Eubios Journal of Asian andInternational Bioethics
EJAIB Vol 18(3) May 2008

ISSN 1173-2571

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

Contents

page

Editorial: Philosophical Dialogues
65
End of life self-determination: Attitudes of patientswith ALS in a prefecture of Japan66- Yugo Narita, Michiko Nakai and Shigeki Kuzuhara
Violence and War
70- K. K. VermaBeyond Biosafety: Biosecurity and the dual-use
dilemma as ethical concerns
71- Michael Barr
Animals in Research: 7-R Principles and Corporate
Responsibility
74- Hans-Martin Sass
Assisted Reproductive Technology in Cultural Contexts 86- Bolatito A. Lanre-Abass
Bioethical Dilemmas in a Pakistani Context
93- Muhammad Ilyas, Mukhtar Alam and Habib Ahmad
Asian Bioethics Association (ABA) Renewal
95
Ordering Information
96
Send papers to the editor in electronic form if possible.
Please use reference style of citations by author’s name in
the article and an alphabetical list at the end of the article, do
not use automatic footnotes or endnotes. Papers are peer
reviewed. The papers do not represent the views of Eubios
Ethics Institute, or the editor or editorial board, which upholds
the principles of freedom of expression.
Editorial address:
Prof. Darryl Macer, RUSHSAP, UNESCO Bangkok,
920 Sukhumvit Rd, Prakanong, Bangkok 10110, THAILAND
Fax: Int+66-2-664-3772
Email: d.macer@unesco.org

Deadline for the July 2008 issue is 31 May, 2008.

Editorial: Philosophical Dialogues
I invite readers to join the UNESCO Asia-ArabInterregional Philosophical Dialogues email group. The
project is coordinated by UNESCO Bangkok and UNESCO
Rabat offices. The yahoo group* helps provide a forum forexchange of views in English and Arabic.
At present we have three working groups in the project:
1) Challenges of globalization to philosophy and democracy;
2) Philosophy facing the challenges of modern technology;3) The roles of philosophy in war and peace.

We hope to publish volumes of papers that will be useful
resources for philosophy teaching on these topics and toinclude papers from individual philosophers as well as papers
the result of dialogue between members of the groups.
Please also note that we are planning to have working
group meetings in person for in Seoul, Korea at the time of
the World Congress of Philosophy (30 July – 5 August), andin Hiroshima, Japan (25-27 July, 2008). While we cannot
support the travel costs of participants to this meeting, we
promise that the events will be attractive and we encourage
you to join so that a critical mass of philosophers canparticipate. More details of the meetings are below.
We also envision holding a dialogue meeting in Southeast Asia in January 2009, to follow-up the 2008 and earlier
meetings held in Rabat, Seoul and Paris. We are also open tosuggestions of cooperation with other networks, and hosts tohold meetings of working groups. We also hope to use
modern communication technology to enable dialogue.
In this issue of the journal we have a diverse range of
papers, including a commentary on violence and war andevolution by Verma, and biosecurity concerns by Barr. HansMartin Sass proposes a 7R framework for guiding animal
research with a special note towards corporate responsibility.
There is a paper by Narita et al. presenting descriptive
data from Japan, as an illustration of how self-determination
can be expressed in living wills. The paper from Lanre-Abassexpresses an African critique of ART, and there is a paper
describing recent bioethics issues in Pakistan.
Hope to see readers as the Philosophical Dialogues andEthics of Energy technologies conferences in the next few
months.
-Darryl Macer*http://groups.yahoo.com/group/AsiaArabPhilosophicalDialogues
For all below please contact: RUSHSAP, Email: rushsap@unescobkk.org
UNESCO Conference on Ethics of Energy Technologies: Energy
Flow, Environment and Ethical Implications for Meat Production(Working Group 13), 24 July 2008, 9am-4pm, UNU-IAS, Yokohama,Japan
Joint UNESCO-UNITAR Dialogues on the Role of Philosophers in
War and Peace, 26 July 2008, UNITAR, Hiroshima, Japan
Joint UNESCO-UNITAR Workshop on Nuclear Dialogues and Ethics
of Energy Technologies, 27 July 2008, UNITAR, Hiroshima, Japan
EWHA-UNESCO International Forum on Bioethics and Asian
Culture, 29-30 July 2008, Ewha Women's University, Seoul, Korea
UNESCO Conference on Ethics of Energy Technologies: EthicalViews of Nature (Working Group 2), 3 August 2008, SNU, Seoul
UNESCO Asia-Arab Interregional Philosophical Dialogues on
Philosophy Facing the Challenges of Modern Technology, 4 August
2008, Seoul National University, Seoul, Korea
UNESCO Asia-Arab Interregional Philosophical Dialogues on
Challenges of Globalization to Philosophy and Democracy, 5 August
2008, Seoul National University, Seoul, Korea

66

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

End of life self-determination:
Attitudes of patients with ALS
in a prefecture of Japan- Yugo Narita, MD, PhD1-3*,- Michiko Nakai, RN2,
- Shigeki Kuzuhara, MD, PhD3,4
1. Mie University Hospital, Medical Care Networking
Centre, Tsu, Mie, Japan.
2. The Liaison Council of the Network for Patients with
Intractable Neurological Diseases in Mie Prefecture, Tsu,
Mie, Japan.
3. Department of Neurology, Mie University Graduate
School of Medicine, School of Medicine & Mie University
Hospital, Tsu, Mie, Japan.
4. National Center of Neurology and Psychiatry Musashi
Hospital, Kodaira, Tokyo, Japan.
*Address correspondence to:
Yugo NARITA, Department of Neurology,
Mie University Graduate School of Medicine,
2-174 Edobashi, Tsu, Mie 514-8507, Japan
E-mail address: yug@clin.medic.mie-u.ac.jp

