regional
Advisor in Asia and the Pacific UNESCO Office in
Bangkok) for giving us the opportunity to publish ourconference contributions in EJAIB and for giving us theopportunity to participate in the UNESCO-Macquarie
Energy of Ethics Forum. We also wish to thank
Associate Professor Irina Pollard (Dept. of Biological
Sciences) and Dr Erika Techera (Dept. ofEnvironmental Law), Macquarie University, fororganizing this event across our disciplines and forreviewing and editing early drafts of our paper.
References
Allen Consulting Group – Final Report. 2005. Climate Change
Risk and Vulnerability: Promoting an Efficient Adaptation
Response in Australia. Report to the Australian Greenhouse
Office, Department of the Environment and Heritage by the
Allen Consulting Group, 78.
Australian Business Roundtable on Climate Change. 2006.
The
Business
Case
for
Early
Actionatbusinessroundtable.com.au/.
Hunter, D. et al (eds). 2002. The “Participatory Revolution” inInternational Environmental Law, (1997) 21 Harvard
Environmental Law Review at 549. In: International
Environmental law and Policy (2nd Ed.) New York,Foundation Press.

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Kaplan, S. 2000. Human Nature and Environmentally
Responsible Behaviour. Journal of Social Issues 56:491508.
Parnell, M. 2006. Public Participation in Environmental
Decision-Making. Environmental Defenders Office (South
Australia). http://www.edo.org.au/edosa/research/aialpaper.
htm
Pittock, B. 2003. Climate Change: An Australian Guide to
Science and Potential Impacts. Paper prepared for theAustralian Greenhouse Office: Canberra.
Stern, P. 2000. Toward a Coherent Theory of Environmentally
Significant Behaviour. Journal of Social Issues 56:407-424.
UNESCP. 2001. State of the Environment in Asia and thePacific 2000; Chapter 14 Major Groups. In UNESCP
Environment and Sustainable development division.
http://www.unescap.org/esd/environment/soe/2000/documents/CH14.PDF
Weiss, J.A. 2002. Public Information. In: The Tools of
Government: A Guide to the New Governance. L.M.
Salamon (ed). Oxford, Oxford University Press, page 232.
World Business Council for Sustainable Development. 2007.
Can
Green
Consumers
MakeaDifference? http://www.wbcsd.org/plugins/DocSearch/details.asp?type=DocDet&ObjectId=MjM4MjQ.
World Commission on Environment and Development. 1987.
Brundtland Report.
Yeh, S. 2007. Climate Change: the Threat, the Effects andthe Legal Challenges. Editorial Vermont Journal ofEnvironmental
Law. http://www.vjel.org/editorials/ED10058.html

Global Warming, Ozone
Depletion and Water
Politics: Political Realist andLiberal Institutionalist
perspectives at the statelevel- Nikhil C. Farias
Department of Biological Sciences,
University, Sydney, NSW 2109, Australia
Email: nikhil.farias@students.mq.edu.au

Macquarie

Abstract
It is without a doubt that environmental issues suchas global warming, ozone depletion and water politics
will have major implications on individuals and their wayof life. However more important are the implications
such issues are having on nation states (countries),
their international relations and security. This paper
examines the role of global warming, ozone depletion
and water politics from political perspectives of Realism
and Liberal Institutionalism in the context ofinternational relations. Both perspectives reveal
different approaches of nation states to deal with theseenvironmental issues in ways that maximize their own
security and welfare.
Realist and Liberal Institutionalism: Overview
Nothing is ever black and white. Shades of grey
always exist within issues relating to global politics andas a consequence, a duality of perspective is observed.

It is without a doubt that environmental issues; such as
global warming and water politics, will have major
implications upon the individual and their way of life. It
is however necessary to examine these issues at statelevels, more specifically the implications of these issues
on bi- and multi-lateral relations between countries. At
present, many environmental issues have impacted the
security of international states creating political conflictand hence, requiring a major need for co-operation.
Two schools of political thought can be applied to theexamination of environmental issues at the state level.
The first is political Realism (herein Realism/Realist),
which focuses on the autonomy of each nation state
and their quest for power, due to the concept of national
interest (Sens and Stoett, 2005). The second is political
LiberalInstitutionalism(hereinLiberalInstitutionalism/Institutionalist), which focuses on the
co-operation (as opposed to autonomy) of international
states to resolve conflict and encourage peace (Sensand Stoett, 2005).
Both Realism and Liberal Institutionalism areappropriate political schools of analysis when
examining environmental issues governing nation
states. International states will exemplify theconventions of both theories depending on the nature of
the environmental issues and their situational context.
Ultimately, no matter what school of analysis is used,
what is evident is that when states respond to global
environmental issues, they do so as to maximize theirsecurity and welfare. Most environmental issues that
result in conflict amongst nation states andenvironmental problems are the result of both theoveruse and misuse of resources. In this context, thetopic of global warming and ozone depletion as aproblem existing because of the overuse of resources
will be discussed from both the Realist and Liberal
Institutionalist perspectives. The topic of water politics
as a problem existing because of the misuse ofresources will also be discussed from both Realist andLiberal Institutionalist perspectives.
Global Warming: The Law, Politics and Ethics
The issue associated with Global Warming, due tothe overuse of resources has created conflict amongst
nation states. The term Global Warming originates froma concept known as the “greenhouse effect” proposed
by Swedish chemist, Svante Arrhenius who used theterm to explain the effect of the Earth’s atmosphereupon its surface. Global Warming occurs whengreenhouse gasses such as carbon dioxide absorb
infra-red radiation from the atmosphere and prevent thedissipation of this infra-red radiation back into theatmosphere. As a result, the absorbed infra-red
radiation results in an increase of the Earth’s
temperature, up to 30 degrees Celsius. The
consequences of this include changes in precipitation
and wind patterns, increases in sea levels and changes
in seasons – essentially the effects of global warming
most commonly result in climate change (Davenport,
2006).
In order to reduce global warming by one means
through the reduction of carbon dioxide emissions,international states have been eager to find solutions,especially through international agreements. One suchagreement is the Kyoto Protocol. The Kyoto Protocol

Eubios Journal of Asian and International Bioethics 18 (November 2008)
was set up under the United Nations Framework
Convention on Climate Change in 1997 as a text
agreement, but was officially entered into force on the
16th of February 2005. The primary feature of the
protocol includes mandate targets on the reduction ofgreenhouse gases (primarily carbon dioxide) for theleading economies (UNFCCC, 2007). The treaty has
proven to be successful in meeting its aims as
exemplified by countries in the European Union such as
Germany whose emissions have declined by 2.3%
between 2004 and 2005 (EU greenhouse gas
emissions decrease in 2005, 2007 ). However, a recent
examination indicates that the behaviour of international
states, when examined under a realist conception,
reveals a disintegration of the Kyoto Protocol as a resultof various issues.
One specific issue is that developing countries such
as India and China while required to take measures tolimit greenhouse gas emissions and promote
adaptation to future climate changes are exempt fromthe stringent emission demands of the protocol. Morespecifically, stated exemptions in meeting greenhousegas reduction targets within a specific time frame(UNFCCC, 2007). To the USA, this exemption wasseen as problematic. According to USA Senator Loft,
such exemptions of a legally binding treaty would
require the United States to reduce carbon dioxide andgreenhouse gas emissions to that of 1990 levels by
2010, whereas developing countries would be exempt
from doing so (Davenport, 2006). With regards to thepolitical behaviour of the developing countries, Realists
would argue that such behaviour is an attempt toexercise autonomy by means of ‘soft power’ (power
without military means) on the developed countries tocarry the burden of the emission cuts set by Kyoto. This
also results in economic benefits to the developing
countries, thus a major advantage to national interest.
As a result of the aforementioned dilemma, President
Bush made a decision in 2001 to withdraw from the
Kyoto Protocol (Davenport, 2006). He did this for two
main reasons. Firstly, he claimed that countries such as
India and China act as “free-riders” in the international
realm governing Kyoto. Although their own
industrialization resulted in increased greenhouseemissions, they leave the solutions of reduction targets
to developed countries (Chow and Leong, 2006). The
second reason has an economic dimension. According
to the US Council of Economic Advisors, the cost of
cutting carbon emissions by 20% by the year 2010
would range from 800 billion to 3.6 trillion dollars.
However, pursuing the goals of Kyoto without actual
affiliation to the treaty and at one’s own pace would
cost a mere 250 billion dollars (Davenport, 2006).
Hence realists would argue that at a time whensovereign states fail to cope with issues affecting theplanet, they seek to resort to national goals, as seen in
the second reason above (Holden, 2002). The USA
accounts for 25% of all global Greenhouse gases(Davenport, 2006). Withdrawing from the Kyoto
Protocol is likely to provide economic stability to theUSA, but yet instability to the economies of other nation
states that are left to manage the global emission target
with the omission of a significant contributor to the175

