Eubios Journal of Asian andInternational Bioethics
EJAIB Vol 20 (3) May 2010 ISSN 1173-2571
Copyright ©2010 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 Note: What is Medical? (2/2)
65Comparisons between Veterinary and
Human Medicine
65- Taka Fujii
Informed consent in the Practice ofOccupational Therapy
69- Katsuaki Yamano
What is medical according to Japanese tradition
71- Koichi Nishida
Do Mental Disorders Really Exist?
72- Toshinori Kitamura
Medicine and happiness74- Shuhei Taguchi
The concept of medicine: Reflections from the transitionof Japanese laws concerning medicine
76- Kazuto Inaba
Medical is medical if and only if it is practiced on
Axioms of Bioethics
77- M.A. Jothi Rajan, Arockiam Thaddeus & S. Vincent
What is Medical? Reflections from clinicalviewpoint and experience79- Shinryo Shinagawa
Proposal of the Nous Self Concept as a worldview for
the symbiotic integration of modern science82- Kayo Uejima
Pathogenicity, Perceptions, Misconceptions andPractices of Control in a Developing Nation96- Victor Chukwudi Osamor
Other information and conferences
102
Order form
103
ABC11 Singapore Conference 2010
104
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.
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 Note: What is Medical?
Papers from Kumamoto
Bioethics Roundtable (Part 2/2)
This extended issue of EJAIB has the second set ofpapers from the Third UNESCO-Kumamoto University
Bioethics Roundtable -What is Medical?-, held on 12-13
December, 2009 in Kumamoto, Japan. Abstracts forthese papers and others presented are on-line. The firstgroup of papers was published in March 2010 issue.
The paper of Osamor in this issue was notpresented in Kumamoto, but is related to the theme.
-Darryl Macer

Comparisons between
Veterinary and Human
Medicine- Taka Fujii, M.D., M.A.
Ph.D. student, Graduate school of Social and Cultural
Sciences, Kumamoto University, Japan
Email: tfujii-sag@umin.net

Moral Considerations for Animals
Firstly, I will consider the moral considerations
over animals. Definitions of these ethical positions
for animals are fundamental to ethical discussions
about veterinary medicine. There are eight major
positions I review: Radical Anthropocentrism,
Animal Protection, Animal Welfare, Animal Lovers(doubutsu-aigo), Animal Rights, Animal Liberation,
Biocentrism, and Biotic community centrism.
Radical Anthropocentrism
Basically, ―anthropocentrism‖ is a position that
believes humans are more important thananything else. There are some wide-ranging
variations in this position. In what we can call theanimal ethics area, Animal Protection, Animal
Welfare, Animal Lover, and Biocentrism are

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Eubios Journal of Asian and International Bioethics 20 (May 2010)grouped with Anthropocentrism.
RadicalAnthropocentrism is the total anthropocentric
position that denies considerations for all othernonhuman beings, and makes judgments for only
human beings.

（2）
（3）
（4）
（5）

Freedom from discomfort
Freedom from pain, injury and disease
Freedom from fear and distress
Freedom to express normal behavior

Supporters of Animal Welfare also feel that it isdesirable to shift to alternative experiments in the
future, if possible, through the 3Rs proposed by
English physiologists Russell and Burch in 1959.
The Three Rs are Replacement, Reduction and
Refinement.

Animal Protection
Animal Protection is an idea that promotes theprotection and love of animals as a social
responsibility. This idea is derived from primitive
passions of sympathizing with suffering or
exploited animals. Advocates of this position havespecial feelings for animals in close connection tohumans. There have been laws that protectedanimals, taking this position, for a long time, suchas for cats in ancient Egypt, and dogs in Edo
period Japan during the reign of Tsunayoshi
Tokugawa.
Today, the idea of protection specific to animals
can be lumped together under the term ―Animal
welfare.‖ The phrase ―animal protection‖ is shifting
more to protecting nature and also wild animals as
well. For some this concept of nature protection
takes on an anthropocentric stance because
supporters of this concept protect the naturalenvironment as public property, and select objects
and methods of protection for human survival, andfuture human generation‘s happiness.
Animal welfare
The World Society for Protection of Animals(WSPA) declares, ―Animal welfare is defined byboth the physical and psychological state of ananimal and the conditions in which it lives.‖
Animal welfare is an improvement of the quality oflife from an animal‘s point of view. Animal Welfare
derives from considering animals for protection
based on a scientific understanding of their habits
and actions, instead of merely loving animals
emotionally.
Animal welfare aims to prevent the suffering orinhumane killing of animals as much as possible,
and to allow the expression of natural behavioral
patterns of each species in their rearing. The Five
Freedoms listed in this table are international
standards of animal welfare.
（1） Freedom from hunger and thirst

Animal LoverI think that Animal Lover; 動物愛護 (doubutsuaigo) may be an unique-styled moral position foranimals represented by Chinese-Characters. It
includes both Animal Protection and Welfare,without regard to their differences.
Many
Japanese laws for animals are made up inaccordance with this position like the Animal
Loving Law.
Maybe, there is an idea of
responsibility for Animals as a duty, from human‘ssuperior status.
Animal Rights
This discussion originated in an attempt toextend the rights of humans to animals. In thisargument, animals are considered as beings, notjust mere objects, with independent inherent
values and equal moral rights and status.
Supporters of animal rights assert that humanbeings are under direct obligations to be kind toanimals and not to treat animals cruelly. Some ofthem limit the coverage to mammals only, as withTom Regan. For proponents of animal rights,
animals are beings that have non-reducible andunassailable values, not just being utilities for theinterest of others.
Animal Liberation
Animal Liberation is an argument proposed fromutilitarian views by Peter Singer. Singer argues
that a sentient being has a right to equalconsideration of interests and a person has a rightto life. He sets the feelings of pain and pleasure
as an index of moral consideration based on thefact that all vertebrate animals have similar
nervous systems.
Biocentrism
Biocentrism implies a philosophical centrality oflife.
All forms of life are equally valuable.
Biocentric thinking focuses on the well-being of alllife in the consideration of ecological, political, andeconomic issues. One of the most radical ones
was established by Paul W. Taylor. He said about
Biocentric thinking as follow.
(a) The belief that humans are members of theEubios Journal of Asian and International Bioethics 20 (May 2010)
Earth’s Community of Life in the same sense andon the same terms in which other living things are
members of that Community.
(b) The belief that the human species, alongwith all other species, are integral elements in asystem of interdependence such that the survivalof each living thing, as well as its chances of faring
well or poorly, is determined not only by thephysical conditions of its environment but also by
its relations to other living things.
(c) The belief that all organisms are teleologicalcenters of life in the sense that each is a unique
individual pursuing its own good in its own way.
(d) The belief that humans are not inherently
superior to other living things.
The moral consideration, from this outlook, isbased on the specificity of moral thinking or
judgments by humans. Therefore, it depends onthe fundamental differences between humans andother species.
Biotic community centrism
This is a concept based on holisticcommunitarianism proposed by J. B. Callicott.
Callicott attempted to rebuild Aldo Leopold‘s Landethic as a holistic environmental ethic. Land ethic
focuses on land, which is a biotic community, anddetermines the ethical quality of each existencefrom considerations about their effects for theLand.
In this position, there is no discussion of special
interests bring held in animals, but animal lives arevalued for the sake of balancing the ecosystem.
Endangered species are regarded as objects ofprotection. However, beings that are breeding too
much and upsetting the balance of the ecosystem
are regarded as targets of extermination.
Classificationofanimals…according
toFeeding States
Next, let us consider how to organize target
animals of veterinary practice. Animals can beclassified according to feeding state in Japanese
animal law. There are actually six classes: Pet
Animals, Display Animals, Farm Animals,
Experimental Animal, Wild Animals, and nonhuman-fed Animals.
Pet Animals are kept for companionship or
pleasure at home or school. Like humane
medicine, medical care for Pet Animals is provided
for each individual. Care for pet animals aims tokeep, recover and increase their own health. Inthat situation, the degree of care is mainly
determined by the paternalistic attitudes of theowner.
Choices of medicine are different
according to the owner‘s economic condition andpreference. These cares are based on the sprit ofAnimal Loving, especially Animal Protection.

67

Display Animals are kept for display, contact orsale, at zoo, shop, breeder or entertainment
agency. This sort of veterinary medicine is not for
Animals itself but for humans, behind thismedicine is the exploitation of animals by humans.
These cares are based on Animal Loving, inparticular Animal Welfare.
Farm Animals are kept for industrial use infarms or factories. Laws on Farm animals areunder the Ministry of Agriculture, Forestry and
Fisheries. In this area, policies are selected not
for animal‘s QOL, but for economically making
delicious meat products for humans. Common
veterinary medicine for Farm animals includes―diagnosis, treatment and prevention of disease‖,―direction for sterilization and improvement ofanimal‘s sheds‖, and ―meat inspection‖. This kindof medicine does not aim to help individuals, but tomanage health of all livestock as a entire
economic production system. Infected animal
usually do not take medical treatment to recover
their own health, and the animal is usually killed tomaintain the health of the group.
This medicine is supported by Animal Welfare.
However, in reality, there are some farmers whotreat farm animals as one of their family members.
Those people may have a view point of Animal
Protection.
Experimental Animals are kept for scientificexperiments at universities or research institutes.
Medical care for Experimental Animals is directedto achieve results of experiments for use to otherexistences, or just for knowledge. Caretakers do
not aim to increase QOL of each experimental
animal. ―The Japanese Standards for breeding
and safekeeping Experiment Animals‖ was set up
to prevent injury and disease, and to cure them,within a scope which does not affect experiment.
The ethical position of this type of medical
treatment is limited to Animal Welfare.
Wild Animals are living in the naturalenvironment. They do not depend on humans.
Though they are affected by human activity.
According to Japanese Veterinary Practice Act,
Wild Animals are out of the target of veterinary
medicine. Also there is a problem that no one canpay a medical bill for treatment of Wild animals.
Japanese veterinarians find it impossible to maketheir living by just providing only care for Wild
animal‘s. Public funds or NPO donors support
them.
Some medical activities aim to protect rare
species of wild animals, based on ideas of biotic
community centrism. Biotic community centrists
focus on rare wild animal species as protectedgroups. In some situations, the species that have

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Eubios Journal of Asian and International Bioethics 20 (May 2010)

too much population are considered targets ofextermination.
Some veterinarians provide medical care forWild Animals to save their individual lives, on thebasis of Animal Protection, Animal Rights orAnimal Liberation, which positions treat eachanimal as individual. Thus, medicines for Wild
Animals are derived from several different ethicalpositions.
Non-human-fed Animals are not kept byhumans now, because of abandonment or escape.
The Animal Law and Veterinary Practice Act ofJapan also exempts these kind of animals frombeing targets of protection and veterinary
treatment. Mainly, medical care for non-humanfed Animals are provided by a group of animal
philanthropists, outside the framework of Laws.
These sorts of activities are probably based on
moral considerations that treat animals as
individuals, like Animal lovers, Animal Rights orAnimal Liberation. A public work undertaken in
the name of dealing with non-fed Animals includes
killing stray dogs and cats. That work has its roots
in more radical Anthropocentrism. But, there aresome effects of Animal Welfare, regarding killing
methods, for example, not to treat cruelly and not
to cause pain.
In fact, many Japanese veterinarians especiallytake an Animal Lover‘s position. It may becausally-related to Japanese Animal Law‘sstandpoint, as Animal Lovers. Also in the eye ofthe law, Japanese veterinarian‘s business islimited to animals reared by humans. However,many veterinarians treat Wild animals and nonhuman-fed animals. And, many people act like ina position of Animal Lover, in the area of Display
Animals, Farm Animals, or Experimental Animals,
which belong to Animal Welfare‘s position
notionally. We can see some gaps between legal
working areas of veterinarians and practicalworking areas of them.

Comparisons between Veterinary and Human
Medicine
The general characteristics of veterinary
medicine can be also examined throughcomparing and identifying similarities anddifferences
medicine.

betweenveterinary

and

human

Similarities
At first, I point out similarities between them.
Medicine for Pet Animals aims to promote QOL ofevery single animal. This kind of veterinary care issimilar to normal medical care for humans,
especially children or incompetent person, in
terms of dependence of the being on other agents
such as owner or parents.
Public health and disaster medical care have
similarity in the care for Wild Animals. Activity of
public health aims to keep or promote the health ofpeople in local groups or country.
It gives
preferences for advancing the health of everybody
instead of each individual. At the time of disaster,
the medical care team is allowed to triage patients.
They emphasize efficient application of time,
medical resources and human labor to save thelargest number of lives, i.e., the utility of the whole
population is more important than individual
welfare. That point is similar to care for Wild
Animals. However, public health and disastermedical care are not based on biotic community
centrism, but utilitarianism.
Differences
I mention the differences between veterinaryand human medicine. Fundamentally, medical law
for humans sets up competent adults as targets
for medicine. In the case of animals, all of them
are treated as an incompetent existence by law.
Well actually, there are probably few people thatconsider all animals have no ability to makedecisions completely.
Many human medicines are provided for eachhuman as individuals and depend on patient‘s selfdetermination. Public health and disaster medicalcare are based on a holistic view, but both intend
to promote the health of the human species.
However, veterinary care aims not to respect foranimal‘s autonomy but to increase human‘swelfare in varying degrees, or to keep the health of
the biotic community. Any stage of veterinary careis controlled by humans. They must involve
paternalism by humans.
The targets of veterinary practice and ethicalpositions are separated by the rearing
environment instead of by the treatment strategy,
patients intention or the situation under whichsickness occurs. This is also a point of differencewith human medicines.
Conclusion
Medical care service is a kind of social pooled
security. That purpose is not limited to recover thehealth of an individual person. Like veterinary
medicine, human medicine includes not only

Eubios Journal of Asian and International Bioethics 20 (May 2010)
treatments to promote individual patient‘s QOL,
but also care that is based on other persons orthat aims to promote the whole population. In thecase of human medicine, people highlight patient‘sautonomy or the right of self-determination. This
review of veterinary medical care can promote us
to be aware of this blind spot.
References
Callicott, J. B. (1983). Animal Liberation: A Triangular
Affair, in Ethics and the Environment, eds. By Donald
Scherer and Thomas Attig, pp.54-67, 72. PrenticeHall, Inc.
Fujii, T. (2008). Tracking Back To The Origin Of Animal
Ethics. Social and Cultural Studies. Ⅰ . 87-102.
Kumamoto University Graduate School of Social andCultural Sciences.
Iliff, S. A. (2002). Remembering the Animals. ILAR
journal. 43. 38-47.
Nakano, K. (ed.) (1988). Jikken doubutsu nyumon.
(Primer of experimental animals.) (in Jpanese.)
Regan, T. (1983). The Case For Animal Rights.
Berkeley and Los Angeles, California: University ofCalifornia press.
Singer, P. (1973). Animal Liberation. New York.
Singer, P. （1993）. Practical Ethics second edition.
New York: Cambridge University Press.
Taylor, P.W. (1986). RESPECT FOR NATURE A
Theory of Environmental Ethics. UK: Princeton
University Press.