Abstract
Objective: The objective was to survey patients’conceptions of autonomy or self-determination, andtheir feelings about participation in medical
management decisions in the advanced stages.
Subjects and methods: Out of 116 patients registeredon the intractable disease (“Nanbyo”) system in Japanas a patient with amyotrophic lateral sclerosis (ALS) in
2004 in the Mie Prefecture, Japan, 21 gave theirconsent and participated. The author visited theirhomes from October 2004 to March 2005, performed
examinations and semi-structured interviews. Fourteen(10 males and 4 females, 57.9±12.0 years old) were
eligible for analysis on his or her diagnosis,
communication ability or cognitive function, and were
followed until all of the patients who had advancedirectives either died or revoked them (June, 2007).
Results: Nine patients indicated that they did not fully
understand the word “autonomy” (“jiritsu” inJapanese). Substituting the word “self-determination”
as an analogous word to “autonomy” and asking thequestion again, eleven patients provided a response
about their interest in maintaining self-determination.
When asked to provide a value for respect-level using
percentages, 10 of 11 affirmed a high percentage ofself-determination (89.1±17.6% [mean±SD]).
Conclusion: This report validates that some Japanesepatients have a desire to control their treatment andmanagement. While recognizing the small sample size,
the authors suggest that neurologists involve theirpatients in medical management decisions regarding
their ongoing care.
Key words: amyotrophic lateral sclerosis, motor
neuron disease, advance care planning, advancedirective, Japan

Introduction
Individuals of any cultural background are hesitant todiscuss their own death and dying when they have an
intractable disease, such as amyotrophic lateralsclerosis (ALS), which requires special care to survive
after respiratory or swallowing function deteriorates (17). Asian people, including Japanese, seem particularly
more hesitant to discuss death and dying (8).
Traditionally, patients and families have expected their
physician to dictate what interventions he or she
believes necessary with little discussion. In Japan, theproportion of patients in the advanced stage of ALS on
mechanical ventilation via tracheostomy was more than
20% in 1997, and nearly one-third in 2004 (9,10). The
high usage of mechanical ventilators is in part due to agood care system, “nanbyo (it means an intractabledisease in Japanese)” system (11,12). It is difficult todetermine when, by whom, and by what process thedecision to initiate such treatment has been made foreach patient. There have been recent reports about
patients who want to decide the management of theirown terminal conditions (13,14). In Japan, discussion
about patients’ involvement in decision making has
increased since a presentation of the Guideline for theProcess of Decision Making on End-of-Life Care by the
Ministry of Health, Labour and Welfare of Japan, in
May 2007 (15).
In the present study, our goal was to survey patients’
perceptions and outcomes regarding feelings ofautonomy or self-determination related to options ofmanagement in the advanced stages of ALS. Since
2003, the authors have provided care to these patientsin our roles with the Liaison Council of the Networking
for the Patients with Intractable Neurological Diseasesin Mie Prefecture.
Methods
Before implementing this study, the ethical andscientific validity was approved by the EthicalCommittees at Mie University, School of Medicine, in
accordance with the Helsinki Declaration. Each subject
was informed by a written document that participationin the study was voluntary and their privacy would bestrictly preserved. The registered numbers from theInstitutional Review Boards at Mie University, Schoolof Medicine are No. 291 and 476.
JMP ver. 5.1 (SAS Institute Inc.) was used for thestatistical analysis. The study design was a crosssectional study.
First survey
Because of requirements related to patient privacy,
we could not contact the patients directly. Public healthnurses, as government staff at the nine Public HealthInstitutes, were asked to talk to as many patients as
possible during their contacts in routine home visits orwork at the institutes. In total, 116 ALS patients wereregistered on the “nanbyo” system in the Mie prefectureEubios Journal of Asian and International Bioethics 18 (May 2008)
in fiscal year 2004. It has been mandatory since 2003
for every patient on the system to have their own casesheet reviewed with them once every year from July to
September. During their routine work, the nurses asked
patients to participate in the study; 21 patients gave
their consent to a visit from the authors, andparticipation in the study. After obtaining written
permission by the responsible researcher, one of theauthors (YN), visited each patient’s home together withthe public health nurse, performed physical andneurological examinations, and evaluated patient
disability using the ALS Functional Rating Scale
Revised (ALSFRS-R). Interviews were conducted from
October 2004 to March 2005. Fourteen of the 21
patients surveyed (10 males and 4 females) were
determined to be eligible for analysis based on theirdiagnosis, communication ability or cognitive function.
Three of the 14 subjects were supported by amechanical ventilator with tracheostomy (TMV) at thetime of the interview, but they wanted to participate in
the survey because of their history of decision-making.
The mean age of the 14 subjects was 57.9±12.0[mean±SD] years old. (Table 1)
To assess how patients wanted to exercise individual
self-determination in management decisions at theadvanced stage of their disease, we performed semistructured interviews at the patients’ homes. Questions
were designed to elicit patients’ conceptions and wishes
for management. Issues explored included their conceptof self-determination and the desire to indicate theirself-determination in regard to the management of theiradvanced condition. Each patient was asked if theyknew and understood the word “autonomy” (“jiritsu” inJapanese, a relatively difficult word). The word “selfdetermination”, as an analogous word to “autonomy”,
was used in the interview when the patient indicatedlack of knowledge of the meaning of “autonomy”. Theinterviewer then asked the patient to subjectively
evaluate the level of respect expected to be given to his
or her own “self-determination” as a percentage, with
100% as the highest level of respect and 0% as thelowest. Patients were also asked if they preferredanother method to indicate their “self-determination”.
Follow-up survey
We followed the 14 cases of the first survey in ourclinic or indirectly via the Liaison Council of the
Networking for the Patients with Intractable
Neurological Diseases in Mie Prefecture, at least once ayear. All participating patients with special documentsof self-determination (advance directives) from the firstsurvey were followed until they died or revoked theirdirectives, that was until June, 2007.
Results
First survey
Nine patients indicated that they did not fully
understand the word “autonomy” (“jiritsu”). Five of67