issue. In this case, realists would argue the existenceof an economic security dilemma, in which theeconomic stability of one country leads to the economic
instability of another.
Another issue relating to the problematic nature of
the Kyoto Protocol is inability of certain developed
countries to meet the prescribed targets associated with
the Kyoto Protocol. Statistical data indicates that many
countries will not meet their prescribed emission targets
by 2010.
Countries such as Denmark, Portugal,
Canada and Japan have actually exceeded rather than
reduced gas emissions by 18%, 49%, 8% and 8%
respectively (Bolin, 1998). All these countries however
have remained within the Kyoto Protocol. A realist
would argue that that it is in a state’s best interest to cooperate in order to attack issues affecting the entire
planet (Sens and Stoett, 2005), thus this may accountfor the reasons as to why each state has remained partof the protocol. However, the reason for not reachingtargets maybe the result of a lack of co-operation.
According to philosopher, Jean Jacque Rousseau,
there is often much difficulty in establishing cooperation in an anarchic environment (Sens and Stoett,2005). In this context, the anarchic environment refers
to the varying increases and decreases of gas
emissions depending on the country. It also reinforces
issues related to collective security and lack of acentralized authority controlling each country’s
emissions, since the agreement allows states tomanage their emissions in a manner they see fit. A
realist would, correctly, argue that this situationencourages a greater pursuit of national interest awayfrom co-ordination and co-operation.
Ozone Depletion: State Politics and Ethics
While the Kyoto Protocol reveals realist perspectivesof states compromising co-operation in order to purport
national interests, liberal institutionalists suggest thatthe desire for institutions to facilitate global co-operation
still exists when dealing with environmental issues(Sens and Stoett, 2005). An example of this wascommonly seen in the Montreal Protocol on Substancesthat deplete the Ozone layer. The Montreal Protocol
was established in 1987 with aim of reducing calculated
consumption and costs associated with the use of
Chlorofluorocarbons (CFC’s) by 50% by the end of
1998. Also implemented was a freeze on halons(another ozone depleting substance) by 1992. At thetime of signing, there were only 24 nations that ratified
the agreement; however in its 20 years of existence, it
has attracted more than 191 nations on a global scale.
In the initial agreement, developed countries were givena specified time in which to reduce ozone-depleting
substances from the atmosphere. Developing countries
on the other hand were given a 10-year grace period sothey could accumulate sufficient economic growth tomeet the needs of such reductions (Davenport, 2006).
This was why Kofi Annan (Secretary-General of theUnited Nations from 1997 to 2007) suggests that theMontreal Protocol is probably the most successfulinternational agreement to date (UNDP, 2007). The
treaty was developed on the premise of scientificdiscoveries of the depleting ozone layer in Antarctica,

176

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

concluding the presence of an “ozone hole” (Montreal
Protocol MP20-Key Points, 2007). This hole occurs
when a large use of ozone depleting substances(CFC’s, halons, freons, carbon tetrachloride etc...) areused in the environment. As a result, UV radiation,
normally shielded by the ozone layer is absorbed more
frequently and hence like global warming generates
similar climatic effects. The first attempt to ban nonessential aerosols was undertaken by the United Statesin a unilateral (one country only) manner. However
more interesting, is the effect of the USA as a vetopower in influencing other developed countries in theworld to ratify the Montreal Protocol. An example ofthis was unilateral legislation with the addition of trade
sanctions against countries that were not inclined toparticipate. Such use of this legislation was observed
against the European Council, which after pressure
from the United States as well as scientific discoveries
on ozone depletion in Europe decided to sign the
protocol in 1987 (Davenport, 2006).
Perhaps one of the most inaugural aspects of thetreaty was the inclusion of developing countries in theagreement. Although CFC production of developing
countries accounted for only 15% of the global CFC
production, future emission rates were predicted at a 710% increase, particular in China (Davenport, 2006). As
a result, developed countries recognized the need for
global participation and thus through the protocol
provided financial funding to these developing
countries. Statistics indicate that the 50% reduction has
been obtained as well a reduction in greenhouse gases
by 8900 million tones (Montreal Protocol MP20-Key
Points, 2007).
Perhaps the most plausible means of examining the
success of the Montreal Protocol is through the
Machiavellian phrase of the ends justifying the means.
Although the actions of the USA may parallel Realist
ideologies, that is, an attempt to maintain power
through domination of other countries; the outcome of
the Protocol was better achieved through thisbehaviour. Furthermore, the ideologies of Liberalism
Institutionalism are reflected in the support given todeveloping countries. Although the Montreal Protocol
was rather successful, the outcome still reveals thatstates will simply respond to environmental issues
depending on the situation, in order to maximize
security and wellbeing. For developing countries
signing the agreement resulted in funding that
increased their security and wellbeing to efficiently
reduce CFC’s. For developed countries, the threat ofozone depletion proposed by scientists instigated theneed of the protocol to protect their own environment(security) and people (wellbeing).
Water Politics: Cause, State Behaviour andSolutions
As exemplified above, environmental issues of
Global Warming and Ozone Depletion have large
impacts at the state level. Also evident areenvironmental implications that arise from theacquisition of energy and water through construction ofhydroelectric dams, resulting in the competitive side ofstates to misuse water for this purpose. A classic
example of this and one that influences the global
environment is known as “water politics”. The Law ofconservation of energy, which states that energy, canneither be created nor destroyed, but rather flows fromone place to another, can be applied to water.
However, this flow of water has posed numerous
problems amongst nation states, especially thosesharing a common river. Globally 47% of land falls
within international river basins and close to 50
countries in over 4 continents have three-quarters of
their land in international basins. With over 40% of theworld’s population living within some type ofinternational basin, there is an increasing need toobtain water of consistent quality and that of increasingstability, hence why conflict instigated by realist motives
have resulted, with regards to water competition(Clarke, 1991). According to Dr Mostafa Tolba(Executive Director of the United Nations Environment
Programme) and in a realist sense, freshwater
shortages contribute to an unstable perception ofnational security as such shortages increase economic
and political differences between countries. In addition
to this, most water crisis issues have a geopoliticaldimension in which “upstream” countries pass wastes
and other pollutants to “downstream” countries. Manywater crises and conflicts among states arise primarily
because of two main reasons. The first involves a large
rapid change that occurs in the physical setting, forexample the building of a dam or the break-up of anation resulting in new international basins. The second
reason occurs when individual states are unable toeffectively manage and absorb these changes,
generally where there is a lack of treaties governing therights and responsibilities of the two nations on theissue (McDonald and Jehl, 2003).
The first reason is noted in Brazil’s decision to build
the Itaipu Dam on the Parana River (part of the Kiodela
Plateau). The Dam stretching over 200 km in length
would present a major source of flooding intoneighboring Argentina, wiping out all of north-east
Argentina. While the Brazilians saw the building of thedam as a potential to increase energy needs, theArgentineans saw this as “military posturing” (Clarke,
1991). Realists would argue that the primary objectiveof all states in such an environment is to follow theirown efforts to ensure their own security. (Sens andStoett, 2005) In this case, Brazil exemplifies this, as its
interests ensure that the creation of a dam will
maximize its own security and thus wellbeing. A realist
would also argue the selfishness associated with Brazil
and its concern being primarily on a uni-axial basis, that
is, actions that revolve only around benefiting one
country.
An example of the second reason is identified byIsrael’s use of water in the Arab states. In 1965, Israel
attempted to carry out a unilateral diversion of its water
into the country. In response, the Arab states also
diverted the water originating from their countries intorivers within the Arab states. As a consequence andthreat to its security, Israel launched a pre-emptive
strike on Syrian construction sites with military aircraft.
Israel also attempted to dissolve salinity issues by
pumping water from the Mediterranean Sea into theDead Sea and construct a dam above Jordan.
However, Jordan believes that such an act will waterlog
areas of agriculture in the East Ghor canal region(Clarke, 1991). The water crisis in the Middle East acts

Eubios Journal of Asian and International Bioethics 18 (November 2008)
as “domino-effect” as each state’s actions havereprehensible and continuing affects on the other.
Application of Thomas Hobb’s theory from theLeviathan reveals a “water arms race” in which theactions of one state are mimicked by another in a plotof revenge (i.e. by diverting rivers). This occurs when
there is lack of treaties regarding the sharing of water.
Hence, Realists would argue that in this situation,nation states take advantage of the opportunity tomaximize security and wellbeing through the use of
hard power (gaining power by military means). This wasclearly seen in the situation in the Middle East as
exemplified by Israel.
A study by Oregon State University suggests an
obvious trend relating issues surround water politics. As
the level at which state conflict is resolved decreases,
the likelihood of state violence and conflict increases(McDonald and Jehl, 2003). Given this trend, a Liberal
Institutionalist would suggest, there needs to be a treaty
that results in the co-operation of states to manage
scarce water resources and avoid competition for theseresources. Currently, the Middle East and areas ofAfrica and South America have a limited number oftreaties compared to the 175 in Europe dealing with thesame issue (Clarke, 1991). There is some evidence ofa Liberal Insitutionalist approach to the water crisis.
Currently, in the Middle East, Turkey has implemented
two “peace lines” responsible for providing water to
Jordan and Western Saudi Arabia as well as Syria,
Eastern Saudi Arabia and the Gulf States. In 1986, theUnited Nations launched the Environmentally Sound
Management of Inland Water Resources (EMINWA) inthe Zambezi River. The program now serves eight
African countries in assisting with the management ofwater pollution and as an overseeing power, creates
strategies to increase water efficiency and equitable
distribution (Clarke, 2005). From the perspective of a
Liberal Institutionalist, co-ordination is imperative topreventing water disputes. Liberal Intuitionalists would
argue that the management strategy implemented byTurkey as mentioned above would be the mostplausible option to states in maximizing security(ensuring at least some supply of clean water) andensuring wellbeing (fresh water to the state’s
populations).
The environment is a complex and controversial
element in international relations as exemplified
throughout this essay. Both the use of resources andthe misuse of resources have adverse effects upon theenvironment including the security, peace and freedomof states. The political schools of Realism and Liberal
Institutionalism are just two political lenses throughwhich issues of global warming, ozone depletion andwater politics can be examined. Neither one provides adefinitive explanation for the way in which states
behave with regard to the environment. While a liberal
institutionalist approach may be more favourable as
explained by Barry Holden in his suggestion of thenecessity for international collective action (Holden,
2002), one cannot be assured that this will occur.
Essentially, the ethical behaviour of states isunpredictable; as standards of sovereignty, they choose
to make their own decisions that maximize security and177

wellbeing whether this is with realist or liberal
institutionalist ideologies.
Acknowledgments
This paper is based on a presentation at the Joint
UNESCO-MacQuarie University Forum on the Ethics ofEnergy Technologies, held 4 May 2008 in Sydney, Australia.