Reference web sites
e-GOV http://www.e-gov.go.jp/index.html
The Aldo Leopold Foundation http://landethic.com/
AWIC (Animal Welfare Information Center)
http://awic.nal.usda.gov/nal_display/index.php?info_c
enter=3&tax_level=1
Delta
Society
http://www.deltasociety.org/Page.aspx?pid=183
FAWC
(Farm
Animal
WelfareCouncil)
http://www.fawc.org.uk/
Japan Animal Police http://www.animalpolice.net/
Japan
Animal
WelfareSociety(JAWS)
http://www.jaws.or.jp/
Japan
Veterinary
Medical
Association
http://nichiju.lin.go.jp/index.php
Ministry of Education, Culture, Sports, Science andTechnology-Japan
http://www.mext.go.jp/
MinistryofHealth,LabourandWelfarehttp://www.mhlw.go.jp/
Ministry of the Environment http://www.env.go.jp/
Net
Vet
Veterinary
Resources
http://netvet.wustl.edu/
OIE(Office
InternationaldesEpizooties)
http://www.oie.int/eng/en_index.htm
UFAW (Universities Federation for Animal Welfare)
http://www.ufaw.org.uk/
WSPA International (World Society for the Protectionof Animals)
http://www.wspa-international.org/
WVA(WorldVeterinary
Association)
http://www.worldvet.org/

69

Informed consent in the
Practice of Occupational
Therapy- Katsuaki Yamano,
Registered Occupational Therapist (OTR), Saga Social
Insurance Health Care Facility for Elderly ―Sun View
Saga‖, Saga, Japan
Email:yamano0403@yahoo.co.jp

The purpose of this study is to grasp the
difference in way of thinking between a client
within the family and the medical caretaker about
disclosure in rehabilitation medical care. In thisstudy, I performed focus group interviews withprofessionals and clients engaged in medical
rehabilitation care. Based on these differences, I
consider how to present an ideal method of thedisclosure from the situation of the occupational
therapist.
The focus group interview started from 1:30
p.m. on 23 January, 2009. We used the meetingroom of the health care facility for the elderly. For
health and nursing care practitioners, clients andthe families, we asked for participation after we
explained it with a paper, and consent. The themeat the group interview is ―What kind of disclosure(explanation) should the medical caretaker do inorder to offer high quality medical rehabilitation?".
Six medical caretakers participated in this study(Nurse: female, 15 years of experience, whoworks at department of rehabilitation medicine in
hospital; Social Worker: female, 5 years ofexperience, hospital; Physical therapist: male, 5years of experience, facility; Occupational
therapist: female, 4 years of experience, hospital;
Care manager: male, 3 years of experience
three, facility). The author acted as the chairman.
Four people participated as client and the family(A: male, 50‘s, finger open fracture, outpatient, sixmonths after occupational therapy started; B:
Client C‘ wife , female , 60‘s, healthy; C is
hospitalized with lung cancer; two weeks after
physical and occupational therapy started at
hospital; D: Female 60‘s, Cerebral infarction left
hemiplegia, six months after physical andoccupational therapy started at hospital, and twomonths after physical therapy transfer at facility; E:D‘s husband, Male 60‘s, healthy).
We performed the interview by a plan of one hour
not to cause a delay in the duties of the medical
caretakers. However, it was forty-five minutes inreal holding time. In the analysis, we put down
remarks on the contents during an interview. Afterthe interview ended, we compiled it immediately
into a database then performed summarizing

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Eubios Journal of Asian and International Bioethics 20 (May 2010)

content analysis and an explicative content
analysis (Flick 2002).
There were three domains provided from afocus group interview with regards to a medical
caretaker‘s opinion of an ideal method of thedisclosure.
The first domain was "Significance of thedisclosure". Five items were extracted in thisdomain; 1) The disclosure is performed based ona contract. 2) We support the understanding ofclient. 3) We respect the right of client. 4) We
perform mediation with a client and physician. 5)
We confirm the understanding degree of the client
for the medical examination of the physician.
The second domain was "contents". Four items
were extracted in this domain; 1) For the therapy
explained the enforcement situation (such as
progress and the present conditions). 2) We don‘texplain prognosis definitely, because themotivation of the client deteriorates be of the
prognosis of the medical rehabilitation. 3) We
explained it (while regarding cooperation) with the
medical caretaker and nursing caretaker. 4) We
made much of opinion and the demand of theclient.
The third domain was ―methods of disclosure".
Eight items were extracted in this domain; 1) We
use a format that is determined by law. 2)(We
perform it mainly on explanation in the word of
mouth), because the letter of the format is small.
3) We give an explanation so we don‘t lose the willof client. 4) We set a place of the explanation. 5)
We explain it to the family of client. 6)We performthe explanation repeatedly. 7)(We entrust the
explanation of the occupational therapy to aphysician partially). 8)We inform with otherprofessions.
[methods:
explicative
content
analysis].
Regarding the disclosure for the client and thefamily, I extracted six items from four domains.
The first domain was ―frequency of thedisclosure‖. One item was extracted in thisdomain; 1) We want to ask a question without
hesitation. We want to reply at that time of thequestion.
The second domain was ―attitude of the medical
caretaker‖. Two items were extracted in thisdomain; 1) (We don‘t want the medical caretakerto take action just by following a legal system). 2)(The medical caretaker should make much of thedemand of a client and the family).
The third domain was ―trust for the medical
caretaker.‖ Two items were extracted in thisdomain; 1) The medical caretaker should work in acooperative manner with a client. 2) The medical
caretaker should work in a manner that (they can
explain to a client at anytime).
The fourth domain is ―contents‖. One item was
extracted in this domain; 1) We want to know thedegree of improvement of the client‘s mental andphysical dysfunction.
We think that perhaps occupational therapists
have the thought not to explain the prognosis.
Because, occupational therapists think that
"explanation of prognosis is a role of physician".
Occupational therapists catches "prognosis" as aconcept the same as "outcome". And it often
seems to be that the occupational therapist
regards explanation of "prognosis" for the client as
a very difficult explanation to make. Furthermore,
Occupational therapy practice is based on―prescription". Therefore we could think that itshould not be allowed for occupational therapists
to explain "prognosis" without permission byphysician. However, occupational therapists draft
occupational therapy plans by themselves. In theprocess, a occupational therapist sets short terms
or long terms goals. And along with theoccupational therapy planning, they may givesome aggression to clients directly. Clients andthe family request that they ―Want you to explain
prognosis" regardless of the type of job for a
medical caretaker. An occupational therapist sets
―goals" after having predicted the effect of theoccupational therapy. The ―goal" is worth being
equal with "prognosis" for a client. An occupational
therapist takes accountability for answering thedemands of the client and their family. We thinkthat accountability is to explain short term or longterms goals that we drafted along with regularoccupational therapy planning.
Occupational therapists make an effort tounderstand disability and the lifestyle for the client.
And we are going to offer the occupational therapy
that is most suitable for a client. However, a format(called ―Rehabilitation jissi keikakusyo‖ inJapanese) and a period set in laws andordinances are established by law in regards toJapanese rehabilitation medical care anddisclosure. Based on this format with consent by aclient and the family, we can receive a fee forhealth and nursing care services through theoccupational therapy. Furthermore, there is achronic understaffing of medical caretakers inJapan, so they can only perform minimal required
function. In other words, the disclosure of the
medical caretaker is performed minimally in orderto evade a legal dispute with a client and thefamily.
On the other hand, for a client and a family,such laws and ordinances and the contract matterare not important. A client and the family want totrust the occupational therapist, and based on theeffect of occupational therapy, their satisfactions
are met. The client who is going to plan to do
rehabilitation through occupational therapy, has tohave a long term relationship with a medical
caretaker. The occupational therapy is supported

Eubios Journal of Asian and International Bioethics 20 (May 2010)

71

by the mutual trust and confidence between the
medical caretakers, the client and family. Eachother can understand through occupational
therapy by replying client‘s demand repeatedly. As
a result, we think that we can offer appropriate
occupational therapy to satisfy the needs of theclient.

physician‘s attitude, and an attention intreatments. In the quotations from Taisokyo, there
are two points.
One is a relation between
environment in which someone lives and sickness.
Another is causes of sickness and treatments. I
think there is a concept of medicine based on
scientific thought in Ishinho.

Reference

2. The concept of medicine according to theidea of “mononoke” in The Tale of GenjiThe story book The Tale of Genji, is one of thebest known old writings in classical literature in
Japan (and the world). The ―mononoke‖s appear
in the book.
The idea of ―mononoke‖ came from Chinese.
However, the idea had changed in Japan. Thereis a characteristic of the idea of ―mononoke‖ in
Heian period. It is that ―monooke‖s were deeply
related to people. They thought that ―mononoke‖s
could be causes of disease. It is believed thatvengeful ghosts came to be ―mononoke‖s, andthey sickened people who were to blame.
Regarding this point, I think there is a concept of
medicine based on mystic thought.

Flick, Uwe. Qualitative Forschung. Translated by
Hiroshi Oda, et al,shunjusya,2002, Tokyo.

What is medical according
to Japanese tradition- Koichi Nishida, PhD,
Project Coordinator, Human Resource Center for
Innovation, Kumamoto University, Japan
Email: kouichi197853@yahoo.co.jp

Introduction
The purpose of this study is to consider theconcept of medicine according to Japanesetradition. The Chinese character of ―医‖ has two
main meanings, one regards medicine, another isabout alcohol. The former meaning is divided into
three meanings: (1) to cure a disease, (2) doctor,(3) spiritual medium. I think that meanings 1 and 2
are based on scientific thought, while the 3rd
meaning is based on mystic thought. I use―scientific thought‖ to mean considerations basedon empirical and systematic knowledge orapproaches, and use ―mystic thought‖ to mean
actions of understanding or creating meanings. I
think scientific thought aims at the body, while
mystic thought aims at the spirit. That is found in
the concept of medicine in the Heian period. I
focus on analysis of a medical book and storybook.
1. The concept of medicine according toIshinho
The medical books called Ishinho comprise 30
volumes. They are the oldest medical books inexistence in Japan. They were edited by Yasuyori
Tanba in A.D. 984. They consist of quotations
from various medical books on Chinese medicine.
In volume 1 of Ishinho, there is a general theory
on medicine. In addition, in the first chapter ofvolume 1, there is an outline of treatments. The
first chapter consists of quotations from six
Chinese medical books. This study focuses on
quotations of two Chinese medical books. The
books are Senkinyoho( 『 千 金 要 方 』 ) andTaisokyo( 『 太 素 経 』 ). In the quotations from
Senkinyoho, there are an outline of treatment,

3. Conclusion
Since ancient times in Japan, there have been
two concepts of medicine, one based on scientificthought and another based on mystic thought.
Prof. Shinmura points out that patients put their‗bodies‘ in doctor‘s hand, but put their ‗life‘ inspirits‘ or Buddha‘s hand in the early modern ages
in Japan 1 . In addition, he mentions that it isimportant for patients to understand or create
meanings of their lives. 2
I think that ―spiritual medium‖ means that adoctor should be a supporter for patients. Whenpatients face their diseases, they need tounderstand them and create meanings of theirlives. I think healthcare professionals should
support patients in their understanding andcreating meanings.
In conclusion we can say that medicine aims atbody and spirit synthetically.

11

Shinmura, T. (1989), Shi to yamai to kango nosyakaishi [The social history of death, disease, andnursing], Tokyo: Hosei University Press, p.21.
2
I think that there are similarities between the act ofunderstanding or creating meanings one‘s life and thenarrative approach in bioethics.

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Eubios Journal of Asian and International Bioethics 20 (May 2010)

Do Mental Disorders Really
Exist?
- Toshinori Kitamura, F.R.C.Psych.,
Professor, Department of Clinical Behavioural Sciences(Psychological Medicine), Kumamoto University
Graduate School of Medical Sciences, Kumamoto,Kumamoto, Japan
Email: kitamura@kumamoto-u.ac.jp

Mental disorders are defined using operational
criteria. The Diagnostic and Statistical Manual of
Mental Disorders (DSM) issued by the American
Psychiatric Association provides a concrete
example of this process. It enables clinicians tocommunicate both with each other and with clientsand serves as a very useful means of defining thetarget of clinical research. As an example of thecriteria operationalised by the DSM, the following
slides show you the diagnostic criteria for
depression.
Depressioniscalled―MajorDepressive Episode‖ in the DSM-IV [1]. It isdefined as being present if:
A) Five (or more) of the following symptoms
have been present during the same 2-week period
and represent a change from previous functioning;at least one of the symptoms is either (1)depressed mood or (2) loss of interest or pleasure.
1) depressed mood most of the day, nearly every
day, as indicated by either subjective report (e.g.,feels sad or empty) or observation made by others(e.g., appears tearful). 2) markedly diminishedinterest or pleasure in all, or almost all, activities
most of the day, nearly every day (as indicated byeither subjective account or observation made byothers)3) significant weight loss when not dieting or
weight gain (e.g., a change of more than 5% ofbody weight in a month), or decrease or increase
in appetite nearly every day4) insomnia or hypersomnia nearly every day5) psychomotor agitation or retardation nearly
every day (observable by others, not merely
subjective feelings of restlessness or being slowed
down)6) fatigue or loss of energy nearly every day7) feelings of worthlessness or excessive or
inappropriate guilt (which may be delusional)
nearly every day (not merely self-reproach or guilt
about being sick)8) diminished ability to think or concentrate, or
indecisiveness, nearly every day (either by
subjective account or as observed by others)9) recurrent thoughts of death (not just fear of
dying), recurrent suicidal ideation without aspecific plan, or a suicide attempt or a specificplan for committing suicide

Modern diagnostic definitions of mental
disorders are very precise so that clinicians canagree without difficulty on the presence orabsenceofeach disorderin patients.
Nevertheless, diagnostic agreement among
clinicians does not necessarily prove that mental
disorders exist.
Although operational criteria of mental disorders
were initially proposed as tentative definitions that
could be modified and changed if necessary,clinicians, students, patients, patients‘ family
members, the media, and others have come toview these disorders as actual, definite entities.
Traditionally, mental disorders have beengrouped into organic and functional categories.
Organic mental disorders are those in whichmental symptoms derive from dysfunction of thebrain or the entire body. Alzheimer‘s disease anddelirium are examples of organic mental disorders.
On the other hand, functional mental disorders arethose conditions in which mental symptoms exist
without obvious organic aetiology. Schizophrenia,
depression, and panic disorder are but a few
examples of functional mental disorders. Organic
mental disorders do not differ from bodily
diseases. The focus of my presentation, however,is what are traditionally called functional mental
disorders.
Some human conditions show a Gaussian
distribution, also known as a normal distribution.
For example, the distribution of a population‘s
intelligence quotient scores is bell-shaped, with apeak in the middle. Conditions characterized bythis type of distribution are thought to be
influencedbypolygenic
heritability
andenvironmental
factors.
Thus,
they
are
physiological. There are no pathological causes.
They are in the range of normal variation.
Other human conditions show exponential
distributions, in which most individuals show no or
only a few signs of the condition. A relatively small
number of people are affected to a greater degree.
Smoking, and specifically the number of cigarettes
smoked per day, may be an example of such a
condition. As with the Gaussian-type conditions
described above, these are also viewed asphysiological. Human conditions with exponential
distribution are normal. Cases that depart from themedian should be viewed as simply the result of
normal deviation.
The appearance of a hump somewhere on theGaussian or exponential distribution curves would
suggest the existence of pathology. It is known
that there exists a small hump on the lower, lefthand side of the intelligence quotient distribution.
This represents a group of conditions involving
mental retardation with organic causes. These
probably include cases such as Down‘s syndrome,
phenylketonuria, and others.