them replied that they were hearing the word for the
first time, even after having the word written in Chinesecharacters shown to them. Substituting the word “selfdetermination” as an analogous word to “autonomy”
and asking the question again, 11 patients provided a
response indicating their interest in maintaining selfdetermination related to care. When asked to provide avalue for the level of respect expected to be given to
their own “self-determination” using percentages, 10 of
11 affirmed a high percentage; the mean ± SD was
89.1±17.6%. Seven participants indicated their respectlevel for self-determination as 100%. Three hesitated to
face the issue, and chose not to respond to the question.
Responses to the preferable method to communicate
their self-determination were via a “document” byseven patients, with six patients stating they had “noidea” of a preferred method. One patient did not
respond (Table 1).
Unexpectedly, two patients were found to alreadyhave self-determination documents during the initialinterviews. In total, five patients had complete
documents for self-determination at the first survey.
Three patients (Nos. 1, 4 and 5) wrote an advancedirective in conjunction with our team. One of thepatients with TMV (No. 5) had started mechanicalventilation during a time when she was not competent
to make her own decisions due to hypoxic
encephalopathy, and was asked whether or not to accept
tracheostomy and mechanical ventilation by her
attending physician. Soon after the mechanicalventilation was initiated, she became competent again,
and regretted that she was unable to participate in thedecision-making process. As her clinical type of ALS
was of the progressive bulbar palsy (PBP) type, she wasstill able to connect and detach the respirator tube to her
tracheal cannula by herself, and did not want to use theventilator except for sleep time. In the advancedirective she developed in conjunction with the team,she clearly directed that the ventilator was not to be
used in the daytime, even if her condition worsened.
Two additional patients (Nos. 2 and 3) had alreadydeveloped an advance directive document in their own
manner, but both lacked items regarded as essential.
One patient’s document lacked the date it wasdeveloped, and the other patient’s document had notbeen witnessed. Six other patients relied to some extent
on their medical adviser (his or her attending physician)or family members to make appropriate decisions fortheir care.
None of the patients were reported to have major
depression by their caregivers. We did not assess thepatients using a depression inventory, but our
subjective assessment of the patents during theinterviews validated the impressions of the caregivers.
When the participants were divided into two groups
based on the possession of an advance directive
document at the first survey, the ALSFRS-R score wasEubios Journal of Asian and International Bioethics 18 (May 2008)68

lower in patients who had such a document (10.2±12.6[mean±SD]) than in those who did not (28.4±15.8[mean±SD]) have a document (p=0.039 by student ttest).

Table 1The demography and responses of the patients.
The data at the first survey were shown, adding the data at the follow-up survey in two rows at the right-end of the table. In the rows “Respiration” and“Respiration at the Outcome”, “still spared” means that the patient’s respiration was still not so deteriorated that he or she needed to use any artificial
ventilation (NIPPV or TMV) or tracheostomy. The row “ALSFRS-R latest”, indicates the score just before death or at the time of the most recent contact
with each patient.

No.

Age

Sex Respect Level (%) Preferable Method Advance Directive ALSFRS-R

1

66

M

100

document

+

2

64

F

100

document

+

3

45

M

100

document

+

4

62

M

70

document+

5

68

Respiration
ALSFRS-R
at the Outcome
latestCommunication

Respiration1

letter board

NIPPV

deceased1

8communication aid

NIPPV

deceased2

32

verbalstill spareddeceased122

personal computer

NIPPV

TMV

1

TMV
(full time)

6

F

100

document+8

writing

TMV(at sleep)

6

72

M

100

document-

43

verbalstill sparedstill spared

36

7

65

M

50

NR

-

44

verbalstill sparedstill spared

38

8

53

M

NR

no idea-35

verbalstill sparedstill spared

30

9

50

M

90

document-

35

verbalstill sparedstill spared

33

10

34

M

100

no idea-5letter board

TMV

TMV

4

11

37

M

NR

no idea-29

personal computer

still spared

NIPPV

24

12

64

M

NR

no idea-27

verbalstill spareddeceased

13

13

65

F

100

no idea-0letter board

TMV

TMV

0

14

66

F

70

no idea-38

verbalstill sparedstill spared35

NR: No Response(at the first survey)
TMV: mechanical ventilation with tracheostomy
NIPPV: non-invasive positive pressure ventilation
ALSFRS-R: ALS Functional Rating Scale Revised

Follow-up survey
Twelve cases were re-surveyed by interviewing thepatients, families or healthcare professionals, and twocases were re-surveyed by telephone. In July 2007, tenpatients were alive, and four patients had died since theprevious interviews. Four patients with TMV were still
alive, though their conditions had gradually
deteriorated.
One patient (No. 11) had made a new written
directive to resolve a conflict within the family that
became apparent since the first survey. At the time of
the follow-up survey in July 2007, a total of six patients
had advance directives. Two patients (Nos. 4 and 5)
revoked their directives and chose TMV, and have been
alive for more than two years. The two patients copedwith their new situation of dependency on TMV. One
had changed his attitude, becoming very active in goingout with his family and in exchanging e-mails, even as
his physical condition worsened.
All four of the deceased patients had chosen not to beplaced on mechanical ventilation. Three (Nos. 1, 2 and12) died at home, and one (No. 3) died at a local
hospital in June 2007 without any resuscitation,
surrounded by family and the attending physician.
These patients’ families were satisfied with the
domiciliary care support of public health nurses,
visiting nurses, helpers, and home visits by physiciansor members of the local ALS Association.