Professor Darryl Macer (Regional Advisor in Asiaand the Pacific, UNESCO Bangkok) for giving me theopportunity and experience to publish this paper in
EJAIB and for giving me the opportunity to participate in
the UNESCO-Macquarie Energy of Ethics Forum.
Associate Professor Irina Pollard (Professor of
Biological Science, Macquarie University, Sydney,
Australia) for giving me the opportunity to participate in
the Forum and for thoroughly reviewing and editing thispaper. Dr Culum Brown (Professor of Biological
Science, Macquarie University, Sydney, Australia) for
supporting the Advanced Biology Students ofMacquarie University in the Forum and this publication.
Professor Arnd Jurgensen and Teaching AssistantHannah Moosa (University of Toronto, Mississauga,
Canada) for providing teaching assistance andknowledge in the first year course of Global Politics
POL114H5F.
My Parents: Dr. Christopher and Mrs Suzanna
Farias, for providing me with the technological andeducational opportunities and resources involved withwriting this paper. To the many authors andorganizations whose resources/works have enabled
this paper to become a concrete reality from its abstract
conception.
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Logistics,<http://66.102.1.104/scholar?hl=en&lr=&q=cache:OUvIxPBuw
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Sens, Allan and Peter Stoett. (2005) Global Politics,
Origins, Currents, Directions, Thomas Nelson publishing,
Toronto178

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

UNDP. (2007) 20 Years of the Montreal Protocol.
<http://www.undp.org/chemicals/20yearsmontrealprotocol/>[Accessed: 5th November 2007]
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4th November 2007]

The Ecological Costs ofHydroelectricity- Matt Saunders
Department of Biological Sciences, Macquarie
University, Sydney, NSW 2109, Australia
Email: matt.saunders@students.mq.edu.au
The construction of large-scale hydroelectric dams
has fragmented and altered the world’s rivers, resulting
in a wide range of ecological impacts with varying
degrees of reversibility and scale. Ecosystem services,such as water purification, nutrient cycling and floodand drought mitigation, are being negatively affected.
The physical barrier of a dam creates an obstruction in
migratory routes for some fish species, which can resultin changes in species composition or even species
losses. Moreover, changes in flow regime caused by
the damming of rivers can lead to further disruption infish and invertebrate migration, changes in waterchemistry and temperature and algal blooms.
Downstream annual flooding is subsequently reduced,
resulting in decreased fertility and productivity ofriparian zones, floodplains and deltas. This reduction of
sediments and nutrients in downstream regions resultsin habitat loss and degradation, directly affecting biota.
Modified habitats are often more conducive to theproliferation of exotic species rather than native
species. The severity of these impacts is a growing
threat. The world’s watersheds are habitat to over 9000
fresh water fish species, comprising 40% of the world’s
total fish species. In recent years at least 20% of these
fresh water species have become threatened,
endangered or extinct. Negative externalities producedby hydroelectric dams in downstream regions, such as
wetlands and river estuaries, includes degradation,
flooding and salt intrusion. The range and severity of
impacts on all adjacent ecosystems to hydroelectric
dams are too great to ignore.
Moreover, hydroelectric dams can actually contributeto greenhouse gas emissions. After clearing, thevegetation left within the reservoir decays, creating
anoxic environments. This subsequently leads toconditions conducive to the formation of methane gas,
which is then released into the atmosphere when wateris passed through the turbines. Although the scientists
have some ideas, it is still unclear what processes are
responsible for the formation of methane in plants;
however, its increasing environmental importance has
stimulated research into its production in decomposed
vegetation. Methane (CH4) is 21 times more powerful intrapping solar heat (effective as a greenhouse gas)than carbon dioxide. Thus, the creation and release of
methane caused by dams is significant. Carbon is also
released into the atmosphere by the initial clearing offorest for the creation of a reservoir. As water depth

fluctuates with seasonal changes, there is a continuous
supply of decaying material. During periods of low
water depth, plants colonise the banks of the reservoir,
which subsequently are covered and drowned as thewater rises, perpetuating the cycle of methane
production. These areas are known as “drawdown”
regions, and in dams that have shallow shelving, canextend for many kilometres. In some cases greenhousegas emissions far outstrip emissions from equivalent
sized fossil fuel powered plants. The Curu´a-Una Dam
in Brazil is one such example, with greenhouse gas
emissions 3.6 times higher than the fossil fuel plantsthat it displaced. Thus, the further construction ofhydroelectric dams needs to be carefully considered in
the face of human-induced climate change. It is time we
recognise the significant negative impacts ofhydroelectric dams and put a stop to the continual
construction of these dams.
References
This paper is based on a presentation at the Joint
UNESCO-MacQuarie University Forum on the Ethics ofEnergy Technologies, held 4 May 2008 in Sydney, Australia.
Fearneside P. 2005. Do hydroelectric dams mitigate global
warming? The case of Brazil’s Curu´a-Una Dam. Mitigation
and Adaptation Strategies for Global Change 10: 675 – 691.
Rosenberg D, Bodaly A and Usher P. 1995. Environmental
and social impacts of large scale hydroelectric development:
who is listening? Global Environmental Change. 5 (2): 127 –148.
World Commission on Dams. 2000. Dams and Development:
A New Framework for Decision-Making. Earthscan, London.

Energy Equity and Human
Security: Where Does the
Solution Lie?
- Tamarind Reynolds
Department of Biological Sciences, Macquarie
University, Sydney, NSW 2109, Australia
Email: tamarind.reynolds@students.mq.edu.auSecurity can be defined as freedom from danger andrisk, and it encompasses water, food, shelter and aplace to call home. The growing problem of theenvironment and climate change directly affects humansecurity, and it affects developing nations to a far
greater degree than developed nations. Environmental
degradation brings natural disasters, droughts, famines,
floods, landslides, disease, ill health and forced
migration. Those affected most are those that cannot
help themselves. Water is a critical resource but we see
glaciers on the Qinghai-Tibet plateau melting rapidly,
and these glaciers provide water to half the world’s
population in China and South East Asia. Coastal lowlying nations like Bangladesh are at extreme risk ofrising sea levels, as well as increasing monsoon rains
causing flooding and prolonged periods of drought. The
world is on the brink of a food shortage as rice, thestaple food for over 3 billion people, doubled in price inseveral months in 2008. Asia is struggling to feed itself
yet huge tracts of land once devoted to food production,

Eubios Journal of Asian and International Bioethics 18 (November 2008)
are now being used to grow biofuels for the European
Union (EU), and people are being pushed off their land
to make way for the plantations, creating forced
migration. Asia is being used to fund the industrialized
world’s fuel consumption patterns, but perhaps thedeveloped world needs to look at fuel consumption
reduction rather than finding a solution that only brings
about another set of problems.
Climate change and its effects are creating more
insecurity in the world for many of its people and theimpact of development and industrialization on theenvironment is a problem that cannot be ignored.
However the idea of equity equates to one of ‘fairness’,
and is it fair to say to developing nations that theycannot develop? The problem of the environment was
originally created by industrialized nations, so the bulkof the responsibility for the solution also needs to comefrom them. China insists that poverty reduction for its
people must be prioritized over meeting energy
reduction targets, and that they have a right toindustrialize and to have a better quality of life. The
Chinese economy is growing at a rate of 10-11%
annually, with no signs of slowing down. Their energy
needs are increasing exponentially and the primarysource of energy is coal. This is the most detrimental tothe environment, causing effects that can undo years ofpoverty reduction schemes and improvements in qualityof life.
Much of the energy fueling China’s economic boom
is used to produce goods that the industrialized worldconsumes. The ubiquitous “Made in China” stamp is
known all over the world. China is criticized for its
increasing output but much of it is generated producing
our goods, so should China reign in its growth, orshould we reign in our consumption patterns? The
environment is a problem that requires cooperationfrom all parties. The industrialized world needs tocollaborate with the industrializing world to help themdevelop in a way that is sustainable, good for theenvironment and meets their growing energy needs.
The developed world also needs to consume less anduse less energy. Our world consists of a finite supply ofmaterials and resources and these simply cannot meet
our insatiable consumption patterns for much longer.
References
This paper is based on a presentation at the Joint
UNESCO-MacQuarie University Forum on the Ethics ofEnergy Technologies, held 4 May 2008 in Sydney, Australia.
http://www.globalissues.org/EnvIssues/GlobalWarming/Justice.asp
http://www.infochangeindia.org