Eubios Journal of Asian and International Bioethics 20 (May 2010)
Therefore, it may be argued that if mental
symptoms in a large population show Gaussian or
exponential distributions, such symptoms should
be regarded as normal. If, on the other hand, there
exists a hump in the distribution curve, theexistence of pathological causation may besuspected.
Meltzer and colleagues [2] conducted a large
epidemiological study, the Office of Population
Census and Survey, to examine this hypothesis ina general population. Carried out in 1993, thisstudy examined some 9,500 community
inhabitants and enquired about 14 common
psychiatric symptoms such as depression, anxiety,and fear. The number of mental symptoms perperson showed an exponential distribution, with no―hump‖ seen. This suggests that psychiatric
symptoms are ―functional‖. There are many otherstudies showing Gaussian or exponential
distributions of mental symptoms.
What do these findings mean? You may feeldepressed after separation from a loved one orafter the loss of important things. You may as aresult meet the diagnostic criteria of Major
Depressive Episode of the DSM. Nevertheless,these feelings are normal. This may be comparedwith an analogy of increased body temperature(fever) after exercise. Fever after exercise could
never be accurately viewed as a disorder.
The second topic of my speech is dysfunction
as the definition of disorders [3]. Disorders may be
defined as conditions that involve some type ofdysfunction. An example is the pathology ofcancer cells. Regardless of the distribution ofcases in terms of severity, if the degree ofdysfunction increases as a condition becomes
more severe, the condition may be defined as adisorder. According to this definition, a more
severe form of the condition would be associatedwith poorer health, while a less severe form would
correspond to better health. If a human condition
were a disorder, one would expect a positive
correlation between severity of the condition andthe degree of dysfunction. Thus, perfect healthand normality may be defined as the absence ofsymptomatic conditions.
Are mental symptoms associated with
dysfunction? Contrary to your expectations, allhuman conditions that are defined in terms of
psychiatric symptoms have potentially adaptivefunctions. Therefore, such mental conditions arenecessary for human life. Such faculties should beviewed as abilities rather than forms of pathology.
I can show you some examples.
Depression may increase empathy towards
others. After the loss of a loved one, grief may be
a necessary step to recover from such a loss. You
may see as abnormal a person who never grieves

73

over the sudden death of a loved one. After a very
stressful situation, you may need a rest that may
be brought by depression.
Fear(phobia)may
reducerisk-taking
behaviours. In the long history of humanity, people
who did not feel fear towards snakes were more
likely to be poisoned by them. People who feelless anxiety near a high cliff are more likely to fall
off the cliff.
People who are overly concerned about disease
are termed hypochondriacal. But people who areconcerned about infection are more likely to takecare of themselves. They may wash their hands
when they return home. They may consult aphysician when feeling physical discomfort.
Hence, they can avoid being infected by viruses orare more likely to identify a serious disease earlyenough to take appropriate measures. People whoare less or not concerned about ill health are more
likely to
suffer from
diseases.
Hence,
hypochondriasis has the capacity to protect you
from ill health.
Even paranoia may lead to a diminished risk ofbeing victimized by theft, fraudulence, or perhaps
murder. People less concerned about thepossibility that their belongings may be taken
away may leave their jacket with a wallet inside it
in a vacant room.
While these traits may be maladaptive inexcess, their absence is similarly detrimental.
There is no dose-response relationship between
the degree of the condition and the dysfunction
caused by it. This is different from bodily
conditions such as cancer cell pathology.
To further my argument, I would like to think
about how to define dysfunction. Dysfunction is
not an integrated part of the individual.
Dysfunction appears in an individual in a specificcontext. For example, strong fear of snakes may
be dysfunctional today but it may have beenfunctional in the past. Therefore, it is not theperson but the society in which the person issituated that defines dysfunction. Hence,
dysfunction is a product of person-environment
interaction. If disorders are defined as conditions
that are dysfunctional, then there are people whoare disordered in some situations but healthy inothers. Such a way of defining mental disorders
cannot meet the requirements of science. It is
culture that defines which condition should beviewed as dysfunctional.
These considerations suggest the possibility
that there is no such thing as a mental disorder.
This is not to claim that professional mental healthsupport or treatment is not needed. You may
argue that medical professions treat people withdisorders. This is, however, not the case. Medical
professions treat patients. The definition of patient

74

Eubios Journal of Asian and International Bioethics 20 (May 2010)

differs from the definition of disorder. An easy
example is the case of hyperlipidaemia. People
with hyperlipidaemia do not complain of any
discomfort. They are not dysfunctional. And yet
medicalprofessionals
treat
peoplewithhyperlipidaemia. In psychiatry, mental healthprofessionals treat those people who feel anxious
while making a speech publicly. According to mypresentation, this is normal. And yet, cognitive
behavioural therapy is an established means oftreatment in psychiatry.
What are the disadvantages of viewing mental
conditions as disorders? Accepting the concept ofmental disorders as established fact, without
critical discussion, may lead you to accept or
recommend drug treatment that has only weakevidence of efficacy. You may stigmatise people
labelled as mentally ill. For example, people
labelled as mentally ill may be regarded asincapable of self-determination. This may result in
violation of human right and coerced treatment inpsychiatry. People who committed a serious crime
may be viewed as lacking criminal responsibility
once they are viewed as mentally ill and thus losea chance to participate in a fact-finding trial. This
may result not only in human rights violations but
also in an indefinite period of coerced treatment in
hospitals or of community commitment.
Considering that there is no such thing as
mental disorder (except for organic mental
disorders) may shed new light on the ethics ofpsychiatry.
References
1. American Psychiatric Association (2000) Diagnosticthand Statistical Manual of Mental Disorders, 4 ed.
Text rev. Washington DC: author.
2. Melzer D, Tom BDM, Brugha TS, Fryers T, Meltzer
H (2002) Common mental disorder symptom counts inpopulations: Are there distinct case groups above
epidemiologic cut-offs? Psychol Med 32:1195-1201.
3. Horwitz AV, Wakefield JC (2007) The loss of
sadness: How psychiatry transformed normal sorrow
into depressive disorder. Oxford: Oxford University
Press.

Medicine and happiness- Shuhei Taguchi,
Ph.D. Student, Graduate School of Social and Cultural
Sciences, Kumamoto University, Kumamoto, Japan
Email: shuhei.taguchi@gmail.com

Medicine and happiness have always been
important concepts in bioethics. However,
especially when we face some of recent bioethicalissues such as enhancement or some growthattenuations like Ashley treatment, we often turn
our attention back to those concepts and therelationship between them. Enhancement isgenerally defined as ‗Intervention on the humanmind and body for ―improvement‖ rather than―treatment‖‘.
The critical problems of enhancement are not
only what kind of enhancement is ethical, but also
what kind of interventions are improvement rather
than treatment and medicine. As a possibility of
medical intervention has been expanded, thesekinds of bioethical issues on the boundary of
medicine have increased. When we face withthese difficult issues in bioethics, we often requireconsiderationsor
confirmationofsomefundamental concepts such as medicine andhappiness of patients.
Firstly, I will confirm the concept of happiness.
Certainly, many philosophers have tried to figureout the concept and there is an enormous amountof research on it. However, basically, there are two
aspects in the concept of happiness, and mostphilosophers and researchers emphasize either an
objective aspect or subjective aspect. Ancient
Greek philosophers such as Plato and Aristotle
are in the position of representing the later.
Aristotle defined ―good‖ in terms of goal or
purpose which something or somebody moves.
Therefore, there are a lot of goods because there
are a lot of activities and goals. In regard to thispoint, he also mentioned ―supreme good‖ amongsuch a lot of goods. According to him, supremegood is one goal which we desire for its own sake,and we desire other things for its own sake, andwe do not choose everything for the sake ofsomething else‖ (Nichomachean Ethics, Book I,
1094a). He thought that only eudaimonia or
happiness can be this supreme good. In theancient Greece society, eudaimonia or happinessincluded both the notion of behaving well and thenotion of faring well. Therefore this kind of state
was described as fulfillment of human functions
and abilities and it means virtuous life. He alsomentioned common basic necessities of life andluck in addition to this, but fulfillment of human
functions and virtues are the most importantfactors of happiness.
Modern philosophers and researchers oftenemphasize subjective aspects. This is also a
concept as a goal but this is mainly related topleasure. Some concepts of mind related topleasure in their argument are sensations, moods
and emotions. Many researchers in this position
put emotions and moods above sensations. This
pleasure as emotion is often related to fulfillmentof preferences and desired acts. In addition to this,although some of them distinguish various
pleasures as emotions, most philosophers and inparticular utilitarians, distinguish some pleasurefrom the other in terms of quality and the amountof pleasure. In regard to this point, they emphasize

Eubios Journal of Asian and International Bioethics 20 (May 2010)
happiness is multidimensional. For example,
completeness, intensity, frequency, variety andduration are some dimension of pleasure.
These subjective and objective positions areopposed to each other but both positions provide
important insights into the concept of happiness.
In fact, these two are complementary positions. An
emphasis on multidimensional aspects is thesame as an objective position. Although a
subjective position criticizes objective theory for its
objective elements, subjective position depends
on some objective elements as long as it
distinguishes some pleasure from the other interms of quality and amount of pleasure. On theother hand, pleasure is also an important factor in
the subjective position. For example, although
Aristotle denied not only fortune and fame but also
pleasure as a state of happiness, heacknowledged that only pleasure meets most of
the requirements of supreme good and thatpleasure is accompaniment of happiness.
As Aristotle thought, there are a lot of goods asgoals, and the concept of happiness as a supremegood is the most inclusive goal in medicine. A goalof medicine includes various factors depending on
researchers or situations. However, it has
generally a commonality. For example, it includes
treatment and prevention of disease, pain relief
and diagnosis as a practical goal. At the sametime, maintaining and restoring of heath,improvement of QOL and best interests of patient
are also included. These concepts can be broader
concepts than some practical concepts.
As I already mentioned, the concept ofhappiness is the most complicated concept and it
is multidimensional. Then, it includes manyfactors, for example, common basic necessities oflife and luck. Therefore, the goal of medicine is notachieving a state of happiness but a contribution
to part of it. To see how medicine contributes tohappiness, I consider the concept of health.
Although all of those broader concepts are basedon and closely related to happiness, the conceptof heath plays the central role in this connection.
This is not only because health traditionally has
been regarded as a goal of medicine, but also
because the other two broader concepts cannot
deal with some ethical problems. The problem ofenhancement is one of the examples.
As I mentioned at first, one of basic problem ofenhancement is about the medicine/enhancement
distinction. In regard to this point, the concept of
QOL or best interest is not useful. This is mainly
because these concepts are basically openended. Certainly, these concepts are also
complicated and we have to examine thesecarefully. However, these QOL and best interests
arguments are basically similar to the concept of75

happiness in regard to this point. On the other
hand, as we will see bellow, there can be ideallyupper limits to the concept of health. Therefore,
we consider this kind of problem of distinction, andwe need the concept of health as a basic concept
to the other two concepts. In this sense, theconcept of health is more fundamental factor and it
is important to analyze this concept for figuring out
the relationship between medicine and happiness.
When the concept of health is argued about,subjective and objective factors are alsoemphasized. Subjective factors include, forexample, some feelings such as ease andwellbeing, or lack of some feeling such as pain
and suffering. Objective factors mainly means
maintaining abilities. Both aspects have causal
and conceptual connections. An example ofcausal connection is that a feeling of ease leads tofulfillment of abilities and feeling of pain disturbs it.
On the other hand, maintaining and fulfillment ofabilities leads to a feeling of ease and wellbeing.
An example of conceptual connection is thathaving pain and suffering means lack of abilities ina broader sense. However, lack of ability doesn‘t
always mean lack of feeling, for example somekind of coma. In regard to this point, maintaining
and fulfillment of abilities can be basic factor tosome extent. Here I will focus on the some theoryof health in terms of ability.
There are two different viewpoints on health as
maintaining and fulfillment of abilities. These are
analytic and holistic viewpoints. One of thesekinds of theory is elementalism and takes theanalytic viewpoint. This is often called biostatisticaltheory (Boose, 1977). They use statisticalmethods to try to identify typical abilities. In thistheory, states of health are defined as maintainingof statistically-averaged ability. Boose is in theposition of representing this, and not only as aphilosopher but also some scientists and medical
practitioners take this position. This idea ofstatistical average of abilities is a practical andimportant idea. However, this theory generally is
not sufficient in terms of justifying what kinds ofabilities are related to health.
In regard to this point, there are two kinds ofabilities in the philosophy of action. One is firstorder abilities and the other is second-orderabilities. First-order ability is an ability thatsomeone acquires through some kind of social
training. An ability of speaking a foreign language
is an example of such ability. A second-orderability is a basic ability for acquiring first-orderability. Ability of hearing and some kind of
intelligence are examples of such an ability. This
concept is almost the same as an innate
capability. Although these two abilities are difficult
to distinguish and partly depend on situations, this76

Eubios Journal of Asian and International Bioethics 20 (May 2010)second-order ability is related to the ability which
the concept of health includes.
Certainly, biostatistical theory regards thesekinds of abilities as abilities related to health.
However, this theory is based on biological
function and its goal and the range of such abilities
is relatively narrow. On the other hand, the othertype of the theory takes a holistic viewpoint andthe theory tries to figure out vital goals of humanactivities. This kind of position regards these vital
goals as human needs, goals set by the agent
himself, and welfare. Although biostatistical theory
is quite important in terms of practice, it needs this
holistic viewpoint as a theoretical foundation anddetermination of practical range of abilities relating
to health.
There are many arguments about these vital
goals such as human needs, goals set by theagent himself, and welfare in holistic positions.
However what is important here is that what these
positions factually regard as vital goals are almost
the same and that all of these factors are somesecond-order abilities for minimal happiness. As I
already argued above, the concept of happinesshas some dimensions, and the concept of minimal
happiness is possible. In addition to this, fulfillmentof some actions and abilities for those actions is
the most fundamental part of the concept.
Therefore, the concept of health is theoreticallyregarded as a state of maintaining and fulfillmentof some second-order abilities of acts forachieving minimal happiness. At the same time,
this shows the basic and conceptual relationshipbetween medicine and happiness. In regard thispoint, ideally there are upper limits to the conceptof health and we have to try distinguishingmedicinefromsomedoubtful
medicalinterventions such as enhancement and growthattenuations.
Here, I confirmed some dominant positions on
the concept of health and medicine. Then I also
confirmed health as a key concept in the basic andconceptual relationship between medicine andhappiness. Certainly we are required to give indepth consideration to many factors such as
second-order ability and minimal happiness, andthese can be some of the most challenging
problems. Philosophers or researchers may nothave given a sufficient answer. However, when weface with some bioethical issues on the boundaryof medicine, we have to turn our attention back tothis conceptual relationship between medicine andhappiness and this can offer basic framework fordealing with those problems.
References
4. Aristotle, trans. David Ross, 1998, Nichomachean
Ethics, Oxford University Press, USA.
5. Boose, C. 1977, ‗Health as a Theoretical Concept‘,

Philosophy of Science, 44, pp.542-573.
6. Nordenfelt, L. Y, 1995, On the Nature of Health: An
Action-Theoretic approach, Springer, 2nd edition.
7. Tatarkiewicz, W, 1976, Analysis of Happiness,
Springer, 1st edition.

The concept of medicine:
Reflections from thetransition of Japanese laws
concerning medicine- Kazuto Inaba
Professor, Chukyo University, Japan
Email: k-inaba@mecl.chukyo-u.ac.jp
1. Introduction
I would like put down some assumptions asfollows:
The law might support, and restrict the system.
The concept of medicine or medical treatment
might be restricted by the law.
I think that it is likely to be able to approach near
the central concept of medicine and medical
treatment by examining the restrictions. As it werethe constitution in the medical treatment the law of
Medical Care Law, we might be able to approachthe concept of the medical treatment by examining
the transition of Medical Care Law.
Next, we are going to analyze the concept of"Medicine or medical treatment" from the"Transition of Medical Care Law".
2. Object and Jurisdiction of the Ministry of
Health, Labor and Welfare
A law authorized the establishment of The
Ministry of Health, Labor and Welfare. This law
requires the jurisdiction of the Ministry of Health,
Labor and Welfare.
As the object of this law, Article 3 is: "To aim atsecurity and the improvement at the national life,
and to contribute to economic development, themaintenance of the environment that leads to theimprovement of social welfare, social security, andpublic health,”
And, as affairs under the jurisdiction:
Concern the spread and the improvement of the
medical treatment.
Concern guidance and the supervisor of the
medical treatment.
Concern the maintenance of the medical
institution.
Concern doctors and dentists.
But article 3 does not define in a substantial
manner "Medicine and medical treatment‖.

Eubios Journal of Asian and International Bioethics 20 (May 2010)
3. Enactment process of Medical Care Law (orMedical Law）
In the Diet, when a new law is enacted, and itchanges, the presenter (It is Cabinet and agovernment usually) explains the outline.
The government delegate in the 2nd Diet in1948 presented and explained the idea of Medical
Care Law, as the following:
What Medical Care Law targets:
The first: Hospital standard
The second: Clinic
The third: Facilities concerning associate
production
The fourth: General hospital
The fifth: License system degree of
establishment
The sixth: Public hospital established by the
local government.
The seventh: Advertisement
4. Transition of Article 1 of Medical Care Law
Transition of obligation of "Purpose" of Medical
Care Law of Article 1 and the idea of supporters.
In the past Article 1 provided "this law aim atsecuring the system to offer the medical treatment
and to contribute to the maintenance of the publichealth".
At present Article 1 provides, "this law aims atsecuring the system to offer the protection of the
profit of the person who receives the medical
treatment, good quality, and the proper health careefficiently, and to contribute to the maintenance of
the Public health that has it”.
"Protection of the profit of the person who
receives the medical treatment" and "Good quality
and the proper health care are efficiently offered"are of intermediate value and the method is added
though the final purpose "Maintenance of publichealth" doesn't change.
Paying attention to the patient‘s esteem anddignity, the doctor, the dentist, the pharmacist andother medical providers should treat persons in the
background of mutual trust.
The treatment might include the following, notonly treatment, but also disease prevention andrehabilitation under the good quality and being
appropriate.
In addition, on the intention of the person who
receives the medical treatment providers should
respect the patient‘s preferences. Treatment will
be offered in proportion to the medical facilities.
Treatment will be offered relating to other facilities
including the welfare.
Moreover, article 1-4 put responsibility on the
doctor, the dentist, the pharmacist, the nurse andother providers to be of good quality andappropriation. They have the duty to obtainunderstanding from persons who are being
treated.