Two of the three patients who died at home (Nos. 1
and 2) had written advance directives, which were notused since an ambulance was not called. The patient
who died at the local hospital (No. 3) had shared his
advance directive document with the healthcare
professionals and his relatives. Two weeks after his
death, his wife and sister told us that the presence of the
document reassured them that the patient’s wishes had
been honored, as the directions in the document wereconfirmed again among the patient, family and medical
professionals thirteen days before his death.
Discussion
The study location was Mie Prefecture, located on
the east side of the Kii Peninsula in south-central
Honshu Island, with a population of 1.87 million and anarea of 5,776 km2. In the prefecture, there is one
medical school, Mie University (a national university),
and nine Public Health Institutes (local offices of the
Department of Health and Welfare in the prefectural
government). The prefecture is of intermediate size in
population, area and economic activity when comparedto all prefectures in Japan.
This study consisted of a small number of subjects,
with a low participation rate of potentially eligible
patients. The 21 initial participants in the sample werefrom a total of 116 ALS patients registered in the Mie
prefecture in fiscal year 2004. By having the publicEubios Journal of Asian and International Bioethics 18 (May 2008)
health nurses ask patients to participate it may havecaused bias, as only people who were concerned with
self-determination may have decided to participate. It isinteresting that seven of 14 eligible patients preferred
the use of a document to indicate their selfdetermination, five patients in the first survey alreadyhad an advance directive, and one patient developed a
new advance directive document during the follow-up
term.
This significant use of advance directives is
exceptional, even when compared to reports fromwestern countries (5,16). There is the possibility thatparticipants’ bias in favor of self-determination may
have impacted the results. The existence of patientsusing advance directives in a relatively rural district inJapan suggests that patient culture may be changing.
The environment may be diversifying from very
conservative to highly autonomy-oriented, assisted by
globalized information from the media and increased
consciousness on the part of the individual concerning
autonomy.
Some patients suffering from ALS seemed to think
about self-determination in choosing options for
medical management in the advanced stage of theirdisease, even though the word “autonomy” was still
unfamiliar to some Japanese patients. The word “selfdetermination” is not as difficult to understand forpeople, and was used as an analogous meaning of“autonomy” in the context of this study. Patients may
not understand the words used to explain their options,
so it is important to ask if patients comprehend.
There is a study in the USA related to predictors andthe course of elective long-term mechanical ventilation(LTMV) for ALS patients who were identified as
hospice-eligible (17). Rabkin et al. followed patientsmonthly, for up to 55 months, and reported that patients
who later chose LTMV were younger, had young
children, had more education, and had a higher
household income on average (17). In Japan, a newresearch
program,Japanese
Consortiumfor
Amyotrophic Lateral Sclerosis (JaCALS), waslaunched in 2006 (18). This survey is prospective and isconstructing a robust database on many aspects of ALS
patients diagnosed by neurology specialists (18). The
data from JaCALS will be available in several years.
JaCALS does not cover highly private and delicate
elements for Japanese patients, like patients’ selfdetermination, income and educational background. We
could not find any longitudinal reports about decision
making in Japanese patients with ALS.
The patients who made advance directive documents
had lower ALSFRS-R scores than those who did not
make advance directive documents. Patients who
thought about self-determination seemed to havechosen written documents rather than verbal expression
to help them resolve their internal conflicts, rather thanusing advance directives as a legal document.
Compared to western countries, the Japanese have a69

relatively short history of personal contract plans
especially in health care. Since the commencement of
the Long Term Care Insurance and the new Japanese
Guardianship plan in 2000, many Japanese may haverecognized the meaning of contracts and that written
documents are preferable in some cases (13). Although
there is no legislation ordaining advance directives inJapan, a newly presented guideline is providing a cue tostart discussion (15). Regardless of future efforts, weneed to consider today how neurologists can advocate
patients’ rights to self-determination regarding their
medical care.
Conclusion
This preliminary report shows that some Japanesepatients with ALS have a desire to control their own
future treatment and management. Based on thisfinding while recognizing the small sample size, theauthors suggest that neurologists need to take aninterest in ALS patients’ decision making; and to
involve their patients, to the degree the patient wishes,in medical management decisions regarding their
ongoing care.
Acknowledgements
This study was supported by a grant from the
Ministry of Health, Labour and Welfare of Japan from
"The Research Committee on the Neurodegenerative
Diseases” (Chairman: Shigeki Kuzuhara) and “TheStudy Group for Improving Community Medicine forPatients with Intractable Diseases” (Chairman: Yasuto
Itoyama).
Disclosure: The authors report no conflicts of interest.
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Violence and War- K. K. Verma, Ph.D.,
Retd. Professor of Zoology, HIG1/ 327, Housing Board
Colony, Borsi, DURG – 491001, India.
Email: kk.sheel@gmail.com
The great philosopher naturalist Julian Huxley(1959) described war as an extremely rare
phenomenon, found only in humans and certain ants
called harvester ants, which live in deserts, amass a sortof property in the form of a grass seeds store in theirnest for use in a dry season, when there are no grasses
around.
The “Seville Statement on Violence”, as quoted byJones (2008), says, “It is scientifically incorrect to saythat we have inherited a tendency to make war from ouranimal ancestors…. that war or any other violent
behaviour is genetically programmed into our humannature…(and) that humans have a ‘violent brain’.”.
This statement was made jointly by 20 natural andsocial scientists, and was published in 1986 by UNO.
Later it was adopted by UNESCO.
Since then views on this aspect of human behaviour
have undergone a substantial change, and this change
has been lucidly described very recently by Jones(2008). Jones refers to the book “Homicide” by Daly
and Wilson, published in 1988. In this book, on basis ofanimal behaviour, anthropology, and pattern ofviolence and murder in modern societies, it has beeninferred that the human brain has violent proclivities,
which find expression in certain circumstances.
The main evidence in support of the human genetic
proclivity for violence has been derived by Jones(2008) from the observations of Richard Wrangham,
who has studied chimps in the wild for more than 30
years. Wrangham’s observations on chimps, the closest
living relatives of humans, as quoted by Jones:“Although chimps live in communities of around 150,
they are rarely all found together. Instead they typicallytravel around their territory in parties of up to 20
animals. From time to time, a roaming party from one
group will cross paths with a roaming party of another.
If they are of equal size, there will be a lot of screaming
and charging. When there is an imbalance of power, thelarger party will often try to isolate and attack an enemy
chimpanzee, sometimes holding their victim down
while the frantically excited attackers hail down lethalblows”. Jones proceeds to point out that a comparable
phenomenon has been observed in primitive tribes,
living in small bands. He says, “a small band of men
leaves its home ground, sneaks up on the neighbours
and tries to kill one or more of them.”. Advantage ofsuch incursions is obvious, namely extension of thehome range and availability of more resources.
These instances remind one of territoriality so
common among animals (Andrewartha, 1970). Vermaand Saxena (2000) have pointed out, “Humannationalism and patriotism have their origin in the
territorial instinct.”
Such examples support the notion of proclivity forviolence in the genetic makeup of humans. But Saxena
and Verma (2007), from their discussion on morality
and altruism, have inferred genetic proclivity foraltruism, which is antithesis of violence. However, theysay, “…(a person) often becomes so much obsessedwith his personal ambitions and desire for social,economic or professional climbing that altruism
becomes pushed to a back seat.”.
In the present state of knowledge it may be inferredthat humans have genetic proclivity for altruism andalso for violence, and which tendency finds expression
is decided by the extant environmental influences. In
this context may be recalled the Article No. 3 of the“UNESCO Universal Declaration on Human Genome
and Human Rights”, which reads as follows: “The