179

The space has been ill – thehumans' fault- Bing H. Tang
Research Consultant, New York College of Traditional
Chinese Medicine, New York, USA
Email: prof.bing@gmail.com
Life’s supposed to be merely a process
In the original innate space.
The Space is in fact not at all a dead vase.
It’s indeed the life-hugging continuance.
Unfortunately, somehow,
Financial assets, for now,
Along with the marketplaces, grow.
Behold! It takes the sources
As the despatialized artifacts.
It was idyllic on all the sites:
The lake's hemmed in by the weeping willow.
Fish appeared to be too hard to rouse.
At the bay, fish and shellfish used to flow.
They swarmed in the waters.
White-fish used to be so copious
That they were strained in by the human’s nets,
Then distributed for manure on the lands.
But now new suburbs’re burgeoning all
Around the space of the original.
The space and sites bear the crash of the throwaway culture of the human fellow,
Who’re coming to set up and to dwell.
The sites’re in a trice well
Sprouted by the mansion and the wall.
Behold! How grasses were paved
Over with cement, while oils’ recollected
On the capacious pavement;
Oils then dripped from the gilsonite.
The selfish people are really domineering,
While the forceful wind is overbearing;
Alike, both throw trash arbitrarily.
For the mansion by the beach and bay,
They need to build storm sewers, for which
They grind away at digging the ditch!
There is indeed the need for new notions,
For which re-allocation will show how;Over where citizens on the planet should alloy

New book on participatory exercises (free todownload from www.unescobkk.org/rushsap)

To corroborate, as well as, to growAn ethical longing for belonging now.
Or, the same old selfish ruse’ll soon follow.

http://www.unescobkk.org/rushsap/ethicsresources/multilingual-material/

Imagine! How it derives from theenvironments, as well as of humans

Darryl Macer, Moral Games for
Teaching Bioethics (UNESCO Chair
in Bioethics, Haifa, 2008).

sourcesWho have accepted as 'true' for their sakeIn the power of cash -- hard to conquer?
Soon more mansions will grow enormous!
Why not now be kind to the space
And work to wake up humans; save our space.

of

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

Teaching of bioethics inmedical schools in
Bangladesh- Shamima Parvin Lasker,
Professor of Anatomy, City Dental College, Dhaka,Bangladesh.
- Arif Hossain,
General Manager, EBCI Group, Dhaka, Bangladesh.
Email: splasker04@yahoo.com
Introduction
In Bangladesh, medical doctors usually have enjoyed
the utmost respect among all other professionals.
Medical practice is governed by legislation and medicallaws which are enforced by the Ministry of Health andFamily Welfare. Hospitals clinics and diagnostic centres
are also governed by government regulations.
Physicians should perform their professional work in
consistency with these regulations, but malpractice andmisconduct by medical practitioners are the mostcommon public concern in Bangladesh. Moreover,there is huge gap in teaching of ethics in undergraduate
medical study. On the other hand, demand for healthresearch in this country is constantly increasing. A large
number of researchers do not possess sufficientknowledge about the basic elements and fundamental
characteristics of research ethics. Strengthening theteaching of bioethics in medical colleges in Bangladesh
is essential.
Existing Ethical Problems in the Health Sector
The standard of public health service is gradually
deteriorating. There is increasing a tendency of
government doctors to practice in the private sector
during office hours. Government consultants also give
much time and labour in private practice rather than ingovernment hospitals. There is an increasing tendencyof doctors from rural government hospitals to remain in
the capital city taking long leave from duties. As aconsequence, villages, hill and tribal areas and urban
slums suffer from lacking of their presence. Doctors aretaking a percentage financial cut from each
investigation. Thus the tendency among doctors foradvising many investigations and even high technology
areincreasing
exponentially.
Unnecessary
investigations not only raise direct ethical issues andincrease the cost of health but also undermine thehumanistic aspect of medicine.
The emerging private sector in health care hascommercialized the profession and raised many ethicalconcerns, such as: self advertisement, overcharging,indiscriminate use of drugs, unnecessary surgicaloperations, recruitment of agents to draw patients awayfrom government hospitals, and providing false andfabricated medical certificates.
Government hospitals provide reasonably goodquality health care free of cost but these are overcrowded, have long waiting lists, and often lackcleanliness and courtesy. Sick patients are often
refused admission in government hospitals due to lackof beds. Many times, doctors in these hospitals have torely on the second or third line of therapy, as the best
may not be affordable by the patients. The physicians
thus constantly face ethical dilemmas in the choice oftreatment, and in the choice of which patient should
receive the available treatment.
The costs ofprocurement and use of life-support systems are
significant. These issues as compounded by theinability of legal systems to adapt to modern situations.
Ethical issues related to HIV/AIDS are also becoming
important. Some doctors refuse to provide treatment to
AIDS patients and many private hospitals have beendischarging patients who test positive for HIV.
HIV/AIDS patients still do not receive good care. They
may be placed at the corner of the unit because oftuberculosis complications. In this situation thesepatients feel social isolation.
Teaching on Ethics in Medical Schools
Bangladesh has at present a Medical University, 17
medical colleges and three dental units in thegovernment sector and 43 non government medicalcolleges and 8 dental colleges in the private sector. All
but eight of the medical and dental schools only
conduct the undergraduate course. Another eight
medical schools have a post graduate course alongwith undergraduate courses, also having research
options. The research facilities of these medicalcolleges are still in their infancy.
Among them, three have institutional ethical review
committees to oversee the ethical aspects of research
but not all research is brought for ethical clearance by
the board. Research projects are approved by thedepartment. Informed consent papers are maintainedwith signatures in some cases. Furthermore, these
ethical review committees have limited numbers ofpeople trained in research ethics, despite the efforts of
the Bangladesh Medical Research Council to train
persons in medical ethics. Most researchers are notwell exposed to the principles of research ethics.
Medical ethics is taught in the 3rd year of the MBBS
ndyear of the BDS course at thecourse and 2
departments of Forensic Medicine and Preventive
Dental Medicine respectively in all medical schools in
Bangladesh. There is a defined course and curriculum
which includes professional misconduct and otherethical issues relevant to medical practice in
Bangladesh. Gradate doctors have to signed an oathbefore registering themselves as physicians.
In the past, there was an informal method of learningand practicing other aspects of medical ethics andprofessional codes of conduct through discussion in theclinical classes. However, the medical students werealso encouraged to respect patient’s rights and to beaware of the moral and ethical responsibilities involvedin patient care. Students learned about ethics andetiquette by following their teachers as role models as
well. Nowadays due to the emergence of private
medical schools and introduction of larger numbers of
medical students in a class, the above approach may
be replaced by classroom teaching only.
Moreover, the main problem in the teaching of ethics
is that teachers have little knowledge about medical
ethics and medical etiquette as well as medical codesof conduct. In addition they are engaged to finish thesyllabus rather than to allow the student to devote muchEubios Journal of Asian and International Bioethics 18 (November 2008)
time on the issues of medical ethics. Also, medical
students do not have much interest in learning about
medical ethics as they consider other subjects andother parts of forensic medicine to be more importantfor passing the examination. Moreover, professional
conduct and etiquette are learnt by observation fromsenior doctors rather than reading of books. The
students rarely find a good role model among theirteachers for ethical practice. Also little teaching iseffectively conveyed during pre-clinical teachingsessions when the students have not been exposed topatients.
In post graduate level there is no syllabus to teachbioethics in any discipline of medicine. A study showedthat a large number of researchers enrolled in
postgraduate study did not possess sufficientknowledge about basic elements and fundamental
characteristics of informed consent. They had to
conduct studies among patients/human subjects tocomplete their thesis/ dissertation as a part of theircourse. So prior to starting a study or thesis, it isimportant to be trained in research ethics. Medical law
and bioethics is presently taught in law schools but
these courses are more adjusted to law than to medical
ethics. At present, the teaching curriculum is being
revised and behavioral science has been included in
the 1st year course giving special emphasis to legal
and ethical aspects of medical practice.
Initiatives Taken to Teach Bioethics
Few initiatives are undertaken to incorporate theteaching of ethics among health professionals. A 4-day
intensive structured course on the teaching andpractice of health ethics for teachers of few medicalcolleges and allied sciences was organized by Centre
for Medical Education (CME) in 2003-2004.
To improve the ethical practice in conducting healthresearch and to prepare experts in ethical review of
research proposals in Bangladesh, the Bangladesh
Medical Research Council (BMRC) conducted five days
workshops in 1999-2000 and 2000- 2001. BMRC has
also conduced a bioethics education programme from2003 to 2006 for six courses these includes certificate
and advanced courses on research bioethics. Under
training on Research Bioethics programme twocertificate courses are being conducted from 20032005. BMRC is facing the challenge of providing thistraining due to limited resources.
Conclusions and Recommendations
Bangladesh has enormous health problems withsignificant ethical concerns. There is large need formore teaching of ethics at the undergraduate level.
Only some proposals for post graduate research arebrought before an ethical review committee for ethicalclearance. Although a few training programmes on
research ethics have been conducted these are still notenough to meet the growing need for research and an
ethical review process.
A structured curriculum for the teaching of bioethics
is needed for preparing health professionals, including
medical students and doctors. Integrated teaching of
bioethics in clinical years can be a better setting.