77

5. Philosophy of law approach
Character and classification as social norm oflaw
6. Law sociology approach
More than 70 revisions to the Medical Care Law
have been passed. I would like to analysis the 13
revisions aiming at the whole change of the law
and 2 revisions. These include items such as
Hospital standards, Clinic, Facilities concerningassociate production, General hospital, License
system degree of establishment, Public hospitalestablished by the local government andAdvertisement.

Medical is medical if andonly if it is practiced on
Axioms of Bioethics
1*

2- M.A. Jothi Rajan , Arockiam Thaddeus and S.
3Vincent1
Department of Physics, Arul Anandar College,
Karumathur-625514, India.
2
Department of Zoology, Jayaraj Annapackiam College,
Periyakulam-625601, India.
3
Department of Zoology, Loyola College, Chennai600034, India.
Email: anjellojothi@yahoo.co.in

Introduction
Our 5-star hospitals have patients who havemoney but no disease and yet on the roadside andthe rural side many patients have diseases but nomoney. This is partly true for the state run
hospitals also. The obsession health for all by
2015 AD inevitably pushes our society towards
creating more medical schools; more doctors,
more ICUs, more gadgets (most of them
imported), manufacturing more drugs and phobias,
all these at the expense of a simple formula-edible
bread and potable water for all by 2015 AD. Now
we are in 2009 and let us list our successes inbringing good health to all, at least in India.
One of the major reasons for the failure of the
WHO dream (initially set for the year 2000 A.D.) is
the failure of the modern medical community toaccept the success of native medical practitioners
in bringing cures for incurable diseases, to go
further steps in the field of orthopedics, forexample. Modern medical science as any otherphysical or biological science has morally divided
the Indian society by depriving the dignity of labourof the traditional medical practitioners. This, in a
way has been called by some as a violation of

78

Eubios Journal of Asian and International Bioethics 20 (May 2010)

fundamental human rights and non-adherence tosome of the principles of bioethics and particularly
to the definition ―Bioethics is love of life‖ (Macer,1990). In this work we present the salient featuresof a case study conducted in Atchampathu village,
which is situated 5kms north of Madurai, Tamil
Nadu, India, where the practitioners adhere to theprinciples of bioethics in the field of herbal
medicine to cure hepatitis. We also present areport on the traditional practices for bone
fractures practiced in Poosaripatti, a village
situated to the north of Madurai, Tamil Nadu,
India.
Manjakamalai Atchampathu
The traditional practice of curing hepatitis byherbal medicine in this village has started 150
years ago. In the late 1950‘s the village was also
called ‗Hepatitis Atchampathu‘ and came into
limelight in the news of all India radio way back in
the year 1976. Almost 80% of the habitants of thisvillage belong to the same caste. Now only 6families are practicing this method as it is quite
interesting to mote that in 1960‘s the feescollected by the practitioner per patient was Indianrupee one and paisa twenty five (5 US cents) only.
This money is spent for two causes. The
practitioners charged 25 paisa for the treatment
and kept it for his/her own maintenance and theremaining one rupee is offered to Lord Murgan‘s
temple, in Tiruparankundram (a scared temple for
the Hindus situated to the south of Madurai) where
the poor are fed once a month. Is this not an
example of ―Sharing‖? But slowly this practice has
declined in modern days as we had from one of
the traditional families who are living in this village
for a long time. Now in 2009 the fees charged
ranges from Indian Rupees Fifty to Three Hundred(US$ 1 to 7).
The Curing Process
The patient who is affected with hepatitis cancome to the house of the practitioner at his/her
own time of convenience throughout the day andat the time even late nights. This reminds as of
Nicodemus in the Bible who went to Jesus for a
spiritual clarification, very late at night. Jesus waswell available for receiving the patient(Nicodemus) and clarifying his spiritual sickness
and curing him of his Jewish spiritual wants. The
availability of the physician in Atchampathu village
at all times is really one of the ethical values of aphysician, which should be followed with greatcare.
The practitioner asks some questions related tothe sickness of the patient (for example the colourof urine, any other related symptoms) knowing theseverity of the hepatitis case then the practitioner
applies a herbal powder mixed with water withhis/her own hands on the head of the patient.
While this is being done a camphor stick is lit
before the photo of the deity and holy ash is
applied to the patient on his/her fore head. This isfollowed irrespective of the religious faith of thepatient. This is a good sign of religious tolerance
and a basic step towards promoting religious
harmony in our country, where we are divided bycaste and religion. Is it not one of the bioethicalprinciples of starting inter religious dialogue, which
is one of the most important needs in our country.
The patient is given the herbal powder and is
asked to apply it three times on the same day atregular intervals. Now the practitioner‘s duty isalmost over. Before leaving the home of thepractitioner
thepractitioner
gives
some
instructions to be taken as precautionary
measures along with a pamphlet, which contains
the instructions to be followed by the patients for aminimum period of one month to a maximum
period of twelve months. One important precaution
for young couples is to avoid sexual intercourse
for a period of six months; this seems to protect
the health of the partners. In a way the dignity ofwomen is upheld by safeguarding her health fromthe contagious hepatitis. But the practitioner
cannot differentiate Hepatitis A from Hepatitis B for
both the causes the treatment is the same. The
treatment is a one day treatment. We wereastonished to hear from almost 675 villagers (whohad underwent the treatment once) in and arounda radius of 15kms at different age groups (9 years
to 82 years) that the success rate of cure fromhepatitis by this method of herbal treatment was
100%.
The Herb
Though the practitioners do not reveal the nameof the herb to the patients, it is a well-known
herbal plant that sprouts in the rainy season nearwater ponds. Now they are plucking and collecting
the plants in the rainy seasons and dry them andmake it in the powder form so that the herbal
medicine can be used throughout the years. We
came to know that some of the relatives of thesefamilies practice this type of traditional medicine intheir own places of settlement in other states ofIndia.
The Bioethical Lessons
The cures for the patient are coming from theaction of the herbs on the biological system or due
to the divine power possessed by the practitioner
or due to both remains a mystery and it is ascientific challenge that has to be researched in
the laboratories. The medicine is obtained ataffordable cost, the treatment time is less andmoreover the practitioner-patient relationship isrightly bonded and this bonding of faith in theEubios Journal of Asian and International Bioethics 20 (May 2010)
practitioner is high in this type of treatment. Evenin Tamil Nadu there are so many like Atchampathu
where traditional medicines are practical not forbusiness but for the ‗beneficence‘ of the patients.
Orthopedics Cure Poosaripatti
There is a village named Poosaropatti which isabout 80 km west of Madurai city in India. This has
been practiced since 1750 AD. The traditional
practice for all types of bone fractures adhering to
the principles of bioethics is one of the numerous
examples of Indian Traditional Medicine. The
patient who suffered a bone injury is brought to the
traditional practitioner. Both the patient and thepractitioner sit on the floor. The practitioner sees
the nature of the fracture and does somephysiotherapy to put the bones in the right position(without the aid of the x-ray). The patient is boundover with a bandage in the afflicted part of the
body. After 24 hours from the time of putting the
bandage locally made oil has to be applied foranother 20 to 30 days. If the patient is an aged
person special oil is applied. The cure for thebones is almost achieved within 42 days
depending on the nature of the fracture. The
maximum fees charged do not exceed US$ 25 inany case.
The bioethical lesson that has to be learnt fromthese traditional practitioners is:
1. The treatment is economical (doing goodto all irrespective of wealth)
2. The patients are not treated after sunset
because, they say that if the patient is treated aftersunset he/she cannot bear the pain as some pain
killing injections have to be administered
immediately for which there are no provisions inthis village or in the nearby villages. They do not
put injections to the patient. This is practice of highethical standards.
3. The practioners maintain an impartial
relationship with the patients (Justice).
Conclusions
The sad news about this type of treatment donein Atchampathu is that almost all the practitioners
are affected by some kind of bodily ailments
especially skin diseases. These practitioners
sacrifice their lives for the betterment andharmonious living of patients affected by hepatitis.
It is our ardent desire to take up this work
exhaustively and find the scientific reason behindthe skin diseases of these practitioners, which isan ethical concern of us who live here in the
Atchampathu village. We would like to conclude
that as we envisage the field of diseases andmedicines, if western practitioners can take thegood from the traditional practitioners, humanbeings pertaining to the lower strata of the79

developing countries will not be at loss with
infections diseases and it is never late for us toturn back and move forward.
Acknowledgment
The tireless work of Mr. S. Kethirapalu of
Atchampathu village is highly appreciated for his
narration of the history of the village and taking us
to different parts of the village. We appreciate Mr.
Mani who is a traditional practioner for bone
fractures of the Poosaripatti village for narrating
the history of the practice.
References
1. Darryl RJ Macer, Bioethics is Love of Life: Analternative textbook; Eubios Ethics Institute, New
Zealand, (1998).
2. Kothari M.L, Mehta L.A., White/might has rights:
apartheid and health; Journal of
Postgraduate
Medicine 30(2) 1984: 65.

What is Medical?
Reflections from clinicalviewpoint and experience- Shinryo Shinagawa, MD
Hirosaki University School of Medicine, Hirosaki, Japan
Email: shinryo@smile.ocn.ne.jp

To discuss on ―what is medical?‖ is almost thesame as to discuss ―what is medicine?‖. Medicine
is a product of human society and civilization, andalways changing – usually developing but
sometime degenerating and retrogressing.
Medicine relates very closely to natural factors
such as climate, biosphere and human factors
such as economy, politics, religion, philosophy,
ethics and so on.
The aim of medicine is usually said to be: (a) toimprove the health of people; (b) to achieve
prevention of preventable diseases; (c) to detectand treat diseases in curable stages; (d) to turnincurable diseases into curable ones; (e) tominimize unnatural and unwanted injuries anddeaths of people.
However, there are many other definitions ofwhat is medicine. Someone says ―medicine should
cover whole fields of health and disease, not onlyof humans, but also of animals and plants,
furthermore of water, air, earth and space. On theother hand, among health care specialists
medicine means very often ―internal (non-surgical)
diagnostic and therapeutic methods‖ or ‖modern
scientific pharmacies‖.
I am neither a bioethicist nor a philosopher but aclinician, more exactly a surgeon, radiologist, and80

Eubios Journal of Asian and International Bioethics 20 (May 2010)a pathologist. During WWII, I was a medical
student in Sendai, Tohoku University School of
medicine.
After WWII, I trained mainly in
Department of Obstetrics and Gynecology,
Tohoku University School of Medicine, andthereafter, I worked as a teacher and a practitioner
in Hirosaki University and her related hospitals
around 40 years. This paper is based on my own
experience.

Perinatal and Peripartum Center, RadiologicalCenter, Rehabilitation Center, Intensive Care Unit,
Departments (hereafter ―D‖) of Anesthesia, D. ofThorax Surgery, D. of Brain Surgery, D. of CardioVascular Surgery, D. of Reproductive Medicine, D.
of Nuclear Medicine, D. of Molecular Biology, D. of
Cellular Biology, D. of Nuclear Biology, D. of
Cellular Pharmacology, D. of Geriatrics, and D. ofPerinatology.

“Medicine” and “Health Care”
Today, the term ―health care‖ is more common,and is used more widely in Japan than ―medicine‖
not only in the public language but also among
physicians.

4. Health Care policy and Medical Education inJapan
Since the Meiji Restoration (in 1868), theJapanese Government took a policy of DeAsiatification and Euro-Americanization (脱亜入欧). And health care was controlled by the Domestic
Ministry ( 内 務 省 ) while education of doctors,
midwives and nurses were organised under the
direction of Ministry of Education (Culture andScience 文部省). Up-to 1937, we had no Ministryof Health and Welfare (厚生省).
To obtain a license of a doctor, we must study inand graduate from a medical university or college,
and from premedical course in high school where
Ministry of Education authorized.
The old Domestic Ministry consisted of eight
departments. They were departments of national
security police, local administration and economy,
construction of roads, bridges, harbors and so on,
issues relating to shrines and religious,
geographical studies, finance, and public healthand hygiene. For a long time, the main subjects
dealt with by Department of Public Health andHygiene of Domestic Ministry was prevention andcontrol of infectious diseases such as cholera,pest, measles, diphtheria, typhus abdominals,
leprosy, tuberculosis and so on, lowering of Kakke(脚気) patients and infant and maternal mortality,
and the elevation of national nutrition level.
In 1937, however, under the strong influence ofNazis in Germany and at the request of the Army
who hoped to have more healthy youngsters, theMinistry of Health (and Welfare) was founded.
Needless to say, the Ministry of Health (andWelfare) was placed under the strong control ofJapanese Army. From July of 1941 to July of1944, the seat of Minister of Health (and Welfare)
Ministry was occupied by Army General.
After WWII, the Ministry of Health (and Welfare)metamorphosed into today‘s style of a Central
Government Office for the health and welfare ofwhole Japanese people from the time of being anembryo/fetus to senile/later high-agers, along aline of Post-war Constitution, especially of Article
25.

The Three Sectors of Health Care
In a wider sense, health care can be classified
into three sectors. They are the popular sector,
the folk sector and the professional sector. Since
the 1870s in Japan, the professional sector ofhealth care was done under the strong influence ofGermany and U.S.
In the popular and folk sectors health careremains up-to date very widely.
They are
Shintoistic practices of rinsing the mouth, washingfingers and hands, sprinkling by the use of salt
and/or salt water, purification of whole body in thebaths, in running streams or river, or under awaterfall.
Probably the most important hygienic habit
among Japanese people is to take off their shoes
when they come back to their homes, and when
they visit shrines, Buddhism temples, Japaneserestaurants and so on. One of the reasons why
we Japanese succeeded to realize the longest life
expectancy is this habit.
3. Specialization of Postwar Medicine
When I was a medical student, in Tohoku
University School of Medicine, only 22 professors
taught us. They were specialized in anatomy,
histology, physiology, biochemistry, pathology,
bacteriology, hygiene, pharmacology, medical
jurisprudence (law medicine), internal medicine,surgery, obstetrics and gynecology, pediatrics,
ophthalmology, otorhinolaryngology, dermatology,
venereal diseases, and psychiatry. On the other
hand, departments of X-ray and radiology, and oforthopedics, and Institutes for Tuberculosis andLeprosy, and Institute for Space Medicine were
founded in 1942. But after WWII, specialization
progressed greatly, and today in Tohoku
University Hospital more than 60 professors areworking and teaching.
More exactly, after WWII, under the strong
influence of American medicine, more than 30
specialties were newly founded. They are: Clinical
Diagnostic Center, Surgical Operation Center,Eubios Journal of Asian and International Bioethics 20 (May 2010)
5. The bright and dark side of Modern HighTech Medicine
Modern medical technology such as X-rays,
magnetic resonance imaging (MRI), computed
axial tomography (CAT) scans, and advanced
fiberscopic technics has radically not only altered
our sense on the human body and clinicalpractice, but also changed the doctor-patient
relationship and health-care economy.
Modern high-tech medical technology has had
major social and economic costs for those who
use it. It is increasingly expensive to buy, tooperate, to maintain and repair. It needs speciallytrainedtechnicians,
maintenanceworkers,
repairers and supervisors, as well as a constant
supply of electricity and a reliable source of spareparts.
On the other hand, diagnostic technologics has
also led to the creation of a new tier of ‗patients‘.
These are the products of (diagnostic) technology
such as strips of ECG paper, X-ray plates orprintouts of blood tests. Sometimes they are thefocus of more medical attention than the patientsthemselves. For some health professionals these‗paper patients‘ are as interesting - or even moreinteresting – than the patients themselves.
Abnormalities can now be detected by thesemachines at the cellular, subcellular, biochemicalor even molecular level, even when patients haveno clinical (or abnormal) symptoms at all.
Indeed now, high-tech medical machines areplaying role of physicians very often. Doctorpatient relationship is now revolutionarilychanging. A new Doctor － Expensive High Tec－
Patient triangle relationship should beestablished. Needless to say, how to maximize
the number of enjoyable people is the mostdifficult problem.
6. The “Crisis” in Today’s Medicine
Here I would like to introduce an outline ofexcellent description of Prof. Cecil G. Helman‘s“Culture, Health and Illness” (2007, page 104-5).
Today many believe that modern (Western)biomedicine is in crisis despite its many successes
in preventing and treating disease, alleviating
suffering, and increasing life expectancy.
In
recent years a growing public dissatisfaction has
been reflected in increasing complaints against
doctors, and litigation, media campaigns against
the medical profession, and the increased
popularity of non-medical and alternative healers.
There are several reasons for this. Modern
medicine has largely eradicated the major killer
infectious diseases in most Western countries andprolonged life-expectancy increased. However, asa result, more people are now living long enough81