Eubios Journal of Asian and International Bioethics 18 (May 2008)
human genome, which by its nature evolves, is subject
to mutations. It contains potentialities that are
expressed differently according to each individuals
natural and social environment, including theindividuals state of health, living conditions, nutritionand education.”.
In humans the environment of an individual plays amore pronounced role in determining which genetic
potentials would find expression than in other membersof the animal kingdom. This is because of an extended
period of psychological immaturity in humans(Remmel, 2006), and, in this period, a specially highcapacity of learning and absorbing environmental
influences in their behavioural pattern.
Both chimps and humans show two sorts of violence,
inter-personal or in-group violence and inter-groupviolence, the latter war, if on a large scale. While wars
are generally politically motivated, personal violence
results from a personal urge for socio-economic rise or
reproductive success.
Citing Wrangham, who has compared homicide rate
in Europe from the twelfth century to the present, Jones(2008) points out that there has been a regular decline
in in-group violence rate. This suggests that with
developing civilization in-group conflicts have become
increasingly infrequent. The time span for this change
has been so small that it cannot be ascribed toevolution; it has to be through environmental
influences. It may be added here that, with developmentof civilization, a finer function distribution takes place
among members of a society, and, as a consequence agreater interdependence among the members and social
coherence result. In these circumstances expression of
the potentiality of altruism gets promoted.
Wars generally result from actions of a
misadventurist and overambitious leader of a state, andunderlying his action is the instinct of territoriality.
Better understanding among states, realization andappreciation of interstate cooperation and coordination ,and nations being led by leaders, who are aware of thehighly destructive nature of modern warfare hamperingdevelopment of civilization, and also of the extent
misery wars cause to people, should avoid war-likesituations. Enlightened voters will choose such leaders
to lead their nation. Bioethics education in schools
should help in this direction, as voters with sucheducational background will choose enlightened
leaders. Besides removal of misgivings among various
religious communities, and emphasis on need ofhealthy and compact societies through bioethics
education will discourage in-group conflicts.
References
Andrewartha, H.G., 1970. Introduction to the Study ofAnimal Populations. Methuen & Co., London.
Huxley, Julian, 1959. Man in the Modern World (eighth
printing). The New American Library of the World
Literature Inc., New York.

71

Jones, Dan, 2008. Killer instincts. Nature 451 (Jan. 2008):
512 – 515.
Remmel, E., 2006. Evo devo psych ( a review of the book
“Origins of the Social Mind: Evolutionary Psychology andChild Development”, editors Bruce J. Ellis and David F.
Bjorklund), published by Guilford Press, 2005). American
Scientist 94(2) (published online).
Saxena, R., and Verma, K.K., 2007. Morality – innate or
acquired? EJAIB 17(1): 11 – 14.
Verma, K.K., and Saxena, R., 2000. Man in Biological
Perspective. Himanshu Publications, Udaipur/New Delhi.

Beyond Biosafety: Biosecurity
and the dual-use dilemma as
ethical concerns- Michael Barr, Ph.D.
PEALS Research Centre, University of Newcastle upon
Tyne, UK; Visiting Fellow, Peking Union Medical College,
PRC
Email: m.t.barr@ncl.ac.uk

Introduction
Increasingly, bioethicists are turning their attention
to the ethical and social challenges raised by the nonmedical uses of bioinformation. One such challenge isbiosecurity – that is, the attempt to prevent thedeliberate use of the life sciences and biotechnology forpolitical or criminal ends. As much of the literature onbiosecurity has focused on the US, UK, or Australia(two exceptions being Enemark 2007 and Smithson
2007), there is a need, for reasons described below, tobetter understand Asian perspectives on these issues.
Scientists, particularly in East and Southeast Asia, areunderstandably focused on preventing emerging disease
outbreaks and on developing vaccines to treat reemerging and existing diseases. However, in their focus
on these important issues, it is possible that preventing
deliberate disease outbreaks may be overlooked.
Indeed, the fact that scientists are working so often withrestricted agents as dengue fever virus, SARS, andavian influenza, is a reason to be concerned about thedegree of biosecurity in the region. In this paper, I aim
to encourage readers of EJAIB to begin to consider how
they may contribute to these debates. Ethicists havemuch to contribute to this field of study since at themost basic level, biosecurity raises an age old ethicalquestion: should we hold an agent morally responsible
for the consequences of an action when those
consequences were not intended and were, in somecases, beyond the agent’s control?
What is the difference between biosafety andbiosecurity?
Many life scientists are familiar with the concept ofbiosafety. The term simply refers to laboratory