181

Implementation of research ethics at a post graduatelevel is desirable. Strengthening capacity building inresearch ethics is needed through holding conferences,seminars, and training.

To Err is Human: The Needfor Patient Safety- P. ThirumalaikolundusubramanianEmeritus Professor in Internal Medicine, The Tamil
Nadu Dr.M.G.R Medical University, Chennai, 600 003,
India
- A. Uma
Professor of Microbiology, Madurai Medical College,
Madurai, 625 017, India
Email: umatks@rediffmail.com
O’ Health Professionals
Take care to elicit findings and history always and at
emergency:
Assess patients thoroughly and interpret data
meticulously:
Arrange and analyse the details serially arrive atconclusions reasonably:.Explain the status clearly for decisions involving
patient and family:
Prescribe in generic name clearly remembering
adverse effects consciously:
Highlight the situation and outcome genuinely withevidence and probability:
Show empathy and manage ethically andcommunicate the constraints gracefully:
Maintainrecords
satisfactorily
forpatients,
professionals and payers properly:
Understand hidden aspects of human science, amystery despite doctor, device, diagnosis, drug anddaily diet:
Avoid confusions, as disease has uncertainty but
eliminate ignorance, innocence and misinformation
mostly:Ask again relevant questions and listen carefully toknow the disease status and stage, need more money
For patients do services and procedures without
delay as well as fear or wrath from public, patients,press and judiciary
Get consent for procedures, if any to avoid
consequences legally:
Help sick and suffering kindly
as well pray to
Almighty silently:
Serve better with clarityand keep away from
benefits and biases, O’Almighty:
Anticipate errors, mishaps or mistakes carefully as“to err is human” everyday:
Document and monitor medical errors regularly
demand for a national policy for quality and safety:
Issue certificates and reports timely upholding the
tradition professionally:
Face socio-medical challenges amicably and train
students and professionals in science and spirituality:
Discourage profiteering health centre[s] in village orcity but respect professional integrity:

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

Learn from books, journals and CME constantly togain confidence and skills definitely
Solve problems smoothly
accepting limitations honestly
Educate on follow-up and preventive measuressurely also undertake research on patient safety:
Introduce patient safety programme everywhere
early as professionals too suffer from sickness
certainly:

Stigmatization of the
Mentally Ill and an Ethical
Framework of Cultural
Contexts, Psychosocial
Development, and Moral
Development.
- Hanzade Dogan, MD,
Associate Professor in Medical and Clinical Ethics,
Istanbul University, Cerrahpasa Medical School,
Department of Medical Ethics;
Correspondence address: Yogurtcu Cayırı Cd. No: 18/5
34710 Moda, Istanbul, Turkey
Email: hanzadeym@yahoo.com
Abstract
This article describes stigmatization and its impact on
the mentally ill and on the advancement of psychiatry.
The article highlights an ethical review of stigmatization
establishing a link between the psychosocial factors,
culture and moral development. This paper offers an
examination of studies conducted in Turkey and theWestern world, and socio-cultural frameworks for
dealing with ethical values and psychosocial
development. The paper then argues for the need to
discuss moral, psychosocial and cultural meanings
embedded in various ethical issues in arriving at
conclusions and suggestions to prevent stigmatization.
The paper concludes by emphasizing the importanceof ethical training, cultural diversity and moral
development giving reasons and examples why these
are important against stigmatization and suggesting
ways of handling mentally ill.
Keywords: Stigmatization, Mentally ill, Culture, Ethics,
Moral values, Psychosocial development.
Introduction
Stigmatization is a way of discrimination based onlabeling. It usually shows up when an item becomesdifferent from the generally accepted norms orchronically normal situations (1). Stigmatization is amajor factor that inhibits developing healthier societies
with sound interpersonal relationships and respect forothers. It is one social attitude that keeps societies
susceptible for discrimination (2, 3).
Stigmatization is a problem in healthcare. Mental
illnesses are accepted as being susceptible to be
stigmatized more than, for instance, cancer andphysical disabilities. Studies have shown that thestigma of mental illness adversely affects the courseand prognosis of illness (4). The most important
adverse effect of stigmatization of the mentally ill is thatthe fear of being stigmatized forces patients not toapply for care. Stigmatization is a social concept,
because stigmatized patients are judged as dissimilar
and kept away from almost all of the societal networks(5, 6), and the irreversibility of labeling and stigma arevery important in psychiatric diagnosis (7). Preventionof stigmatization might even be accepted necessary forsocial peace as families of mentally ill and anybody
responsible for them suffers from the process, as well.
Stigmatization might create diminished liberty for thementally ill even after they are successfully treated andthis can be accepted against civil rights.
Stigmatization of the mentally ill has been subject tohistorical evaluations which show that its roots takeplace in the days not very far from the modern times
when “madness” was associated with poverty,
vagabondage, social dissidence, criminality, and thepotential for uprising and violence and the mentally ill
were segregated officially (8, 9, 10). Mentally ill werehandled in crowded and unsanitary conditions. In themodern ages in the West, the handling of mad persons
as a distinct social category took place in asylums,
which is thought to be an important factor in promoting
psychiatric stigma in the modern era. Psychiatric stigma
is present in non-Western societies such as India andespeciallyChina,
asordinarily
studiedbyanthropologists and social historians (10). Studies
suggest that social stigma is less prevalent in Islamic
societies. In all societies where the Great Traditions
dominate, there exist more supernatural, religious,
moralistic, and magical approaches to illness andbehavior.
There are studies on various cognitive andbehavioral factors that comprise stigma; designing
strategies to reduce stigma and improve access to care(11). The origins of stigmatizing seem related to sharedculture, morality and psychosocial development of
individuals (12 - 16).
This paper offers an examination of studies
conducted in Turkey and in some other cultures. Sociocultural framed ways and ethical issues surrounding
stigmatization are discussed, Suggestions to prevent
stigmatization are proposed from different perspectives.
Evaluation of the Social and Cultural Roots of the
Problem
It is prejudice or stigma that brings with it negative
judgment, action and generalization. In most cases,
stigmas are based on invalid and poorly justified
knowledge (2). Defined ‘knowledge structures’ that arelearned by most members of a social group are an
efficient means of categorizing information about socialgroups. Nevertheless, stereotypes do not always leadpeople to negative judgments, or to act on them in a
discriminatory manner.
When it comes to mental illness, society has notcaught up to science. Mental problems are still believed
to be related with character and self-discipline. Mentally
ill persons might point out to things that individuals arescared of in themselves. It is proposed that whensomething about human nature is not understood, there
are different defense mechanisms such as embracing

Eubios Journal of Asian and International Bioethics 18 (November 2008)
and making a career out of it, investigating it, avoiding
it, laughing at it or to believing it is very different andfight it. (3) The concept of mentally ill comprises a wide
range of disorders, which are different from each otherin terms of prognosis, treatment, side effects of drugs
and job performances. Mental illness needs to beevaluated from different points of view such as the realorganic nature of the disease, the possibility oftreatment, public approach and stigmatization,susceptibility to violence, and relation with ethics interms of reflections of the disease to behaviors (5). It isrelated to cultural, sociological, and economic factorsthat a theory of psychiatric stigma will ultimately have toaddress (10).
Observations of Studies in Turkey and Other
CulturesA study carried out by the Department ofConsultation-Liaison Psychiatry at the Cerrahpasa
Medical Faculty, University of Istanbul, Turkey showedthat part of public who believe that it is possible to treat
the mentally ill, tend to stigmatize them less (1). It isalso the case that, there have been tremendous
advances of treatment in psychiatry in the last century(17) and with increasing chances of treatment; public
fear of mentally ill people has decreased not only inTurkey but also in other countries (1). One universal
factor in the stigmatization of mentally ill people isindeed related to advances in therapy. Giving mental
health care opportunities to the public and a healthy
approach from health care professionals would
convince them of the therapeutic possibilities of mental
illness. Darrel Regier, the director of research for theAmerican Psychiatric Association (18), pointed out that
it is the time to end legal insurance discrimination
because it is the time of triumph of science over stigma
and ignorance. Norman Dain claims that recent
advances in biological treatments have rekindled
optimism about recovery that may go far in eliminating
stigma (19).
On the other hand, fear of stigma is an importantfactor in the resistance to treatment. The tremendous
impact of this unresolved aspect of the problem
prevents the treatment from being widely effective inmany societies in which a majority of the patients refuse
even being referred for treatment because of the fear of
being stigmatized. Sometimes health care professionals
are involved in the process of stigmatization, as well(20). The stigma associated with mental illness is amajor factor in the resistance of rural residents tomental health services (21). Lower socioeconomic
classes who tend to have less education might show
discrepancies in terms of negative attitudes. In anotherstudy, it was reported that chances of availing treatment
facilities for mental diseases were better in cases of
educated, economically independent and nonagricultural workers than the illiterate, economicallydependent and agricultural workers (22). Research
results from the Epidemiological Catchments Area
(ECA) study illustrate that many people with mental
illness never access treatment. Results from this study
showed that less than 30% of people with psychiatricdisorders seek treatment where the nature of the