to suffer from the chronic diseases such as
diabetes, hypertension, cancer, arthritis, neuromuscular disturbing, mental disorder and so on.
Now we are living in an era of ―revenge of thechronic‖.
At the same time, the costs of medical care are
growing because of the escalating costs of
hospitals, modern high-technology, drugs, medical
bureaucracies, staff salaries, training, litigation andmalpractice insurance. In most societies theserising costs exaggerate the effect of the unequal
distribution of health resources in the population,
dividing them even further into those that canafford full medical care and those that cannot.
Doctors in Western medical system are undergoing major changes in their traditional roles andin what is expected of them. Like other healthprofessionals, doctors are now expected to becompetent in a wide variety of roles. These
include those of manage, education, computer
specialist, bureaucrat, government (or medical
insurance company) employer, technologist,
writer, financial expert, businessman, judge,
ethical expert, advocate for patients, family, friendand confident, as well as healer.
Often they are expected to behave as secular‗priest‘, in their own ‗temples of medical science‘,even when they have no pastoral training to do so.
7. Roles of Health Care Professionals,
Especially of Doctors
Health care professionals, especially doctors,
are now expected to be competent in a variety ofroles. These include those of being a manager ofhealth care facilities or of hospitals, educator of
medicine, excellent biomedical scientist /technician, computer specialist, biomedical
ethicist, health-care bureaucrat, health insurance
system specialist, health-financial specialist, and aprotector of human rights, especially of patient‘srights.
In many countries, furthermore, many doctors
believe that ―protection of environment, avoidanceof terrorism, and abolition of mass-destructive
ABC-weapons‖
are all their professional
obligations.

82

Eubios Journal of Asian and International Bioethics 20 (May 2010)

Proposal of the Nous Self
Concept as a worldview for
the symbiotic integration ofmodern science- Kayo Uejima, M.A.
Ph.D. Student, Graduate School of Social andCultural Sciences, Kumamoto University
Email: kayo@lablink.jp
1. Overview
In this paper, I try to explain in detail from aphilosophical perspective the design of the NousSelf concept.3 The most important viewpoint that islacking in science is the linkage between thewhole and part as well as the position andstandpoint of each scientific domain as a whole. I
attempt to show a linkage between the whole andpart as well as position of each scientific domain in
the whole with the Nous-Self Concept. This means
symbiotic integration of worldview in various
scientific domains with the Nous-Self Concept as auniversal policy that can contribute to attainmentof the Millennium Developmental Goals (MDGs)
for construction of a sustainable society.
Symbiotic integration of science and philosophy
with a comprehensive exploration needs
collaborative work of a lot of diverse people rather
than one genius for construction of sustainable
society. Because, progress by collaboration ofinternational diverse people rather than progressof only one genius can contribute to concrete
construction of sustainable society. Though I will
later write more scientific detailed evidence about
the Nous-Self concept, I only propose the NousSelf concept that becomes a foundation of a newworldview as a scientific and ethical direction for
MDGs by arrangement of scientific concepts toedit various modern scientific domains withphilosophy.
In short, I suggest the Nous-Self concept forcontribution to universal policy concerning
construction of sustainable society. The Nous-Selfconcept aims at one of fundamental frameworks
for creation of new ethical standards. This isbecause the Nous-Self System is formed bysystemic physiology as an organism. At the sametime, the Nous-Self Process is formed by aprocess of interaction between consciousness andthe social system.
3

This paper also links to my contributions to report ofWorking Group 2 (Ethical worldviews of nature) andWG3 (visions and hopes of the nature) in Ethics andClimate Change in Asia and the Pacific (ECCAP)
project in UNESCO Bangkok.

In this paper, Nous shows the notion that links
to the universe. Nous also shows infinite and selfrule by continuous motion of itself. At the sametime, Nous shows the intelligence of living
universe as noetic.
Self shows the notion that links to individualfrom the universe. Information shows the notionthat links to transformation of form between Self
and Nous for emergence and evolution between
individual and universe. If the individual self withspatial structure has an open system as organism,
individual self becomes a partial system ofuniverse as whole system. If an individual self withspatial structure has nesting hierarchy as the
being, individual self becomes the universe as
itself. This means macrocosm and microcosm that
cosmos exists outside and inside Self. Self withnesting hierarchy as the being has a boundlessopen system as the organism. Nous-Self concerns
the form of organism as a notion.
The form of organism as a notion derives from
metaphysics of Aristotle. Lancelot Law Whyte(1995) indicated that the form as a notion has themeaning of shape, configuration, structure,pattern, organization and system of relationships.
Whyte (1995) indicated the need of naturalphilosophy for integration of spatial form in
multiple process in physics, biology, psychology
and art.
In the case of molecular biology, scientists
consider that DNA base sequence operates andcontrols the form of organism. What operates andcontrol the form of DNA base sequence
throughout body?
In the case of biophysics, biophysicists
considers frequency, wavelength, phase of wave
and field as well as DNA base sequence operates
and controls the form of organism. What operates
and control the form of wave sequences?
In the case of sociology, sociologists consider
that social system operates and controls form
concerning organization of individual as organism.
What operates and control the form of social
system?
In the case of psychology, psychologists
consider that cognitive system or the relationshipbetween individual and others like anotherindividual, society, transpersonal etc operate andcontrol the form of individuality. What operates
and control the form of individuality throughout
consciousness?
The above concerns the holon structure of form
concerning self-organization and self-sustainment.
A confused state of modern science andtechnology as well as philosophy for underlying
solution of ethical problem derives from lack ofcomprehensive direction to elucidation of
mechanisms for linkage of each level concerning
each holarchy like the above.

Eubios Journal of Asian and International Bioethics 20 (May 2010)
In other words, the one of the most importantscientific enigma is a mechanism for linkage ofeach level concerning each holarchy like theabove. In short, how does a level of holon link toother holons?
Thus enigmas go back to ancient Greek
philosophy. For example, in the case of Aristotle,
the key notion for solution of thus enigma ismotion for organization of organism. Meanwhile, inthe case of Plato, the key notion for solution ofsuch an enigma is Idea as information for processof organism. In the case of cosmologicalperspective by Aristotle, while organism gradually
repeated self-organization for generation of form inindividual organism, all occasions in selforganization created a systemic process as
wholeness in the limited space and time. In thecase of self-organization by the organism, Aristotleemphasized the functional world rather than thegeometrical world*. In other words, Aristotle had ascientific perspective as a functional system oforganism.
The difference between functional world andgeometrical world links to the difference between
life as the being and the living creatures as the
becoming. The life as the being links to theoperation concerning motion. The living creatures
as the becoming link to function concerning
autocatalysis. The autocatalytic cycle becomes asystem for adjustment of entropy for the
becoming. The living creatures balance thedecrease or increase of entropy concerning
irreversibility i.e. adjustment between nonequilibrium and equilibrium needs the creation of
autocatalytic cycles. This autocatalytic cycle
creates function in the system. Multilayer functions
as Energeia by autocatalytic cycle accelerate theself-organization as Enthelecheia. The process ofdifferentiation of functions and differentiation offunctions for self-sustainment creates spatial
structures. This means that the one of the mostdifficult scientific enigma is elucidation of
mechanism
concerning
emergenceof
autocatalyst.
By biological discovery and physical discovery,
scientists of advanced system theory attempt toelucidate scientific enigma like the above byintegration of notions between motion andinformation. In the case of physics, a Russianscientist, Ilya Prigogine (1980) who was familiar
with ancient Greek philosophy including Aristotle
and Plato, aimed to integrate the functional world
and the geometrical world. In other words, heaimed to integrate between functional systems asorganism and information theory with entropy as
the dissipative structure theory that showed
direction of advanced system theory. About thefunctional perspective of Aristotle, Prigogine

83(1980, p.4) indicated as below: “We see theprogressive organization of a biological space inwhich every event proceeds at a moment and in aregion that make it possible for the process to becoordinated as a whole. This space is functional,
not geometrical. The standard geometrical space,
the Euclidean space, is invariant with respect totranslations or rotation. This is not so in the
biological space. In this space the events areprocesses localized in space and time and not
merely trajectories.” In short this suggests a
dissipative structural theory as potential order andmeasure about irreversibility as well as systemic
linkage in each holons of organic holon.
Ervin Laszlo (2004) suggested Akashic Field
theory for integration of various scientific domains
and thought as well as comprehensive direction
for elucidation of mechanism for linkage of eachlevel concerning each holarchy. Meanwhile,
though Laszlo (2004) showed a process of linkage
between individual and universe in his theory as
well as comprehensive direction for solution ofscientific enigma, he didn‘t show the process andsystem of organism concerning Self. Self becomescore of every occasion and phenomenon. Everyoccasion and phenomenon derives from the Self
as organism.
Therefore, in this paper as a proposal of Nous
Self concept, I aim my proposal of thefundamental vision of Nous-Self Concept byarrangement of notion of process, system andinformation in order to complement the Akashic
field of Ervin Laszlo.
2. The self and care
The care concept by Takao Takahashi (2008) isan example of a holistic approach withcosmological inclination can be adapted to various
scientific domains and social systems in order toaim at a concrete solution of ethical problems for
future generations. Thus I aim to create a concept
like Takahashi with a holistic integrative approachas a naturalist with cosmological inclination as
contribution of philosopher to diverse society andpeople as well as nature.
The Nous-Self System is needed for researchand development of medicine that are based theattribution of human-beings including systemic
physiology of human-beings. Most ethicalproblems in material civilization derive from lack ofperspective of systemic physiology as anorganism in modern western science.
In the Nous-Self System, all occasions as
continuance of moment affects systemic
physiology. The self is center of all occasion.
Therefore, I defined self as: “The self is thesynthesis that is created by momentary andcontinuous interactive relationship between

84

Eubios Journal of Asian and International Bioethics 20 (May 2010)society and individual organism that nature andcosmos enfolds.”
Depending on the definition of self, I havedesigned a lot of diagrams, only some of these areincluded in this paper. My intention for
construction of sustainable society is creation of asocial system where human beings can harmonize
with nature, diversified society and pluralist
culture.
At this time, the core concept of the segmented
scientific and philosophical domains is the selfconcept. Then, systems theory is effective as amethodology for editing achievement by modern
science and modern society. Because, at thistime, only both self-concept and system theory arecross-sectional ideas in society, science andphilosophy. By utilizing systems theory, forsuggestion of new self-concept that can be utilized
as actual universal policy, creation of self concept
concerning systemic system as organisms is mygoal. Because human beings are multicellularorganisms that live in society on the Earth that is
enfolded by the Universe. This means need ofconcepts of all systems including social system,
natural system, cognitive system, etc. Whileutilizing the concept of all systems for elucidationof an organism, elucidation of systemic physiology
in Nous-Self concept as an organism can link to
the important direction of science and philosophy
for actual contribution to construction ofsustainable society.
Ervin Laszlo (1987)
suggested Grand
Evolutionary Synthesis as a direction of scienceand philosophy that can suggest actual
construction of sustainable society by interaction
between philosophy and science like mysuggestion. He considered science that had ascientific system. Therefore, he indicated the needand idea of elucidation of scientific system fordirection of social evolution.
As universal policy for construction ofsustainable society, elucidation of systemic
physiology as an organism is needed. For
elucidation of systemic physiology, achievementsof the segmented scientific domains is needed.
Therefore for editing scientific components, I
suggest a framework of Nous-Self concept by
Nous-Self System and Nous-Self Process withachievements of system theory.
3. Nous-Self Process
The fundamental ethical problem derives from
attribution of human-beings. For comprehensive
explanation of the relationships between thefundamental ethical problems and attribution ofhuman-beings, I had designed the following
diagram while I consider the consistency of two
diagrams and the flow about transformation of
information concerning mechanism of formation ofoccasion. Figure 1 illustrates the Nous-Self
Process. Figure 2 illustrates the Nous-Self
System.
I have already explained the theoreticalbackground about the foundation of Nous-Self
Process as process of self in my paper (Uejima,2008). Individual self as atman with microcosm is
the integration of various social holons including
process as part in whole which has subordinate
and integrative function to the upper holon associal humans. Human beings each have a social
holon.
1) Economic holon: economic material value thatlinks to reward and benefit.
2) Political holon: belief that links to control ofsomeone by acquirement of power.
3) Educational holon: educational morals that links
to relativity.
4) Diversity holon: there is relief by belonging thatlinks to stabilization and dependence of mind.
5) Bio organization holon: Body awareness inbody with spatial space as organisms concerning
psychophysical operation
6) Earth holon: collective unconsciousness, souland nature as cooperative by organic network
7) Universe holon: Spirit, Oneness, Emptiness,
Nothingness, Something Great as creation by
universe
From 1-4 compose social holons, while 5-7
compose the Organic holon. Meanwhile, there is aboundary zone in the process between social
holon and organic holon. The boundary zoneshows the limitation of cognitive system withsystem of perception in species. In addition, aboundless zone in process means the initialboundary conditions of boundary from boundary to
infinity. The initial boundary conditions of the
Universe are that it has no boundary. Thisboundless zone also means not only philosophicaldifferences between metaphysical concepts andempirical concept but also the biggest scientificenigma for elucidation of scientific mechanism forformation to substance from wave for formation
concerning emergence and evolution*1.
Furthermore, I add the following explanation
about holons that human-being can recognize as
occasion by cognitive phase transition of
information* with ―Nous-Self Process‖ that I had
designed as matrix.
(1) Physical transition of information concerns
formation of social holon.
(2) Molecule transition of information concerns
formation of holon of bio- organization and holonof earth in organic holon.
(3) Causal and subtle transition of information
concerns formation of holon of universe.
When we observe ethical problems of
medical ethics and bioethics as well as
environmental ethics with Nous -Self Process, weEubios Journal of Asian and International Bioethics 20 (May 2010)
can understand the gap between the social holonof the above boundary zone and organic holon of
the below of boundary zone (Figure 1). In short,though the organic systemic system that emerges
in life concerns organic holons, a social system
focuses on social holons. Though ethical problems
concerning medical ethics and bioethics as well as
environmental ethics derives from disharmony
between organic holon and social holon, as far associal system keeps on focusing on developmentsof social holon, humans cannot solve fundamental
ethical problem.
By the way, Gregory Bateson (1979) showedthat information is any difference that makes adifference. In other words, our perception canrecognize only information as difference. In thecase of our perception concerning affordance asremarks of J.J. Gibson (1979), we can recognize
information as difference that various perceptions
as the observer configure in a dynamic process ofcommunication between the environment asobjective others and subjective self with spatial
structure. Thus perspectives show viewpoints asobservers. We can recognize each object byrelative comparison of object as differentiation.
In short, our cognition needs to classify
objects in nature with the essence of wholenessby differentiation. The classification with thus
cognition becomes the viewpoint of the observer.
Our cognition has the limitation of perception as
species. It is important that we always awake our
cognition about classification of occasion including
nature. Therefore, about classification by our
cognition as viewpoint of observer, each color in
Nous-Self Process (Figure 1) shows the object
that we recognize and classify.
If we lose perception or transform perception,
what can we recognize in occasion including
nature? One of answers to this question folds inour recognition with condition of coma as
remarked by Arnold Mindel (1989).
4. Nous-Self System
4.1. Philosophical ideals
Philosophy emerges from culture, religion,
mythology and lifestyle in a diversified society.
Philosophy is folded in society. Therefore,
philosophy affects the mindset of human-beings.
As a result, philosophy affects behavior of humanbeings. Philosophy affects the meta cognition ofpeople. After Takao Takahashi (2001) investigated
the influence of philosophy to students in highschool, he discovered some concept of modern
western philosophy affected the value of Japaneseyouth regardless of awareness. Thus influence ofmodern western philosophy to youth shows thepossibility that affects to meta cognition ofscientists. Therefore, suggestion of direction of85

philosophy as well as science is the mostimportant.
The suggestion of a new worldview for directionof science and the intention of construction ofsustainable society is the most important role ofphilosophy. This also is the most important
purpose of ethics.
(1) The distinction between modern western
philosophy and eastern philosophy
At first, a simple distinction between modern
western philosophy and eastern philosophy is in
Table 1.
Table 1: The difference of concepts between
modern western philosophy and eastern
philosophy
Modernwestern Eastern philosophy
philosophy