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

procedures and policies aimed at reducing accidental
exposures. It includes instructions on how to work with,store, and export pathogens and toxins properly in order
to avoid accidents that could be harmful to people,
animals, and plants. Biosafety, in short, is about lab
procedures, equipment, and the right handling of
hazardous materials.
In contrast, biosecurity refers to the wider societal
issue of the protection and control of pathogens andtoxins to prevent their deliberate theft, misuse, ordiversion for the purposes of biological warfare or
terrorism. It includes researchers’ personal knowledge,
choices and behaviour, as well as society’s collective
responsibility to safeguard a population from thedangers of pathogenic microbes. Biosecurity, in short,
is about measures taken to minimise the possibility ofdeliberate bioviolence.
There is some evidence to suggest that scientists are
far less aware of biosecurity than biosafety (althoughpart of the confusion may be that some countries use
the same term to describe both meanings). A recent
survey of over 300 Asian life scientists found that there
was better awareness of laboratory biosafety issues
compared to biosecurity and that overall, awarenesslevels and perceived threats about biological terrorism
remained very low across Asia (Sandia 2006). Indeed,
my own informal discussions with life scientists in
China confirms this finding.
To help understand the notion of biosecurity and why
it deserves ethical attention, it is necessary to examine
one of the key elements of the biosecurity debate: thedual use dilemma.
The dual use dilemma
The dual use dilemma simply refers to the possibility
that the same scientific research or products which areintended for social good could also be used to threaten
a population in a deliberate act of bioviolence. Two
examples will help shed light on this idea.
One instance of a dual use experiment is theAustralian mousepox tests (Jackson et al. 2001).
Australian researchers modified the virus that causes
mousepox in an attempt to make mice infertile. The
hope was that they could limit the millions of dollars ofdamage mice inflict on Australia’s grain belt. After
their initial trials failed, researchers tried inserting an
IL-4 gene (a cytokine that helps regulate immune
system reactions) into the virus which they thenadministered to the mice. As a result, the researchers
inadvertently created a recombinant virus which killed
the mice, including 60% of those which had been
vaccinated. Eventually it was discovered that theinserted gene had shut down the rodents’ immune
systems. Inevitably, researchers wondered if similar
work could be done on smallpox or chickenpox tocreate a deadly modified form of those viruses that
could overcome existing human vaccinations. The dual
use controversy became worse when a team in the US
duplicated the study with even greater lethality andconducted similar experiments with cowpox, a disease
which can afflict humans.
A second dual use example is the recreation of the
Spanish Flu. In 2005, US scientists identified thesequences for the remaining unsequenced parts of thevirus’s genome and described the reconstruction of thevirus (Taubenberger 2005; Tumpey 2005; von Bubnoff2005). This allowed the benefit of testing the functionof certain genes in the transmissibility and virulence ofthe virus which was a major scientific advance but had
the consequence of risking that the recreated strain
might escape, and/or that the publication of the fullgenome sequence gives any rogue nation or bioterroristgroup all the information they need to make their own
version of the virus. A number of experts in the US
believed that the decision to publish the flu’s genome
was a mistake since it amounted to a blueprint of aweapon of mass destruction.
In both these cases, the knowledge and techniques
generated by scientific inquiry had the potential fordual use: that is, they could aid in the fight against
disease or be used to further spread it. The issue atstake the thus raises fundamental questions about therole of science in society and the necessity of regulatory
safeguards to protect innocent populations.
Security oriented regulation of the life sciences
In many ways, biosecurity and the dual use dilemma
provides a new angle on an old question: if a
researcher’s intentions are good – to contribute toscientific progress and to save lives – then can we holdthe researcher responsible for the unintended andunforeseen malevolent use of their discoveries? (Kelly
2006; for more sustained philosophical analysis of thisquestion, see Miller and Segelid 2006).
Currently, self-regulation within the scientificcommunity is the most commonly advocated strategy tominimize the risks posed by dual-use research.
At the moment, editorial boards of medical andscientific journals have taken responsibility for judging,on a case-by-case basis, whether particular studies
should be edited or withdrawn because the data or
methods might have dual use implications. However,there are proposals that there ought to be a international
pre-project and pre-publication review system tomonitor research. Additionally, the Biological andToxic Weapons Convention (BWC) Intersessional
Meetings for 2008 will specifically address theappropriateness of codes of conduct for scientists aspart of a larger ‘web of prevention’ to help combat themalign use of biological research.
Proposals for a review system have stemmed fromstudies such as the so-called Fink Committee in the US.
This board named seven ‘experiments of concern’ thatwould, in their view, warrant, stringent review for dual
use implications. These are projects that would do any
one of the following: demonstrate how to render avaccine ineffective; confer resistance to therapeuticallyuseful antibiotics or antiviral agents; enhance theEubios Journal of Asian and International Bioethics 18 (May 2008)
virulence of a pathogen or render a non-pathogen
virulent; increase transmissibility of a pathogen; alter
the host range of a pathogen; enable the evasion ofdiagnostic/detection
modalities;
enabletheweaponization of a biological agent or toxin (National
Research Council 2003). Similarly, the Controlling
Dangerous Pathogens Project (also conducted in the US
but with international delegates) recommended thatafter a detailed questionnaire, the proposed project
would be classified as either potentially, moderately or
extremely dangerous. It is thought that most proposals
would fall under the potentially dangerous category andwould thus be reviewed at the local level. The other two
categories (moderately and extremely dangerous
projects) would require national and international
scrutiny for their security implications (Steinbruner et
al 2007).
Of course these proposals raise many questions about
the norms of science and scientific openness. One study
found that UK based life scientists believed that
attempts to build a pre-project funding or prepublication review system would potentially harmscience, which in their view, was already subject tostrict regulations and ethical review (Rappert andDando 2005). Respondents to this study also indicatedthat in their opinion, scientific development andexperimentation were in some sense ‘inevitable’.
Importantly, there was also a strong view that thepressure to publish (and thus secure further grantmoney) made it hard for researchers to not publish theirwork. Thus finding that many life scientists were
unaware of the dual use risk and sceptical of security
oriented review systems, the authors of this study
concluded that is ‘likely that large sections of theworldwide life sciences community have hardly begun
to address the question of their responsibilities in regard
to the dual-use potential of the results and techniques of
their work’ (Rappert and Dando 2005: 27).
As mentioned that the start, however, most of thesestudies have focused on the views of Western based
scientists. There is little doubt that Asian countries will
have their own perspective on these issues and thatwithin Asia, there will be considerable variation inconcerns and opinions. Compared to their counterpartsin the US and EU, Asian based life scientists report thata lack of funds and equipment, as well as delayed
shipments due to export controls are serious problems(Sandia 2006). Arguably, there is a danger that further
security oriented laws may unfairly limit access to key
samples and technologies, needed for genuine research
purposes. And yet, as many East and Southeast Asianlabs handle a high degree of dangerous pathogens, italso seems that the potential for misuse is also real.
Asian based policy-makers and academics have, tosome extent, been involved in international efforts
through the work of the BWC, UN, and WHO. Yet
there is still relatively little input from relevant parties(ethicists, social and life scientists) to the wider