183

problem is the stigma (23). One might think that thisratio represents those with relatively minor adjustment
disorders who choose to withstand relatively brief
psychiatric discomfort rather than to be immersed inmental health treatment. However, findings from the
ECA study showed that only 60% of people withschizophrenia participated in treatment. The U.S.
Surgeon General 1999 Report classifies Mental Health
Barriers as (a) failure to recognize the disease, (b)failure to access to the sick, (c) because of
stigmatization, failure to access to treatment (d)capability of paying for the services, etc (24).
Fink proposes that the stigma associated withpsychiatry is the most critical problem facing theprofession. He identifies additional sources of stigma as
psychiatrists’ internal conflicts over treatment ideas andstigmatization of the patients by the physicians
themselves (25). The criteria for involuntary
hospitalization, involuntary medication, restriction ofliberty of the patients, outpatient commitment, themonitoring of medication compliance might need to berevised to decrease the stigma associated with serious
mental illness (26). According to McCullough (27, 28,29), since medicine is a social institution, and was laidthopen to conviction in the late 20 century for social,moral and economic integrity, it might be of great
importance for the prevention of stigmatization toestablish a multidisciplinary approach to patients, forthe evaluation of patients for their best interests during
the rehabilitation process, as well (27 - 31).
Certain empirical studies in Turkey show that thethreat of possible danger from the mentally ill patients is
one of the most important factors that lead tostigmatization by others. One study (32) reports thatinterviews with the public show that the public conceptof ‘being crazy’ is related to a group of mentally ill who
are aggressive and have to be treated throughhospitalization. The perceived association between
violent behavior and serious mental illness was
explored by Torrey et al to determine the validity that
individuals with serious mental illness are no moredangerous than members of the general population. It
is likely that more persons are killed and seriously
injured by drunken drivers during the course of a single
week than by all combined categories of psychotic
individuals over an entire year—perhaps even several
years. However, the society demonstrates a truly
astonishing tolerance for this group of demonstrably
dangerous persons. The labeling of the mentally ill as
dangerous could in itself be regarded as a rather
dangerous activity (33). Bruce Link, a psychiatricepidemiologist at the Columbia University School of
Public Health in New York presents in Baltimore at a
recent meeting of the American Association for the
Advancement of Science that mental illness is a verysmall contributor to overall levels of violence. Link andcolleagues recently conducted a large-scale study ofmental disorders and violent behavior in Israel, findingsof which were similar to those in a previous study inurban areas of the United States. The study found rates
of violence for people with mental illness to be about
three to four times the rate for the general public.
Therefore, it is not a rational basis for rejecting or

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

discriminating against people with mental illness (34). It
is also reported that the portrayal of mentally ill persons
in movies and television programs has an importantand underestimated influence on public perceptions of
their condition and care. Mentally ill are usuallypresented as rebellious free spirit, homicidal maniac,
and narcissist parasite (35).
According to a study carried out in Turkey (36), thelack of public awareness of the social–role–taking
ability of a mentally ill patient has a crucial role instigmatization in Turkey. This strategy of providing
patients with a social role and maintaining their social
contacts is expected to keep them productive. In
addition, families should be convinced about thesuccess of the mentally ill in the housework. In this way,patients might be kept away from demoralization,loosing self-confidence, and relating all their personality
traits with their illness. Greenberg et al conducted a
related study (37) and underline that the above
precautions are not satisfactory alone. Establishing amethodology to keep these measures alive andfunctional in the society is also very important. It isstrongly emphasized that providing patients with asocial role does not minimize the stresses and burdensthat families experience in coping with mental illness
nor imply that all clients with mental illness makecontributions to their families. It is important to balance
the often-held view that families experience only burdenwith the mentally ill. One of the consequences of thediminution of stigmatization would be the reduction of
the many social, judicial, economic and cultural
obstacles standing in the way of people with mental
disorders (37).
It is important to note the cultural differences
regarding the attitudes towards the mentally ill in
cultural contexts (38). In the contemporary cultures,(39) the tendency to perceive and report distress in
psychological or somatic terms is influenced by anarray of social and cultural factors, one of which is therelative degree of stigma attached to each. Depressive
symptoms are considered to be private and evendangerous, according to research in South-India,
Taiwan and China, which sharply contrast with reports
from the West (39). In China, diagnoses of depression
are less common than in the West and one of therelevant factors is that patients avoid seeking help
because of the stigma of mental disorder (40). In
Norway inadequate treatment of mood disorders is
related to disinformation about methods of treatment
and the stigma of psychiatry (41). In Laos, apredominantly peasant society, the individual’s selflabeling is a more critical factor than social labeling forthe social disability associated with chronic psychosis(42). As an example to the situation in the UnitedStates, Frederick Frese who was diagnosed withschizophrenia at age 25 emphasizes in his work (43)that learning to cope with a disability is a function ofexperience and guidance from others. The author is
now a psychologist who works with persons
hospitalized with mental illness. He claims that those
who were struck with mental illness were ejected fromsociety and isolated as asylums and until thirty years
ago not expected to return to society. Some
precautions and protocols for patients to cope with thedisease are observed in the new health care pattern of

the United States that are thought to be some of theeffective and practical precautions to cope withstigmatization (43):• Recently, the National Mental Health Consumer’s
Association adopted a six–part national agenda. For
discrimination, the following is stated: “Discrimination,
abuse, ostracism, stigmatization and other forms ofsocial prejudice must be identified, and vigorously
opposed at every opportunity.”• A National Stigma Clearinghouse has been
established in Albany, New York, with monitors, whichchallenges media stereotypes of the mentally ill.
• Mike Jaffe and his family (1993) have produced
and widely distributed posters highlighting “People withmental illness (who) enrich our lives.” They point out
that such persons as Robert Schumann, the composer,
Vaslov Nijinski, the dancer, Eugene O’Neill, theplaywright and many other accomplished individuals,
suffered from serious mental illnesses.
• The Americans with Disabilities Act (ADA) is
shown as a significant step forward in the area of
employment opportunities.
• Networking self-help is also very important fordestigmatization, in which people who had experienced
the same disorders help each other.
• Hospitalization and diagnostic labeling are notadvised because of their risk.
• Health care system is suggested to serve without
letting any disruptions in the communication between
the patients and the society.
• The words “crazy,” “insane” and “nuts” must be
avoided in the language of the mass media.
• The movies are pointed out to have an unfortunate
tradition of portraying the mentally ill as monsters.
Socio-cultural Framed Ways of Ethical Values andPsychosocial Development
An empirical study in Turkey was undertaken toshow if personal acquaintance influenced positively theemotional reactions to the mentally ill. Two possible
mechanisms were discussed (44). Past acquaintancewith a mentally ill person may have an effect on the
conscious level or if past acquaintance desensitizes
prejudice, personal experience would be expected toshow its positive effect on the unconscious level.
Consciousness and unconsciousness at the individual
and societal level might be two important elements ofstigmatization. Unconsciousness is described as beingout of experience which is subjective experience ofbeing aware of a phenomenon (45). According to theTurkish perspective (44), interacting with a mentally ill
person in the past possibly influences the unconscious
feelings of the society. Thus, persons who wereacquainted with a mentally ill person in their past aredesensitized for their negative feelings that were
produced by their false perceptions on mental illness.
This shows, according to Arikan et al., two points:
1) The society is readily sensitized emotionallyagainst the mentally ill.
2) It is possible to be desensitized emotionally byacquaintances with the mentally ill.
Penn et al investigated what type of information
reduces stigmatization of schizophrenia. Those
individuals who had no previous contact perceived theEubios Journal of Asian and International Bioethics 18 (November 2008)
mentally ill as dangerous and chose to maintain agreater social distance from them. More information
about the target individuals’ post-treatment living
arrangements decrease stigma (46).
Corrigan et al reported that contact with people withmental illness also yields significant improvements in
attitudes about mental illness. Research shows thatmembers of the general public who are familiar withmental illness are less likely to endorse prejudicial
attitudes (47). Spiro et al have reported that different
populations studied at different points in time bydifferent investigators have shown a willingness toadmit contact with the mentally ill. It has beenconcluded that the hypothesis the public will denycontact with the mentally ill is not supported and has
not been supported for at least a decade by empiricalevidence (Baltimore City field survey 1960, Kentucky
State, rural North Carolina, and the City of New York)(48).
On the other hand, Black et al dealt with children,
whose mothers were killed by their mentally ill fathersor vice-versa. These children had to cope with thetrauma of violence, the grief associated with the loss ofboth parents simultaneously, stigma, secrecy, andoften-massive conflicts of loyalty. These events are rare
but very complicated. This type of possible stigma
about past acquaintance, which is not related todesensitization, needs special handling (49). Fear andexclusion in respondents with children is not related tolack of knowledge of mental illness or sensitization but
to the conscious belief that the mentally ill are actuallymore dangerous because of their children’s vulnerability(50).
Arikan’s empirical study in Turkey (44) proposes thatacquaintance with mentally ill reduces stigma,
especially the ones excluding stigma depending on
violence (51). As we have discussed, when stigma
occurs either because of the fear of violence orsometimes because of the acute phase symptoms ofserious psychotic illnesses, past acquaintance mightalso have a negative impact on the contrary side ofwhat we have presented. However in reality, fear ofreal danger or fear of real bad symptoms of mentally ill
without treatment might be interpreted as rational fears
or functions of the conscious world either created bypast acquaintance or knowledge of possible danger
rather than a stigma. In stigmatization, all mentally ill
are considered as bad.
Stages of Moral Development
In addition to the social, cultural and psychologicalfactors, the moralists, according to moral theory, define
stigmatization as a moral judgment (12). In science of
psychiatry and psychology, according to Sigmund
Freud and his followers, moral development of
individuals have special conditional link withpsychosocial
development(13).
Therefore,
stigmatization might be both a psychosocial and amoral problem and might be placed at the intersectionof moral and psychological development. If
stigmatization gets very strong to the point of disturbingsocial peace or prevents an individual from being185