Dualism
Reductionism
Rationalism
Materialism
Humanism
Analytical
Individuality
Happy as individual
System











MonismHolismIntuitionism
Organismic
Cosmology
Holistic
Community
Harmony as whole
Process

The origin of modern western philosophy aswell as modern science was Ancient Greek
philosophy. Ancient Greek philosophy had bothcharacteristics of Table 1. Meanwhile, the origin of
Eastern philosophy is Indian philosophy. Of
course, religion, mythology, culture and lifestyle ofdiversified society affected the philosophy of eachnation. Therefore, derivation of two mainstreams
became religion, mythology and culture of eachnation. However, characteristics of philosophies indiversified minorities of Mongoloids are close toeastern philosophy. From an anthropological
viewpoint, traditional philosophy in the world had
an organic perspective as the characteristics ofeastern philosophy. In short, organic perspectiveof eastern philosophy leaves behind the archetypeof human-beings. Khroutski (2007) indicates that
distinction between modern western philosophy
and eastern philosophy has distinctions between
rational and realistic.
Secondly, Table 2 shows achievement anddetriment of material civilization. Material
civilization that I use adapts to sensate culture by
Pitirim A. Sorokin (1941). He indicated that the first
generation of sensate philosophy was Descartes,
Lockes, Kants, Humes or Comtes. The second
generation was scientific philosophy and ideational
or idealistic system by potential Kants and Humesof philosophy. The linkage between modern
philosophers since Descartes and modern

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Eubios Journal of Asian and International Bioethics 20 (May 2010)

scientists since Newton affects development andproblem of modern material civilization in Table 2.
The detriment by modern material civilization
concerns the lack of concepts of eastern
philosophy that Modern western philosophy lost or
downplayed. Meanwhile, achievement by modernmaterial civilization is based on contribution tomodern western philosophy. This means the limitsof modern western philosophy, material civilizationand modern social systems.
The distinction between modern western
philosophy and eastern philosophy means thepossibility that relationship between modern
western philosophy and eastern philosophy
becomes gestalt in social cultural system. Thismeans that the relationship between modern
western philosophy and eastern philosophy
becomes relationship between yin and yang.
4.2. Transcendence of material civilization bysymbiotic integration of modern western
philosophy and eastern philosophy
The symbiotic integration of western philosophy
and eastern philosophy can contribute totranscendence of material civilization. This is themost important task in modern philosophy. In spiteof Preference Utilitarian, Singer (1993) indicatedneedofcosmologicalperspectivefor
transcendence of self as social animals in ethicalperspective.
However,his
cosmologicalperspectiveissimilarwithcosmologicalperspective in pure reason of Kant. In short,
Singer as well as Kant focuses on process of
consciousness for solution of ethical problem.
Pitirim Alexandrovich Sorokin (1965, p.842)
indicated prognosis of the shape of integral
sociology to come as future direction of sociology
andhesuggestedasupersystemfortranscendence of sensate culture.
At first, for symbiotic integration between
accomplishments of modern western philosophy
and eastern philosophy, I utilize the mind-set of yin
and yang in Tao. Chinese traditional philosophy
like theory of yin and yang and the five elements
thought yin and yang as worldview. Yin and yangis close to thought of gestalt in cognitive processof western thought. Though gestalt concerns
cognitive principle for influence of dualism, Yin andyang as holistic and cosmological approachmeans fundamental principle that constructs
human, society and nature that is enfolded bycosmos. Yin and Yang emphasize balance as
whole that means holistic harmony. In this paper, I
emphasize balance as whole between modern
western philosophy and eastern philosophy forsuggestion of new mind-set for science and policy.
Secondly, for symbiotic integration of modern
western philosophy and eastern philosophy aswell as ancient Greek philosophy and philosophiesof diverse minorities, I attempt creation of new selfconcept. Self also is a core scientific concept.
Therefore, creation of new self concept can link to
not only symbiotic integration of diverse
philosophy but also various scientific domains.
Indian philosophy like Advita philosophy of
Sankara elucidates all occasion in process of Self
with universal approach including integrative,
holistic and cosmological perspective. Eastern
philosophy considers self as process in nature andcosmos as evolution for creation including lightand shadow like Shiva or Tao or Nothingness as
Mu or Wu or Bhava. Meanwhile, ―Know of thyself‖
was philosophical theme by sophists including
Socrates.
Thirdly, I use a genealogical chart of systemtheory. The origin of system theory was Aristotle.
While system theory affects philosophy, systemtheory contributes logical direction and symbiotic
integration of science. At the present, a core ideaof system theory is an open system. However, inspite of suggestion about open system, classicalsystem theory elucidates classical open systemwith boundary. This logic is inconsistent. The
inconsistent idea of classical system theory isderived from reductionism of modern western
philosophy. If scientists of system theory explore
logical open system, they need to consider
interaction between universe and individual self as
well as social system, natural system andcognitive system. Thus inconsistent idea is thepotential task in modern science. Because, thispotential task is derived from a lack of mindset of
metaphysics or cosmology. For solution of thisproblem,Laszlo(1980)
founded system
philosophy.
Fourth, for transcendence of scientific mindset,
symbiotic integration between modern western
philosophy and diverse philosophy is needed. For
transcendence of scientific mindset, I suggest
elucidation of Nous-Self System with systemic
physiology. Nous is word of Ancient Greek
philosophy. Curd (2007) indicated the meaning ofnous that Anaxagoras suggested at the first:“Nous has control over all things that have soul,both the larger and the smaller.” This suggests not
only a perspective that Anaxagoras took theactions of humans and animals as the model for
how nous controls the cosmos, but also aperspective that nous differs from the otheringredients. This is the nous that Aristotle, Plato,
Anaxagoras indicated concerns cosmology andmetaphysics. Nous-Self System as my suggestion
becomes the reinstalling of metaphysical andcosmological concept in scientific concept thatmodern science rejected for oppression by Church
as a remark of Erwin Schrodinger who wasEubios Journal of Asian and International Bioethics 20 (May 2010)

87

Table 2: Some achievements and problems caused by material civilization concerning modern western
philosophy
Achievements with modernization by modern western
philosophy, science and technology(Achievement by material civilization)
The development of science and technology
Much knowledge by modern scienceMany artificial materials by science andtechnology

Virtual linkages by information technology
A material rich, convenient and comfortable
lifestyleRich and convenient lifestyle by using muchmaterial and energyThe progress of globalization by development of
capitalismStabilization of democracyExpansion of western ideas and civilization withcapitalism and democracy by globalization
Spread of centralist and bureaucratism

Human dignity and Human Right
Spread of modern education and English
Spread of western medical care

Detriment with modernization by modern western
philosophy, science and technology(Detriment by material civilization)
Social problem that cannot be controlled bydomestic and international law and moral (e.g. useof atomic weapons in war)
Destruction of environmentDiscrimination of minorities concerning
identify of cultural and ethnic communities

Decline of social responsibility
Growing economic disparity
Collapse of culture and rural community
Lack of linkages and communication to wild
nature
Decline of real sense of life and community
as a natural creatureDecline of body awareness and functions as
natural creatureDecline of spontaneous healing ability as
natural creature
Lack of holistic wisdom as like Tao and asense of ethics

88

Eubios Journal of Asian and International Bioethics 20 (May 2010)

Eubios Journal of Asian and International Bioethics 20 (May 2010)

the founder of quantum theory or a remark ofGeorg Henrik von Wright.
Founders of quantum theory like Erwin
Schrodinger, Georg Henril von Wright and David
Bohm were affected by Indian philosophy. W.K.
Heisenberg who was founder of quantum theory
was affected by ancient Greek philosophy.
Quantum theory was derived from mindset ofIndianphilosophy
andancient
Greekphilosophy. George Henrik von Wright (1981)
indicated a direction for explanation of sciencetranscendent that concerns metaphysics. While
Sorokin (1965) traced about view concerning
consciousness by authority of quantum theory,
he prefigured that development of quantum
theory affected not only social system but alsosocio cultural system.
The symbiotic integration between modern
western philosophy and oriental philosophy aswell as suggestion of Nous-Self concept aims toshow direction of science and policy forconstruction of sustainable society in order to
aim to contribute achievement of MDGs.

89

5. Ethical significance of the Nous-Self
SystemThe hypothesis of Nous-Self System withsystemic physiology of human-beings asorganisms has mechanisms for externalsustentation as external physiology andmechanism for internal sustentation as internal
physiology concerning homeostasis in body as
spatialstructure.
Konstantin
Viktorovich
Sudakov (2008) tried to demonstrate system
quanta that meant specific operators in the
dynamic activity of the organism's functional
systems discovered by P. K. Anokhin with
scientific experiments about neurophysiologicaland neurochemical mechanism.
In our time, material civilization that is basedon material consumption including process for
supply of product and energy has spread in theworld by globalization from westernization.
Material civilization gives not only efficient andconvenient lifestyle with rich products but also
spreads economic disparity. Meanwhile, modern
humans keep on losing not only bodyawareness but also contact to nature andvarious physical motions by work and90

Eubios Journal of Asian and International Bioethics 20 (May 2010)

ambulation in modern lifestyle. As the result,modern humans keep on losing physiological
function for sustentation of homeostasis
concerning spontaneous healing system.
Thoughsciencecancontributetodevelopment and spread of material civilization,science cannot show fundamental methodologyof ethical problem like destruction of communityand communions of environmental destruction
and chronic disease.
Science emphasizes scientific evidence as aquantity for reproducibility by linkage withtechnology. As the result, most scientists also
research physiology in partial systems with thecontrolled
experimentallaboratory
andlaboratory animals or the simulated model bycomputer. Scientific evidence concerning
physiology that is developed and discovered
with the controlled experimental laboratory andlaboratory animals or the simulated model bycomputers becomes fundamental of product andtechnology including drug and medical
technology. The research of evidence as aquantity in a short period concerns therelationship between a partial system andphysiology in a controlled experimentallaboratory is not more difficult than research ofevidence as quantity in relationship between theactual whole system and physiology.
In the latter situation, one of scientificmethodologies is epidemiological study. Thoughepidemiological study generally is designed after
emergence of some ethical problems likepollution or environmental assessment forscientific judgment in court or policymaking, due
to difficulty in reproducibility as epidemiologicalstudies tend to be considered more weaker thanscientific evidence gathered in the controlled
experimental laboratory. However the results will
be different when they derive from differences
between a whole system and a partial system as
a topic for investigation or research.
For example, as damage by pollution links todamage of the whole system, epidemiologicalstudy or environmental assessment treats therelationship between physiology and wholesystem as possible. Neil Cherry (2001) wrote anenvironmental assessment for a lot of people
including victims in the world*2.
The bias becomes a problem in
epidemiological study and environmental
assessment. Especially, the problem of bias
concerns cognition of victims about pollution.
For example, if victims are familiar with pollution,
a victim might claim more serious damage about
pollution which is a bias. This shows thatscience focuses on natural system that is basedon quantity as physiology of human-beings byinfluence of dualism and rationalism. Actually,

human-beings have both natural system andcognitive system as well as a sociocultural
system as an organic system. Therefore,
response of body by knowledge of pollution andrecognition of stress for emergence of social
problem like pollution is normal. However, mostscientists or physicians downplay bias as aproblem of mentality caused by trauma that
affects the response of victims.
In short, this shows lack of ethicalawareness in scientists or physicians as well as
ethical problems in science caused by dualism
and reductionism that has the trend of reduction
to individual problem in spite of whole social
problems. Scientific explanation by quantity
about response or narrative of victims is difficult.
Because, trauma and narratives of victims
contain relationships between the whole systemand pollution concerning damage, statisticalanalysis that is based on deviation by linearly
analysis with quantity of partial system in a shortperiod that scientists or physicians utilize inepidemiological study and environmental
assessment cannot describe transformation in
nonlinearly dynamic process of whole system inlong period. The consistency between nonlinear
phenomenon and linearly statistical analysis
becomes a mathematical task. Instead, there iscase that origin of transformation in individual
data rather than the analyzed data showstransformation of whole system. Because eachindividual has wholeness. Furthermore, whenscientists select analytical methods, subjective
assessment by scientists affects the selection ofanalytical method and data for analysis. This
analytical method and data by scientists
becomes an ethical bias rather than bias
concerning recognition of victims.
In sum, it is difficult that science controlled
by dualism and reductionism deals with problem
concerning whole system. After Jahn andDunne (2001) classified science concerninginteraction
betweenmind
andmatterconsciousness as tangible physical module(moduleT)andcoconscious
mind
module(module C), they indicated the limitationsof science concerning materialistic view andneed of comprehensive quantitative science.
The proposal of direction for transcendenceof the above limitations of science byreductionism and dualism is elucidation ofsystemic physiology as Nous-Self system. The
transcendence of limitation of modern sciencecan contribute to construction of sustainable
society. This means targets of integrative
science as science of ethics. Systemic
physiology as Nous - Self system is useful for
epidemiologicalstudy
orenvironmental