73

academic debates. Arguably, these voices need to beheard if only to confirm or to refute Western views of
the importance of the dual use dilemma. Specifically,
there is a need for better understanding of current
biosecurity methods and review procedures across theregion, both at institutional and national levels, as wellstudies into life scientists own views on the dual use
risks of their work and their wider responsibilities forthe how their research is used. Results from suchstudies can thus inform wider efforts to raise awarenessand promote educational programmes to publicise theissue of biosecurity (as opposed to mere biosafety) andto aid in the construction of international codes andsecurity oriented review systems which are sensitive tocost-benefit analysis and are able to perform objective
judgments so as to not impede life saving work on
vaccine development and the sequencing of emerging
and re-emerging infectious diseases.
Of course nothing in this short paper denies the lifesaving importance of biosafety measures or the priorityof research into infectious disease. But Albert Einstein
is known to have been plagued with a sense of
responsibility and guilt for how his work on atomic
energy in the early 20th century contributed to thedevelopment of atomic and nuclear weapons (Einstein1954). Potentially, life scientists today are facing asimilar situation. It is hard to disagree with thestatement that ‘the human species is relentlessly
acquiring power far in excess of its vision and isthereby posing monumental problems of prudential
judgement – problems that society is not yet
conceptually or institutionally equipped to handle’(Steinbruner et al 2007: 3).
Acknowledgements
This paper was supported by a Department of
Universities, Innovation, and Skills UK-China
Fellowship of Excellence, which the author gratefully
acknowledges.
References
Einstein A (1954) Ideas and Opinions. New York: ThreeRivers Press.
Enemark C (2007) Disease and security: natural plague
outbreaks and biological weapons in East Asia. London:
Routledge.
Jackson R, Ramsay A, Christensen C, Beaton S, Hall D,
Ramshaw I (2001) Expression of Mouse Interleukin-4 by a
Recombinant Ectromelia Virus Suppresses Cytolytic
Lymphocyte Responses and Overcomes Genetic Resistanceto Mousepox. Journal of Virology 75: 1205-1210.
Kelly M (2006) Infectious disease research and dual use
risk. Virtual Mentor: Ethics Journal of the American Medical
Association 8: 230-234.
Miller S and Segelid M (2006) Ethical and philosophicalconsideration of the dual use dilemma in the biologicalsciences. Canberra: Australian National University andCharles Strut University.

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

National Research Council (2003) Biotechnology
Research in the Age of Terrorism. National Academies Press:
Washington DC.
Rappert B and Dando M (2005) Codes of Conduct for theLife Sciences: Some Insights from UK Academia. Bradford
SeriesBriefing
Paper
No
16.
Availableat:
http://www.brad.ac.uk/acad/peace/publications/.
Sandia National Laboratories (2006) A survey of Asian life
scientists: The state of biosciences, laboratory biosecurity,and biosafety in Asia. Sandia National Laboratories: NM.
Availableat:
http://www.biosecuritycodes.org/docs/Asia%20summary%20
SAND%20report%20final.pdf.
Smithson A (2007) Beijing on Biohazards: Chinese
Experts on Bioweapons Non-proliferation Issues. Monterey
Institute of International Studies: CA.
Steinbruner S, Harris, E, Gallagher N, Okutani S (2007)
Controlling Dangerous Pathogens: A Prototype Protective
Oversight System.
Taubenberger JK, Reid AH, Lourens RM, Wang R, Jin G,
Fanning TG (2005) Characterization of the 1918 influenza
virus polymerase genes. Nature 437: 889–893.
Tumpey TM, Basler CF, Aguilar PV, Zeng H, Solórzano
A, Swayne DE et al. (2005). Characterization of thereconstructed 1918 Spanish influenza pandemic virus.
Science 310: 77–80.
von Bubnoff A (2005) The 1918 flu virus is resurrected.
Nature 437: 794–795.

Animals in Research:
7-R Principles and Corporate
Responsibility- Hans-Martin Sass, PhD
Kennedy Institute of Ethics, Georgetown University,
Washington DC, USA;
Institute of Philosophy, Ruhr University, Bochum, Germany;
Research Center for Bioethics, Peking Union Medical
College, Beijing, PR China.
e-mail: sassh@georgetown.edu

Cross-cultural Consensus and Diversity
Culture and nature: Cultures are made and developedby humans, they are not natural. On the contrary,cultures overcome the obstacles, dangers, and cruelties
of raw nature. Cultures manipulate wild plants andanimals into cultured and farmed crops and animals forthe benefit of humans and human communities. The
term culture literally comes from cultivare, i.e. digging
and working the soil. Cultures build houses andinfrastructures to liberate humans and humanity fromnatural limitations, dependencies and uncertainties andto improve individual and collective health, life, andqualities of life.
Cultivation includes the cultivation [i.e. breeding,using, and manipulating] of animals, also the use ofanimals in research. In 1998, the official number ofanimals used in research in the US was estimated to be
1,213,814; but if rats, mice and birds would be

included, which were not covered by the Animal
Welfare Act, the real number would be tenfold, ataround 12 million [4]. Today, worldwide probably 50
million animals are used in research, not including
microbes, insects and annelids.
Cultures represent different traditions and visions,but they share common concerns, intuitions and visions
regarding health, life and environment as well. Among
those common visions and goals are first and primarily
the priority of human security and liberty to be
defended and protected against unfavorable powers andseasons of nature, against dangerous animals anddangerous humans. But then there is also secondly anunderstanding of the close relatedness of humans andhumanity to nature and natural laws and limits,
including different forms of recognition, evencompassion with other living beings. For example,
mortality, suffering and disease are essential to allliving beings, but visions of immortality, health andenhancement of health and happiness has been virulent
in all cultures at all times.
A story told by Al Ghazali, the great Iranian scholar
and unknown to the West, is the story of the prophet
Moses who one day fell ill. His doctors recommended
that he takes a special herbal medicine. Moses repliedthat God’s will be respected; if God wanted him tosuffer and be sick or even dead, then God as well could
heal and make him feel better. The next day Moses’
condition got worse and his doctors told him, that God
had put healing powers into natural herbs and had given
them the knowledge to know about those powers and toprescribe the most efficacious doses. Moses accepted
the argument, took his medicine compliantly and got
well, - a complex story narrating the relation between
nature and culture, medical expertise, scientific inquiry
and human solidarity more impressively than the best
analytical essay. We humans of all cultures use nature
to protect, to comfort and to cultivate our lives andcommunities.
Compassion and respect: Compassion and respect forthe ‘other’, i.e. for fellow humans, in particular the
weak and suffering, is one of the core principles in all
cultures. But morally and metaphysically, nature andanimals are included indirectly or directly. A German
proverb holds ‘Do not harm an animal for fun, as itfeels pain just like you’. Even more encompassing is a
Chinese proverb ‘heaven and man are an integral one;as a result they are in constant pursuit of harmony
between humanity and nature’. This Chinese proverb
was recently prominently quoted by Pan Yue, Vice
Minister of State Environmental Protection of thePeoples Republic of China [12]. Both proverbs are notjust part of cultural history, but very much in the mindsof people, educated and uneducated, in Eastern andWestern cultures.
An indication of a transcultural sensitivity towards
cruelty to animals, in particular to animals in research,
has led to the widely accepted 3R’s presented by WMS
Russell and RL Burch 1959 in their book ‘The