treated, then it is worth to analyze the very mechanismsthat contribute to stigma build up.
From a Freudian approach, for the concept ofmorality to develop, an analysis of the “character” is
proposed to be necessary (13). Sins or virtues become
more meaningful when they are interrelated with thecharacter particularities of an individual. A virtue
separated from the character might not be valuable atall (e.g. humbleness due to fear or repressed
megalomania). In the same way, a sin might meandifferent issues when evaluated together with acharacter (as in the case of a high state of pride which
is a result of low self-esteem or inferiority complex). The
Freudian approach suggests that for an analysis of theconcept of morality, it is essential to evaluate virtues
and sins together with each individual character and not
as separate and isolated features. Ego plays such astrong role to direct the action, which the research ofmorality cannot neglect (14, 15). Psychoanalyticaltheory has been very useful for us to recognize andunderstand “the moral values” scientifically, which havean important role during the process of stigmatization.
According to moralists, stigmatization is a type of
moral judgment, which is made in the name of being ahuman and which tries to protect the values ofindividuals and general moral principles depending on
those values.
Moral judgments show themselves as either directly
by words expressing value as ‘good-bad’ or ‘true-false’
or by value-laden words such as ‘insane’, ‘crazy’,‘terrorist’ without thinking about our actions (12). The
latter implies an example to the stigmatization ofmentally ill. Moral judgments might shape our behaviors
about our society, our world, or us (12). As a result ofhealthy psychosocial development, it is believed that
moral judgments are replaced with the “status ofrealizing and evaluating the conditions, just likerealizing the conditions of mentally ill instead of
stigmatizing them.” (13). According to Kohlberg, thepreeminent moral development theorist, value
judgments are related to stages of moral development,
as well (52). Kohlberg proposed that there are six
stages of moral development that humans go through,the same way babies learn first to roll over, then to sit
up, then to crawl, and finally to walk. It is important toknow that, majority of the individuals according to thestage they have reached, designate the stages of thesocieties according to moral development theory andmoral judgments at societal level (52). Those moral
values or judgments or urges, which are embedded instages at individual level, are reflected at the societal
level to shape a pluralistic society. There are two
essential correlates of Kohlberg’s theory: First,
everyone goes through the stages in the same order,
but not everyone goes through all the stages; second, aperson at one stage can understand the reasoning of
any stage below him or her, but can understand no
more than one stage above. These correlates,
especially the latter one, are important when it comes toassessing the nature of disagreements about ethicaland moral judgments one of which might bestigmatization (16). At stage 1, what is right is to avoid
breaking rules and punishment. The person at this186

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

stage does not consider the interests of others andactions are judged in terms of physical consequences
rather than in terms of psychological interests of others.
At stage 2 what is right is acting to meet one’s own
interests and needs and letting others do the same. A
person at this stage separates own interests and pointsof view from those of authorities and others. A person
at stage 3 is aware of shared feelings, agreements, andexpectations, which take primacy over individualinterests. The person might put oneself in the otherperson’s shoes. In short, the person has empathy forothers and gets rid of stigmatization. At stage 4 the rightis doing one’s duty in society, upholding the social
order, and maintaining the welfare of society or thegroup. At stage 5, the right is, upholding the basic
rights, values, and legal contracts of a society, evenwhen they conflict with the concrete rules and laws. At
stage 6, principles are the equality of human rights andrespect for the dignity of human beings as individuals.
The rational individual recognizes the basic moral
premise of respect for other persons as ends, notmeans. Stigmatization might be overridden by respect
for others.
Moral and Cultural Meanings Embedded in EthicalIssuesKohlberg (52) states that it can be so far connoted
that, in a pluralistic society, every member of thatsociety embraces a moral mechanism, totally or
partially, while all ethical systems do not agree upon asingle good; cultures, religions, institutions, andprofessions may each have a unique idea about what
constitutes the good which is pursued by the rightaction that is achieved through the right decision, andwhich is accomplished over moral reasoning at theindividual level. The source of this variation in ethicalreasoning can also be linked to personal attainment ofdifferent stages of moral development and psychosocial
development among individuals within that pluralistic
society (52).
According to moral theory, the reasons of action or
purpose of action should be sought (53, 54). Reasonsfor doing/not doing are critically important. The second
point about actions is the power of the reason. Whenpeople react to mentally ill because they are afraid ofviolence, they might have some power of the reason. If
one has to choose between stigmatizing a patient or not
and if the latter is chosen, it is proposed by moralists
that this eventually, is also the urge and wish of that
person, by all means, because people eventually preferto choose what they want most in that particularsituation. This is seen to be the ethically right way ofacting. The difference is mainly in the purpose of theact (53). Theory is true to a certain extent but there isno certain answer to the resolution of dilemmas.
There are interesting works about the link between
consciousness and values. Steve Torrance ofMiddlesex University proposes that in both the areas of
ethics and consciousness there are problematic gaps
and it is proposed that empathy is a precondition for ascience of consciousness in his presentation named‘Consciousness, inter-being, and value.’ (55). Evan
Thompson (56, 57) proposed to explore how conceptsof mind and consciousness relate to concepts of value.
He emphasizes that one’s consciousness of oneself as

an embodied individual is accomplished in empathy
with another. He suggested that the world of fact is not
purely objective, neutral and values are not extrinsic to
the world, imposed by arbitrary choice. Instead theworld is seen as a lived world in which values areembedded and which can thus only be grasped
evaluative or empathetically.
The science of psychology depends on ethics (58).
Psychoanalyticalknowledgeisanethicalcomprehension, at the same time. It is also proposedthat the help of ethics explains preconditions thatpsychoanalysis depends on and ethics uses a conceptof action. Ethics education compromises judgment
through values and action depending on that judgment.
There are only a few studies that have sought thepsychology of stigma and to diminish self-stigma andbased on the cognitive functions resembling ourapproach. Kingdon et al (59) used cognitive behavioral
approach to help people reframe stigma as a normal
event. The interventions were well received by patientsand seemed to yield more acceptance of their illness.
Self-stigma is weakened when people learn researchbased information that counters it. Thus, educating
individuals who self –stigmatize about mental illness
can help them challenge their negative beliefs.
A very recent study from Malaysia (2008) also
reports that Malaysians tended to favor socialenvironmental explanations for schizophrenia. Ethnic
and sex differences played role in the comments. They
agreed that schizophrenia has a social cause andschizophrenic behavior is sinful and hospitals do notprovide effective treatment (60).
Another study (2007) proposed that about moralitythat civilian trained health professionals altered theirviews about mental illness durıng the First World War
but initially the military imperatives inherent in a global
conflict perpetuated the notion that mental illness was
linked with defective morality (61). Kleinman alsomentioned in his work (2006) that culture is crucial to
medicine and culture is about the changing moral
experiences of patients, families and practitioners andthose experiences powerfully affect the doctor-patient
relationship even to create stigma (62). Nelson
emphasized one of the main points in this review article
in his work that ethical issues associated with mental
illness have been generally neglected in the literatureand texts of the discipline of bioethics. Pervasive stigma
attached to mental illness is a major reason for that.
Attention of bioethicists would bring lots of benefit to theattitude towards mental health by emphasizing ethicalsignificance in health care (63).
Conclusion
It is widely appreciated that a social stigma
surrounds psychiatric illness in contemporary society.
Although psychiatric illness has some biologicalcharacter, it also is socially constructed throughdevelopment of the self. A significant barrier toengaging in mental health treatment or the restriction of
the liberty of the patients is stigma associated.
There has been some research about stigmatizationin Turkey one of which introduces the consequences ofpast acquaintance with the mentally ill and a probableunconscious dimension supported by other literatureEubios Journal of Asian and International Bioethics 18 (November 2008)
findings either from West or East, although there aresome contradictory findings, as well.
As we have reviewed, stigmatization is affected bysocial and cultural factors. We face socio-cultural
framed ways that have connections with ethical values
and psychosocial development. Furthermore, moral,
psychosocial and cultural meanings embedded invarious ethical issues are discussed to arrive
conclusions. Moral development theories propose amosaic structure of values, feelings and social impacts
at different stages of life.
Stigmatization is a multifactorial topic. Again, there isneed to acknowledge the fact that ethical issues carrywith them social and cultural meanings that must be
taken into consideration. Also, studies emphasize thatpsychology has connections with ethics and moral
development. We observe that in different cultures,common ethical issues like social values, dignity,
empathy, love for human beings, informing
communication, respect for individuals might help towelcome mental diseases and prevent stigmatization.
Since ethics is a specific form and concept of
medicine including psychology, cultural diversity, social
values, and moral values, education of ethics andresearch of ethics about mental health might be a major
challenge to stigmatization.
This paper has examined recent developments forstigmatization against mental illness. It offered ananalysis and review of the framework of ethics, cultural
approach, psychosocial and moral development. As aresult of values, some cultures and societies might
have positive memories about mental illness andstigmatization is not a problem.
The paper argued for the need of training andresearch of ethics, cultural diversity and moral
development. I invite more research results and culture
based comments to protect mentally ill against
stigmatization.
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Report of the Asian
Bioethics Association (ABA)
General Meeting (2008)
website for ABA <www.eubios.info/ABA.htm>
Presided over by the President and Secretary[Jayapaul Azariah (India) and Darryl Macer (Thailand)]Meeting held on 5 November, 2008 at the time of
the Ninth Asian Bioethics Conference (ABC9): Healthy
and productive life in harmony with nature / Third
UNESCO Asia-Pacific School of Ethics Bioethics
Roundtable, 3-7 November, 2008, Jogyakarta,
Indonesia.
There was an explanation of ABA and appreciation
to ABC2008 hosts, the Indonesian National Bioethics
Commission. The results of the election of new board
members whose term was expiring on 16 November
2008. The two successful candidates were:
President elect: Prof. Leonardo de Castro (thePhilippines)
Vice-President for Korea: Prof. Young-Rhan Um(Republic of Korea)
Self-introductions of ABA Board Members present
were made and appreciation was given to those whoseterms were expiring.
Asian Bioethics Association (ABA) Board of Directors(November 2008-2010)
President: Leonardo de Castro
Vice President for China: Yanguang Wang
Vice President for India: Abnik Gupta
Vice President for Japan: Atsushi Asai
Vice President for West Asia: Aamir Jafarey
Vice-President for South Asia (East of India, excluding
other named regions): Soraj Hongladarom
Vice President for Asian Ethnic and Religious
Minorities: Alireza BagheriVice President for Korea: Young Rhan Um
Secretary: Darryl Macer (Thailand/New Zealand)
Immediate Past President: Jayapaul Azariah (India)
The Secretary’s report noted
http://www.eubios.info/ABA.htm