Eubios Journal of Asian and International Bioethics 20 (May 2010)
assessment as well as design of policy forconstruction of sustainable society.
The actual systemic physiology also closely
relates not only to the natural environment but
also socio culture.
4.4. Perspective map for suggestion of NousSelf System (Figure 3)
1) Philosophical significance of perspective map
My purpose of perspective map is close to
the following suggestion of Werner Karl
Heisenberg (1984) who discovered theUncertainty principle in quantum theory, wholamented the circumstance that physics wasimitated in modern philosophy by boundaries,
and he indicated that scientists needed researchin the limited domains. Then, while he suffered
for contributions to development of atomic bombin Germany in his youth, he indicated thatbalance between scientific truth and religious
truth needed for integration in self and for ethicalsolution by development of science andtechnology.
While George Henrik von Wright (1981)
recognized the significance about causal
explanation, he indicated attribution of domain
by causalist like Wiener is function, purpose(fullness), and organic whole (systems) inbiology. Scientific elucidation of the natural
system is facilitated by development ofbiophysics as well as development of molecularbiology for development of observationequipment of quantum. Therefore, Nick Lane
(2000, p.571) indicated a distinction between
physicists and neuroscientists. Lane indicatedthat quantum physicists tried to elucidate
consciousness for failure of providing a physicalbasis for consciousness by molecular biology.
Karl H. Pribram (1982, p.29-30) who isfounder of the holographic model of brain
indicated the relationship between mentality andbrain about fundamental problem concerningobserver of natural science as below:“(1) Brain, by organizing the input from thephysical world, as obtained through the senses,
constructs mental properties.
(2) Mental properties are the pervasive
organizing principles of the universe, which
includes the brain.
Paradoxically, almost all behavioral andneuroscientists would today subscribe to someform of statement one, while, as noted above,statement two reflects the belief of many of themostinfluential
theoreticalphysicists.
Mathematicians have faced the dilemma more
directly: how is it that the operations of theirbrains so often describe faithfully the basic orderof the universe they perceive? “91Thus the distinction between quantum
biologists and molecular biologists is distinctionof research topic by their mindset concerning
their worldview concerning philosophy inscientists*1. Therefore, if symbiotic integration of
their research achievement is possible, what
scientific perspective can we get?
Forsuggestion of Nous-Self System to scientists
from my standpoint as a philosopher, I designed
a perspective map (Figure 3) for expression offlow-chart of concept on the base of logicalconsistency and mind-set concerning scientificidea of scientists concerning system theory with
their autobiography as well as the paper ofscientists. In the case of logical consistency,
each scientific concept shows modules in thescientific system as one of the cultural systems.
In short, if we think of science as a scientificsystem, each scientist becomes an element aswell as scientific domain becomes partial system
in scientific system. Because science is one ofpartial system in social cultural system asremarked by Sorokin (1965) and Ervin
Laszlo(1987).
One of the important roles of philosophy isholistic arrangement of scientific knowledge andsuggestion of scientific direction. Because
philosophy becomes one of meta cognition inscientists. Only verbal expression has limitation
for handing on and spreading. Therefore, I
designed perspective map as methodology for
elucidation of Nous-Self System by collaborationof diverse people on the future. For suggestionof the direction of science on the future, nobody
can keep on sustentation of logical coherenceby collaboration between scientists andphilosophers for a long period without a flowchart concerning definition of each scientificconcept by diagram. I had designed perspective
map for symbioses as integration of science andphilosophy as well as relationship between
science and philosophy by cognitive process ofhuman-beings
byliteraturestudy
asphilosophical method.
Philosophical concepts are folded in scientificconcept. Scientists utilize philosophical ideas
and philosophical concepts in order to develop
and discover new domains of science.
Meanwhile, a lot of scientists that are familiar
with philosophy indicated limitation of science.
The concept of Autopoiesis that Humberto
Maturana and Francisco Varela suggested
derive from auto – αυτό for self- and poiesis –ποίησις for creation or production by Aristotle.
Hence, holistic arrangement of modern
scientific concept is possible by investigation ofmind-set concerning meta cognition of scientists
with word as scientific concept in paper and their

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Eubios Journal of Asian and International Bioethics 20 (May 2010)

idea in their autobiography. Of course, holistic
arrangement of all modern scientific concepts is
impossible by myself. Therefore, I focus onsome frequently-used concept in genealogicalchart of system theory that shows scientificrelationship between whole and part segmented
scientific domain.
Explanation and construction of framework ofNous-Self System needs achievements ofmodern system theory and a full scientificexplanation of the concept is being publishedseparately.
I designed a Conceptual schema (Figure 4)of science and thought by Nous-Self concept forsymbioses as Integration of science and thoughtby nesting hierarchy of self for integration ofscience. Each colour in the conceptual schema
adapts to each colour of Nous Self process as
cognition of human-beings. 4 I designed theperspective map and Nous-Self System as baseof classification of each holon with holon
structure of conceptual schema.
The perspective map (Figure 3) is a flow
chart of each concept in nesting hierarchy withholon structure of concepts itself by metacognition and mindset of scientist andphilosophers that I read and elucidated.
Therefore, the definition of each concept shows
the process of concept of right side and lower
level. Furthermore, concepts of lower pink color
show concepts that are developed by quantum
theory in genealogical chart of physics.
Concepts of yellow colour show concepts thatare developed by system theory in genealogicalchart of biology. Concepts in green show
concepts that are developed by environmental
science in genealogical chart concerning
solution of environmental problem. Concepts inorange show concepts that are developed bysociology
andpsychology
likethebiosychosocial system by Don Edward Becknd
and Clare W. Graves that is frontier of social
system in genealogical chart concerning solutionof social problem.
Information concepts in blue show concepts
that are developed by information theory thatdevelops
interdisciplinary
domainofmathematics, physics, neuroscience, biology,
engineer, cognitive science and social sciencein spite of background of mathematics andelectronic engineer. In other words, information
concepts
includingconcepts
concerning
dissipative structure are bridge concept that canlink to mathematics, biology, psychology andphysics including Newton mechanics and4

Refer to the pdf file of the electronic version of
EJAIB for colours.

Quantum mechanics or natural system,
cognitive system, social system.
Concepts of darker pink show philosophy or
thought concerning Nous-System theory that
describes circulation of flowing of meta cognitionof scientists and philosophers between
philosophy and quantum theory in perspective
map.
5. Discussion
The operational implications of the theory
are further explored in another paper. Here wecan discuss some of the implications.
At the present, modern science canelucidate process, network, structure andfunction in partial system or element withstatistic or objective and scientific proof inelaborate designed experiment and calculated
method. Though demonstration about themechanism of the whole system that can be
integrated into natural system, cognitive systemand social system with objective quantity isdifficult, I attempt to integrate natural system,
cognitive system and social system by NousSelf system with systemic physiology as
hypothesis.
Since systemic physiology of human beings
has a dynamic web of networks andmultilayered loops that is formed by linkages ofcomplex systems, distinctions between molecule
biology and quantum biology mean different
observations to gradual transition in processconcerning transformation of information. Thisdifference shows the following distinction ofperspective about self-concept.
In the case of molecular biology, thisconsiders interaction between the living creatureand natural environment. Meanwhile, in thecase of quantum biology, this considers
interaction between the living creature andexternal environment including nature anduniverse as well as Fields. The distinction ofboth derives from difference in the viewpoint as
observers. While perspectives of molecularbiology and quantum biology have lack ofperspective of interaction between society andliving creature, Luhmann (1981) focused on
elucidation of mechanism of social system insociety without perspective about interaction
between society and nature as well as cosmos.
Thus modern western science with
reductionism causes new ethical problems
about enhancement of human-beings as
species concerning spread and development of
new technology like nanotechnology. Wolbring(2009) indicated a need for a much broader,holistic analysis of the impacts of science andtechnology developments as direction ofEubios Journal of Asian and International Bioethics 20 (May 2010)human-beings as species and relationshipbetween human-beings and other species.
Khroutski (2006) emphasizes elucidation
about process of interaction between society
and nature as well as cosmos for future directionof science and philosophy. Laszlo (2004) aims
to integrate accomplishments of molecularbiology and quantum biology as well associology and physics. The actual occasion in
actual reality world emerges from multilayer
loops that is formulated by complex andhierarchical linkages in element, partial system
and various networks like Nous-Self system(Figure 2). A system with structure that means
the integral of the order and measure forformation of organization repeats functionaltransformation for sustentation of organization.
Conclusion
In this paper, I suggest the Nous-Self concept
as a new worldview for construction of asustainable society. The Nous-Self concept iscomposed with Nous-Self process and Nous Self system.
At first as my conclusion, in the case of
systemic physiology of Nous-Self system,
systemic
physiology
concerns
scientificelucidation of spontaneous healing system andprocess of coma. The elucidation of
spontaneous healing system and process ofcoma show the direction of medicine for actual
construction of sustainable society.
Second, I hope that the scientificphilosophical elucidation about mechanism ofNous-Self concept by collaboration of diverse
people in the world as well as linkage of diverse
people for elucidation begins to show a way likeTao for tangible construction of suitable society.
Konstantin S. Khroutski indicated the important
intention about harmony between holistic
approach and reductionism as below in peer
review of this paper: “We need not transcend
reductionism, but need to develop our holistic
approach in symbiose with reductionism, taking
its useful results as the means for the realizationof the goals of Nous-Self System constructions
and Nous-Self Process effects.”
The spread and development of symbiotic
integration of science and philosophy for
harmony as whole can gradually constructactual sustainable society. Finally, I suggest the
final ethical target of Nous-Self concept as Love
becomes fundamental for self-awareness as
new ethical standard with daily ethical practicethat diverse individual people gradually create
sustainable society in each lifestyle and society.
Because Love is folded in life as remarks ofDarryl Macer (1998).

93

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Acknowledgements
Since first design of Nous Self System as diagram andconcept 6 years ago for solution of environmental ethicalproblem and construction of sustainable society, I keep on
researching the mechanism of Nous Self System byachievement of modern western science and philosophy indiverse people. Of course, I recognize that I cannot
elucidate the precise scientific mechanism of the Nous Self
System with comprehensive philosophical perspectives.
Therefore, a lot of diverse experts around the world haveeducated and supported me. I recognize that I cannot
suggest the Nous Self System in this paper without
collaboration by diverse people.
I express my deepest gratitude about daily guidanceand support of Dr. Takao Takahashi who is supervisor in96

Eubios Journal of Asian and International Bioethics 20 (May 2010)

Kumamoto University, Dr. Darryl Macer who is expert ofbioethics in UNESCO Bangkok, Dr. Konstantin S. Khroutskia Russian philosopher, Dr. Michael Anjello Jothi Rajan who
is a physicist and bioethicist, Dr. George Joseph a Indianphilosopher, Dr. In-Suk Cha a Korean philosopher.
Especially, I cannot write this paper without their daily
guidance and support. I feel so happy for encountering anddaily contacting to them.
Then, I also appreciate the following people. Dr.
Susumu Tanabe a mathematician in Kumamoto University,
Dr. Gregor Wolbring a biochemist and ethicist of Canada,
Dr. Tamotsu Suzuki an architect and engineer, Dr. S.
Pannerselvam an Indian philosopher, Dr. Ramesh R.Varieran expert of the advanced Ayurveda, Dr. Antony Paul
Gnanasekaran an Indian historic philosopher, Dr. Lee
Yasuhiko a physician of Eastern alternative medicine, Dr.
Masakazu Kitano an economist.
Finally, I express my gratitude for a tree and forest as
well as sky, GAIA, friends and my parents from my spirit.

Malaria and Sterile Insect
Technique (SIT):
Pathogenicity, Perceptions,Misconceptions andPractices of Control in a
Developing Nation- Victor Chukwudi Osamor, Ph.D
Department of Computer and Information Science(Bioinformatics Unit), College of Science andTechnology, Covenant University, P.M.B. 1023, Ota,
Ogun State, Nigeria
Email: vcosamor@gmail.com

1. Introduction
The feeding habit of several insects has been
linked to several diseases that plaguehumankind today. Among these disease vectors
is the fatal human malaria infection which is
initiated when an infected female Anophelinemosquito–Anopheles
gambiae,injects
sporozoites during a human blood meal. Afterinjection, sporozoites enter the bloodstream andgo to the liver, where they invade hepatocytes
and develop into exoerythrocytic forms (Coppi etal., 2005). These liver stage parasites mature
and are released into the Red Blood Cell (RBC)for erythrocytic stage, a form characterized withsymptomatic malaria. Four species of the genus
Plasmodium are responsible for the humanmalaria out of which P. falciparum stands out as
the most lethal compared to P. vivax, P.malariae
and P.ovale.
Plasmodium species is a protozoan parasitethat infects approximately 500 million people
annually, killing more than one million, mainly
children and pregnant women in Africa.
Evolving drug resistance involving Plasmodium

falciparum strains and insecticide resistance ofthe female Anopheles mosquito account for
major obstacle against all efforts to eradicate
malaria in Sub-Saharan Africa (Osamor, 2009;
Le Roch et al., 2003) and several parts of Asia,
except Maldives which is malaria free since
1984 (WHO, 2009). Malaria is endemic to morethan 100 countries and by far the most costly interms of human health causing major losses
among many African nations including Nigeria.
Four of the countries in the South East Asia
accounted for 97% of the estimated cases in theregion in 2008 (Bangladesh, 10%; India, 55%;
Indonesia, 15%; and Myanmar, 17%). Infection
in most of these area are due to P. falciparum,
although the proportion varies by country;transmission is due almost entirely to P.
falciparum in Myanmar and Timor-Leste but due
exclusively to P. vivax in the Democratic
People‘s Republic of Korea (WHO, 2009). This
article reviews the pathogenicity of infection andthe numerous perceptions and misconceptions
affecting modern control efforts including SIT for
eradicating the disease among developing
nations of the world.
2. Malaria Transmission and Pathogenicity
When a parasite-infected mosquito feeds on ahuman, it injects the parasites called sporozoites
from its salivary gland into the subcutaneous
layer of the skin and into the bloodstream.
These migrate to the liver cell forming a quiet
liver stage parasite in the parasitophorous
vacuole. The co-receptor on sporozoites thatmediates invasion involves, in part, thethrombospondin
domainsonthecircumsporozoite protein (CSP) and on
thrombospondin-related
adhesive
protein(TRAP). These domains bind specifically toheparin on hepatocytes. Inside the hepatocyte,
each sporozoite develops into tens of thousandsof merozoites (Miller, et al. 2002), which caneach invade the red blood cells (RBC) on
release from the liver.
Furthermore, the blood stage parasites growand multiply severally, invading many more RBC
and releasing the metabolic products arisingfrom RBC degradation and leading to malaria
symptoms. To commence sexual stage
development, some merozoites undergo several
developmental stages namely ring andtrophozoite stages and finally differentiate into
gametocytes which are picked up by bloodsucking mosquitoes during a bite on an infected
person. Eventually, up to 10% of all red blood
cells becomes infected and patients‘ may begin
the manifestation of clinical features of malaria,
including fever and chills, anaemia and cerebral
malaria which can lead to death in case ofEubios Journal of Asian and International Bioethics 20 (May 2010)
Plasmodium falciparum from female anophelinemosquitoes.
On each mosquito bite of an infected human, it
takes up blood containing gametocytes, whichdevelops into male and female reproductive
cells (gametes) in the mosquitoes gut, andfusion occurs to form a zygote. The zygote inturn develops into the ookinete, which crosses
the wall of the gut and forms a sporozoite-filled
oocyst. When the oocyst bursts, the sporozoites
move to the mosquito‘s salivary glands, and theprocess begins again (Wirth, 2002).

97

releasing essential molecules from apicalorganelles and initiating the actin–myosin
moving junction that brings the parasite inside
the vacuole that forms in the RBC.
Although other parasite proteins on themerozoite surface and in apical organelles havebeen proposed as receptors, there is no direct
evidence so far. Because invasion is such acomplex series of events from RBC binding, toapical reorientation, to entry, it seems likely thatseveral proteins are required for efficientinvasion. For example, evidence has suggested
that RBC invasion requires the cleavage of asurface protein on the RBC by an unknown
parasite serine protease. Thus, the molecularand cellular events surrounding each step ininvasion still remain to be elucidated.
Understanding these pathways will give insight
into parasite virulence and will facilitate rational
vaccine design against merozoite invasion. A
single parasite protein, P. falciparum erythrocyte
membrane protein 1 (PfEMP1), which isexpressed at the infected erythrocyte surface
connects parasite binding to all the various
receptors. PfEMP1 is encoded by the large anddiverse var gene family that is involved in clonalantigenic variation and has a central role in P.
falciparum pathogenesis. Adherence protects
the parasite from destruction, as non-adherent
mature parasitized RBCs are cleared rapidly inthe spleen.