thewebsite:Eubios Journal of Asian and International Bioethics 18 (November 2008)
The Current ABA Membership was 151 members (ofwhom 20 have paid money for 2008). More members
were encouraged today. The production and circulationof the ABA journal, EJAIB, continues to operate on anannual loss subsidized by Eubios Ethics Institute.
The Membership benefits are reduced conference
admission and the journal, EJAIB. The journal can be
downloaded by anyone from the website.
http://www.eubios.info/EJAIB.htm
There was distribution of 2008/2009 ABA renewal
forms (and readers are encouraged to use the form on
p. 191 of this issue for 2009).
Asian Bioethics Association Fees
Membership fees are payable from October of theprevious year to the completion of the following
calendar year (e.g. at the time of renewal to EJAIB, theofficial journal of ABA).
A three tier system exists for annual fees:a) Regular price (US$50 Euro 40 Yen 5000).
This includes the EJAIB journal subscription and freeassociate membership of Eubios Ethics Institute.
b) Reduced contribution (the amount is up to themember, and is also suggested for students)
This includes the EJAIB journal subscription.
c) No fee, because the person is not in a position to pay
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This does not include a hard copy of the EJAIB journal,
but anyone can apply to Eubios Ethics Instituteseparately for a hard copy of the Journal, to beconsidered case by case.
The ABC10 conference will be held on 26-29 April
2009 in Teheran, Iran (details below). Participants
were encouraged to come and to propose sessions.
There was a proposal from the board for an additional
article in the ABA Constitution. The background was acall for greater diversity of geographical representationand diversity (e.g. gender and other diversity) among
ABA members. The benefit was that it would make theassociation open to more persons, in countries orregions that are not represented by vice-presidents.
These persons help to promote ABA membership andgoals in their area.
The proposed additional article was adopted byacclaimation to the ABA Constitution, reading:“The board members present unanimously suggest
to add an article: The board can co-opt, byconsensus, associate non-voting members toincreasethediversity
andgeographicalrepresentation of the board for the current term.”
There was also a discussion that a growing number ofactivities were happening in South East Asia, and the
may need to be increased representation from that
region in the future. Current country representatives
are:Australia: Irina Pollard
Bangladesh: Shamina Lasker
Indonesia: Amru Hydari Nazif
Philippines: Leonardo de Castro

189

Sri Lanka: Anoja Fernando
Turkey: Sahin Aksoy
Further representatives in these and other countries
are encouraged.

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

The international bioethics education
network is now an official network of theIAB.

IAB Genetics & Bioethics Network: On-line
The complete address list is updated on theInternet. Send all changes to Darryl Macer.
There was a session at the IAB World
Congress of Bioethics in Croatia in September
2008.

UNESCO Asia-Pacific School of
Ethicshttp://www.unescobkk.org/index.php?id=apse

Conferences
Tenth Asian Bioethics Conference (ABC10)/Fourth
UNESCO Asia-Pacific School of Ethics Bioethics
Roundtable: Bioethics in Asia: Bringing Ethics into
Practice , 26-29 April, 2009, Tehran, Iran.
Hosts: Tehran University of Medical Sciences.
Abstract submissions of 300 words in English arewelcome to email: ABC10IRAN@TUMS.AC.IR
Limited financial assistance is available, please send acovering letter if required. ABA members will have a
50USD discount for registration fee.

ABC2009 Conference website:
http://abc10iran.tums.ac.ir/

190

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

Conferences
For a list of some ethics meetings in Asia and Pacific:
http://www.unescobkk.org/index.php?id=current_and_future_
eventsFor all below please contact: RUSHSAP,
Email: rushsap@unescobkk.org

UNESCO Gender Studies Network
Conference
9-13 February 2009
Imperial Tara Hotel, Bangkok, Thailand
UNESCO Youth Ethics Training
Workshops. An Introduction to the
ethics of science and technology throughlectures.
5 February 2009; 20 March 2009
Bangkok, Thailand
UNESCO Ethics Education Workshop
17-18 March 2009
Dhaka, Bangladesh
Tenth Asian Bioethics Conference /Fourth UNESCO Asia-Pacific Schoolof Ethics Roundtable
26-29 April 2009
Tehran, IranHigh level Conference on Teachingof Philosophy in Asia and thePacific, 25-26 May 2009
Manila, Philippines
UNESCO Asia-Arab Inter-regional
Philosophical Dialogues,
27-29 May 2009
Bangkok, Thailand

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

The goals of EJAIB include:
1. EJAIB is the official journal of the Asian Bioethics
Association (ABA) and the IUBS Bioethics Program.
2. To review and update news and trends in bioethics
from around the world. Bioethics is broadly defined aslife ethics, including both medical and environmental
ethics, and environmental, ethical, legal and social
issues arising from biotechnology.
3. To pay particular attention to issues raised by genetic
and reproductive technology, and other news for theInternational Association of Bioethics Genetics
Network. To publish letters on such topics, promotinginternational debate.
4. To publish research papers, and relevant news, andletters, on topics within Asian Bioethics, promoting
research in bioethics in the Asian region, andcontributing to the interchange of ideas within andbetween Asia and global international bioethics. Asia isdefined for the general purposes of this journal as thegeographical area, including the Far East, China, South
East Asia, Oceania, the Indian subcontinent, the Islamic
world and Israel.
5. To promote scientific responsibility, in cooperation
with the International Union of Biological Sciences(IUBS) Bioethics Program.

Send papers to EJAIB Editorial Office
Editorial address:

Prof. Darryl Macer
RUSHSAP, UNESCO Bangkok,
920 Sukhumvit Rd, Prakanong,
Bangkok 10110, THAILAND
Fax: Int+66-2-664-3772
Email: asianbioethics@yahoo.co.nz
d.macer@unescobkk.org

Send papers to the editor in electronic form if
possible. Please use numbered reference style, do not
use automatic footnotes or endnotes. Papers are peer
reviewed.
The journal is independent of UNESCO and thecontents are not endorsed by either Eubios Ethics
Institute or UNESCO, but are published in the spirit ofacademic freedom.

Eubios Journal of Asian and International Bioethics 18 (November 2008)
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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.
Cost: US$30 UK£18 NZ$34 A$36 C$36 ¥3000
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Bioethics is Love of Life: An alternative textbook
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Bioethics in Asia (includes 118 papers from Nov.1997 conferences, ABC’97 Kobe and Fukui Satellite)
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Eds: Norio Fujiki & Darryl R.J. Macer
June 1998 ISBN 0-908897-12-X, 478 pp. October 1999 ISBN 0-908897-14-6 (Japanese), 320pp.
Ethical Challenges as we approach the end of the Human Genome Project
Editor: Darryl Macer, April 2000 ISBN 0-908897-15-4, 124pp. Cost: US$20 UK£12 NZ$30 A$30 C$30 ¥2500 NZ$35
Bioethics Education in Japanese High Schools (in Japanese only)
Editor: Darryl MacerApril 2000 ISBN 0-908897-16-2, 112pp. Cost: US$20 UK£12 NZ$30 A$30 C$30 ¥1000 NZ$35
Bioethics and the Impact of Human Genome Research in the 21st Century
Eds: Norio Fujiki, Masakatsu Sudo, & Darryl R.J. Macer March 2001 (English and Japanese bilingual, 350pp).
Cost: US$30 UK£20 NZ$40 A$38 C$40 ¥3000

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

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