2.1 Red Blood Cell (RBC) Invasion
In respect to RBC invasion, Miller et al. (2002)
noted that what remains completely unknown iswhich merozoite surface molecules recognize
the RBC surface and then signal the start of theinvasion process. The parasite induces avacuole derived from the RBC‘s plasma
membrane and enters the vacuole. Threeorganelles on the invasive (apical) end of theparasite (rhoptries, micronemes and dense
granules) define the phylum Apicomplexa.
Receptors that mediate invasion of RBCs bymerozoites and invasion of liver by sporozoites
are found in micronemes, on the cell surface,
and in rhoptries. Identifying the signalling
pathways that release organelle contents on
contact with a host RBC is a critical issue inparasite biology. Invasion events include

HAEMOGLOBIN

HAEME

Plasmepsins

Oxidation
HAEMATIN

Polymerisation

HAEMOZOIN(Malarial pigment)

SMALL PEPTIDES

Falcipain and plasmepsin

SMALLER PEPTIDESAMINO ACIDS(Aminopeptidase)

Figure 1: Plasmepsins from Plasmodium falciparum Degrades Haemoglobin in RBC.
(Adapted from http://wisdom.eu-egee.fr/malaria/plasmepsins.pdf)

98Eubios Journal of Asian and International Bioethics 20 (May 2010)

2.2 RBC (Haemoglobin) Degradation
The ability of the blood protein haemoglobin tocarry oxygen depends on an iron-containing
haeme group, which is made separately in thecell and then binds tightly to a crevice on theglobulin protein surface in red blood cells (RBCor erythrocytes). Haemoglobin is degraded by aseries of proteases in the digestive foodvacuole. The sequential process is represented
in Figure 1.
Plasmepsin I and II attack the haemoglobin
breaking it down to haeme and small pepetides.
The haeme is converted to haematin byoxidation and further polymerises to haemozoin
which causes the high fever. Eventually, smaller
peptides result and metabolise into amino acid.
Two homologous plasmepsins I and II are
responsible for the initial attack on the
hemoglobin Alpha chain between the residues
Phe 33 and Leu 34, in the hinge region. Thisregion is highly conserved and responsible forthe stability of the haemoglobin tetramer. Upon
cleavage, haeme (ferrous +2) is released whichis toxic to the parasite and is further oxidized tohaematin (ferric +3), also toxic to the parasite.
Finally, the haematin is polymerized tohaemozoin, the malarial pigment. Bothplasmepsin I and II are capable of causing an
initial cleavage in the hemoglobin, and theplasmepsins are also capable of several othercleavages after the initial attack.
3. What Is Anopheline Malaria Vector Sterile
Insect Technique (SIT)?
In integrated control of malaria vectors, thetechnique introduces genetic sterility inanopheline females of the target population in
the field following their mating with released
sterile males. Sterility is caused by dominantlethal mutations in the sperm of the released
males resulting from radiation. A dominant lethal
mutation is one that leads to the death of thedeveloping zygote, in this case the embryo,irrespective of the genetic contribution of theother gamete. A sterile male has therefore tomate and transfer viable sperm and also
accessory fluid of the appropriate quality andquantity to ensure appropriate female behaviour(Robinson et al., 2009). This process results inpopulation reduction or elimination via embryolethality caused by dominant lethal mutations
induced in sperm of the released males. Usingsterile males to control mosquito vector
populations can only be effective as part of an
Area Wide – Integrated Pest Management (AWIPM) programme. The area-wide concept entails
the targeting of the total mosquito population
within a defined area. The success in area-wide
implementation in the field can only be achieved

if close attention is paid to political, socioeconomic and environmental sensitivities and an
efficient management organization (El Sayed etal., (2009). Several ethical, legal and social
issues are associated with the approach Sterile
Insect Techniques (SIT) need to be seriously
considered and handled with care.
4 Ethical and Social Issues in Sterile Insect
Technique (SIT)
4.1 Ethics and Biosafety Aspects of Handling
Mosquito Irradiation
Several biosafety aspects of handlingmosquitoes and the irradiation process must be
considered. To prevent the escape of rearedmosquitoes, appropriate quarantine containment
and precautions will be put in place, as
described in the Arthropod Containment
Guidelines, Arthropod Containment Level 2 (TheAmerican Committe of Medical Entomology,2003). The specified gamma radiation dose (70Gy) currently requires one minute exposure.
Included with the samples are dosimetry films tohelp confirm that the proper radiation dose wasreceived by the mosquitoes. Malaria cases, andthe abundance and genotype of released males,
will be monitored indirectly by trapping females
and assessing their fertility status. Population
genetics, GIS/GPS, mass-rearing, and mosquito
biology and behaviour. Group training is being
carried out during experts' missions forresearchers and health personnel of the malaria
control programme (El Sayed et al., 2009).
.
4.2 Social issues surrounding Sterile Insect
Technique (SIT)In SIT,non-target species are not affected
because the it is species-specific, and thispreserves as much as possible the natural
ecosystem. The eradication of
femaleanopheline is not expected to affect the foodchain significantly against the need of the
inhabitants since the dearth of malaria causing
species of mosquitoes is utmost desirable forattainment of good health.
In addition,
alternative prey exists to replace the roleanopheline in the food chain. It was clearly
demonstrated that the abundance of a nontarget anopheline species in the Lake
Apastapeque releases in El Salvador,
Anopheles pseudopunctipennis was not affectedby the application of the SIT against the target
species Anopheles albimanus (Lofgren et al.,1974).
Community leaders, public health workers andrepresentatives of various organizations working
on health-related issues in the area haveEubios Journal of Asian and International Bioethics 20 (May 2010)
identified a great need for training and access to
up-to-date information and technical support(Krishnamurthy et al., 1962). El Sayed et al.,(2009) reviewed SIT in Sudan and noted that
there is need to established how much local
people understood about the existing malaria
problem,assesstheirsocio-economic
background and create awareness for theongoing anopheline SIT project while sensitizing
community members for active participation.
4.3 Current SIT Efforts in Sub-Saharan Africa
In spite of several SIT trials carried out on
mosquitoes (Benedict and Robinson, 2003), themalaria vector is being targeted on an area-widebasis using the SIT in sub- Saharan Africa for
the first time in Northern Sudan. The Sudan
Government has requested support from theInternational Atomic Energy Agency (IAEA) andthe Islamic Development Bank (IDB) for theapplication of the SIT in Northern State to help
eliminate the population of An. arabiensis fromthis region. This region fulfils certain criteria thatmake it suitable for an Area Wide-Integrated
Pest Management (AW-IPM) programme
incorporating the release of sterile males(Malcolm et al., 2009).
Equipment needed to implement use of thecollection of GIS data has been installed and isfunctioning well. For example, four automatedweather stations have been installed, and two
field stations have been established at the site
by the Ministry of Science and Technology. In
Khartoum,two
insectaries
have
been
established where populations of An. arabiensis
from the field site have been colonized.
Laboratory experiments on these colonies havebeen started. The insectaries also act as asource of mosquitoes for the colonies at the
FAO/IAEA Agriculture and Biotechnology
Laboratories in Seibersdorf, Austria (El Sayed etal., 2009)
5.
GeneralSocio-Behavioural
Habits,Perception and Misconceptions Of Malaria
Behavioural changes that impact mosquito
breeding, such as the removal of pools kept forwatering animals, and bush clearing were
methods that community members practiced toreduce the population of mosquito. Failure ofthese practices often accelerate the population
increase of disease causing vectors. In spite of
the fact that flood pools are the main mosquito
breeding sites, man-made breeding sites
represent the majority of sites throughout theyear. These are mainly pools created for brickmanufacturing near the river banks, and are
constructed to retain water indefinitely. Irrigation

99

practices are also one of the main sources ofbreeding sites, although most breeding may
occurs in riverside pools.
Socio-behavioural aspects associated withmalaria affect the control and prevention of thedisease. Malaria occurrence and transmission
are also affected by key behavior andperceptions of the people towards it. Differencesin beliefs, perceptions, and attitudes of the rural
Filipinos associated with ignorance has beenshown to hamper prevention and control
measures. Several rural Filipinos attribute thecause of malaria to some naturalistic andpersonalistic folk concepts. Such folk concept
attach naturalistic situations like heat, cold,
winds to be the cause of malaria including. On
the contrary, personalistic causes include theparticipation of human, non-human, or
supernatural agents in the development ofmalaria. Some Filipinos were found to believethat drinking contaminated water causes
malaria. Some people do not believe that the
major cause of malaria are the mosquito bites
rather their misconception is that malaria iscaused by drinking water contaminated withmosquito eggs.
5.1 Socio-Economic and Political Migratory
Risks Factors
Honrado and Fungladda (1994) in his work
reviewed studies in Thailand and in thePhilippines with migratory risks contributory tomalaria incidence. They noted that a sizable
proportionofthesemovements
areeconomically motivated, which could either belegal or illegal, e.g., gem mining in Thailand;gold panning both in Philippines and Thailand;
labour migration for sugar cane plantation,
hunting and poaching, etc. (Sornmani et al.,
1983; Singhanetra-Renard, 1986).
However,some are politically driven, e.g., the illegal
movement across the Thai-Myanmar or
Cambodia borders (Singhanetra-Renard etal.,1986) the movement of security forces into
endemic areas in Indonesia and Malaysia(Arasu, 1992; Oemijati, 1992) and the intensive
transmigration scheme of the government inIndonesia (Arasu, 1992)
In Africa, much political instability, militancy
and war exacerbated failed malaria control
strategies. Malaria infection can kill soldiers in
war situation if medication is not nearby.
5.2 Certain Customs and Beliefs on DDTHouse Spraying
Moreover, lack of knowledge or disbelief inthe benefits of DDT house spraying, lack of

100

Eubios Journal of Asian and International Bioethics 20 (May 2010)

health education efforts regarding the purposeof spraying operations, misconduct or failure ofspraymen to establish a good rapport with thecommunity as well as defects in the
management land supervision of spraying
operations have all been implicated as reasonsfor a relatively poor community compliance. The
negative aesthetic effects (e.g. causing the walls
to become dirty or the roof to rust) and certain
customs and beliefs of some communities,
particularly in Malaysia have also been pointed
out to be reasons for refusal (Honrado and
Fungladda (1994); Hongvivatana et al., 1982).
5.3 Behavioural Apathy to the Importance of
Bed Nets
The Roll Back Malaria (RBM) campaign in all
malaria endemic communities in the world has
greatly exploited enlightenment programmes
towards the importance of mosquito net
categorized into Insecticide Treated Net (ITN)and Long Lasting Insecticidal Net (LLIN). AED
Netmark, a US company engaged in privatepublic partinership for sustainable malaria
prevention is responsible for liaising with various
governments agency especially in provision ofaffordable and free mosquito net in SubSaharan Africa. NetMark has a representation in
Nigeria, Ghana, Senegal, Mali, Ethiopia,
Uganda,Zambia(http://www.netmarkafrica.org/Countries/).
Among the proposed users of the bed nets,
our observation with the immediate communityand various countries at large shows that net
owners do not use them owing to somebehavioural attitudes. Reasons adduced is thatthey are unable to sleep under the net because
they grew up without living within mosquito nets
since they were born and nothing has killed
them. Others adduced night sweating arisingfrom the reduced aeration occasioned by the
bed net as their reason for non-use of themosquito net. In Kenya and most Africancountries, most people sleep under a net
throughout the year, while a few only used a net
when mosquitoes are abundant. The actual
usage of various methods might be decided by
the household head and depend on the socioeconomic status of the household (Opiyo et al.,2007).
5.4 Behavioural Attitudes Predisposed to
Drug ResistanceIn many communities in developing nations,health care centres are never approached until
cthe omplication stage of infection arises. Thisis usually the case after several failed attemptsof self- medication with no sign of improvement.
This is compounded by taking subtherapeutic

doses or failure to take prescribed full course oftherapy especially when there are signs ofrecovery at the onset of the early dosages. Most
drugs sold over-the-counter as treatment formalaria in the village markets contained only
one or two tablets of antimalarial drugs such as,chloroquine, quinine, primaquine, mefloquineand sulfadoxine/pyrimethamine. Some countries
are not yet fully ready to forget Chloroquine as
first line treatment for malaria due to expensive
nature of Artemisinin Combination Therapy(ACT) which cost as high as about 1000 naira in
Nigeria.
Has nonregulated use of antimalaria drugs
on the Thai-Cambodian border promoted therecent loss of mefloquine sensitivity to
Plasmodium falciparum parasites? Plasai andSpielman (1996) attempted to investigate theproblem and noted that local nonregulated
healersprescribedorallyadministeredconcoctions containing chloroquine, quinine,
tetracycline or primaquine for gem miners
suffering mild illness. Because gem miners
appear not to have had informed access to
mefloquine before 1990, Plasai and Spielman(1996) concluded that the loss of antimalaria
efficacy of this drug on the Thai-Cambodian
border during the late 1980s was independent of
its nonregulated use. However, it is pertinent tonote that WHO (2009) reported that artemisininmonotherapy in South East Asia has been
responsible for resistance and advocated for its
removal from the market and the highlighted theneed to use Artemisinin Combination Therapy(ACT).
6. Conclusion
Most urban and rural communities indeveloping nations of the world have been
neglected over the years by their politicalleaders for unfulfilled promises. The case of
Nigeria, the efforts have been bedeviled bycorruption, political and leadership problems andlack of faith in the proposal of government.
Government
approachwithtangible
implementation of unfulfilled promises, like
provision of uninterrupted power and watersupply, improvement in health care andpresentation of gifts in form of free medical
check-up and free drugs to citizenry will change
the heart of the people and help in convincing
them to accept malaria programs as their own
and not another government gimmick. This will
go a long way to help win rural communities
cooperation to imbibe new malaria strategies
like SIT, and other ways to eradicate thedisease.
Among the population identified to be at
greatest risk, since behavioural risk seems to beEubios Journal of Asian and International Bioethics 20 (May 2010)
more difficult to change at shortest possible
time, evolution of new malaria control schemes
and strategies need to be tailored toaccommodate
effective
controlmethodnecessary for modification of most behaviouralrisk. Aggressive and efficient health education
control programme is also inevitable in thisregard.
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Revelations. Nature 419, 495-496.

Conferences
For a list of some ethics meetings in Asia and Pacific:
http://www.unescobkk.org/index.php?id=current_and_future_events

Eleventh Asian Bioethics Conference (ABC11),
and the Fifth UNESCO Asia-Pacific School of Ethics
Bioethics Roundtable, 31 July – 2 August, 2010,
Singapore. (In conjunction with the TenthInternational Congress of Bioethics, 27-31 July2010).

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

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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,
by D. Macer, Y. Asada, M. Tsuzuki, S. Akiyama, & N.Y. Macer
March 1996, ISBN 0-908897-08-1, 200pp.(A4)
Cost: US$25 UK£15 NZ$30 A$30 C$30 ¥2000

NZ$40

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

NZ$35

Bioethics in India (includes 115 papers from Jan.1997 conference)
Eds: Jayapaul Azariah, Hilda Azariah & Darryl R.J. Macer
June 1998 ISBN 0-908897-10-3, 403 pp.
(Printed in India)
Cost: US$30 UK£18 NZ$34 A$36 C$36 ¥3000
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Bioethics is Love of Life: An alternative textbook
by Darryl Macer, July 1998 ISBN 0-908897-13-8, 152pp. Cost: US$26 UK£14 NZ$34 A$34 C$32 ¥3000
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Bioethics in Asia (includes 118 papers from Nov.1997 conferences, ABC‘97 Kobe and Fukui Satellite)
Eds: Norio Fujiki & Darryl R.J. Macer
Cost: US$36 UK£20 NZ$40 A$38 C$40 ¥3000
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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
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Bioethics and the Impact of Human Genome Research in the 21 Century
Eds: Norio Fujiki, Masakatsu Sudo, & Darryl R.J. Macer March 2001 (English and Japanese bilingual, 350pp).
st

Cost: US$30 UK£20 NZ$40 A$38 C$40 ¥3000

Bioethics in Asia in the 21 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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104

Eubios Journal of Asian and International Bioethics 20 (May 2010)

The Eleventh Asian Bioethics Conference (ABC11)
Singapore, 31 July -2 August 2010

Mundalization, Bioethics and Policy
Organised by the Asian Bioethics Association, the Centre for Biomedical Ethics of the
National University of Singapore (NUS), and UNESCO.
This is also the Fifth UNESCO Asia-Pacific School of Ethics Roundtable

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The 31st July sessions of ABC11 will be held in conjunction with the 10 th World Congressof Bioethics (WCB), and abstracts for presentation on that day should also be submitted
to the WCB secretariat [abstracts@bioethics-singapore.org], with a copy to the ABC11
secretariat. Submitted abstracts if accepted will be in concurrent sessions. Registration
fee either included with WCB registration, or SGD150 for one day for IAB member.
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Call for papers: Research findings, discussion papers, and othercontributions dealing with the above theme are welcomed. Papers areinvited on, but not limited to, the following sessions:










Brain Research and Neuroethics in Asia (Date 1 August)Globalization and Mundalization in Asian Bioethics
Trials of UNESCO Core Curriculum in Bioethics Education (Date 2 August)
Ethics and Climate Change (Date 2 August)
Ethical issues in Practice of and research in Traditional andComplementary Asian Medicine
Migration of Health Care Professionals
Emerging issues in Asian Bioethics
Cultural diversity and Globalization
Disaster Ethics

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