Eubios Journal of Asian and International Bioethics 18 (May 2008)
Principles of Humane Experimental Technique’:replacement of sentient living animals with nonsentientanimals or materials, reduction of the number ofanimals used in an experiment or procedure, andrefinement of the techniques used in order to decrease
the incident or amount of animal pain and distress [14].
The Indian term for ‘do not kill’ or in the broader sense‘do not violate’ is ‘ahimsa’ and is based on the Hinduist
and Buddhist notion which sees ‘all living things as
incarnation of a single life force’ [13; see also the 2004
CPCSEA report to the Indian government]
Love your neighbor: ‘Humane’ techniques refer todirectly to humans, indirectly only to animals. Moreprominent and more essential is the cultural, ethical andpolitical responsibility and respect for humans,families, and communities. Ethics literally means ethos,customs, good behavior, respect for traditional models
of human interaction towards friends and foes, within
the family and community, towards the elderly,
especially towards the weak and dependant, the poor,sick, suffering, and dying. Ethics is based on cultural
traditions and experiences, enlightened by religious andphilosophical teachings, often enforced by social
contracts, regulations and laws. Sometimes the priorityof reciprocal value-and-vision based interaction withand responsibility towards humans and humancommunities is so strong that nature, animals are noeven mentioned in codes and rules for moral conduct.
The Jewish prophet Micah defines the golden rule ‘love
your neighbor and go lowly before your God’; Jesus
similarly said ‘love God and your neighbor as you loveyourself’. One of the five central commands in all
fractions of Islam is ‘to give charitably to the poor andsick’; animals are not mentioned. Confucian master
Mohist even underlines responsibilities towards humans
in contrast to animals in requesting ‘treat humans as
humans, do not treat them as you treat horses’.
But then there are very strong traditions in religious
and philosophical teachings stressing the integration ofrespect for and compassion with the animal kingdom in
all forms. Confucian master Mencius includes harmony
with all nature into his ‘doctrine of harmony’ which has
to
lead
into
‘benevolence-oriented
politics’.
Theocentric and anthropocentric Judaism is very muchaware of the Talmud teaching ‘killing a mosquito on a
Sabbath is a sin much greater than aborting a fetus’.
Christian Saint Francesco Assisi holds that ‘sun, moon,
animals, plants and all creation are our brothers andsisters’. To demonstrate that age old traditions andteachings are still of cultural and political relevance, I
again quote from the already mentioned keynote
editorial of Vice Minister Pan Yue in ‘China Daily’ of
July 7, 2006: ‘Confucianism: All creatures stem fromnature. It stresses that benevolence be shown to people
and all other creatures, extending a spirit of
benevolence to everything in the universe. - Taoism:
Law of nature the supreme principle governing theuniverse and human society... believes that harmony

75

between nature and humanity is more important than
good relations between people.- Buddhism: All living
beings are born equal and have the right to live’ [12].
When harmony is more important than manipulating
nature in medicine and medical research, then extreme
modifications of natural laws such as intensive medicalcare, heroic interventions, creating transgenic animals
are morally questionable, even counterproductive toachieving harmony; this would be a genuine Taoist
view. When suffering is an unavoidable and essential
part of all forms of life according to Buddhist
reasoning, then the goal of improving the quality ofhealth and life and reducing suffering and pain, might
not be the highest moral goal, rather the endurance andfinal escape from the wheel of karma, of suffering, of
being born and reborn. Asian worldviews are moreintuitive than argumentative; they rely more on direct
experience than on principles; doing good and being
compassionate is more important than having a correct
argument or a principled answer to a complex
challenge.
Care for the weak, the sick, the needy, the helpless:In medical ethics of all schools and traditions, we find asimilar concentration on human solidarity with the sickand the suffering: Buddhist monks are very committed
to and revered for serving the sick and the dying
compassionately. All Christians will understand therules of the charitable Order of St John ‘serve your
Lord by serving your Lords, the sick and the poor’.
Ayurveda medicine intends to protect and to improvehealth; Asian medical cultures concentrate on family
ethics, community health and human healthenhancement and anti-aging.
African traditional
medicine uses the natural and spiritual powers of thevisible and invisible world to heal and to protect fellow
humans from evil spirits and evil diseases.
Cultivating nature: Global birds-eye perspectives oncultural traditions seem to confirm a dominant
relevance of two interrelated concepts and visions: First
above all, it is ethical that people care for each other, inparticular for the sick and the poor; it is unethical not tocare for the less unfortunate. Secondly, nature andanimals are for the benefit of human life and humanculture, but manipulation and exploitation should bedone compassionately and responsibly in respect for the
harmony of the world, but also indirectly for the benefitof the future of humanity. Cultural traditions such as
the Abrahamitic monotheistic religions or the harmonybased Asian worldviews are not monolithic; they are
diverse in themselves and some of their schools andconcepts overlap or are identical with those visions
from other traditions. In a globalized world, thesecomplex identities and interactions of moral
communities are often forgotten; but they are essential
for personal as well as professional understanding of
moral concern and moral visions, including those in
medicine and in medical research.

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

Who has the authority to interpret moral imperatives:
Let me illustrate the role of worldview and moral
conviction by a recent case in family practice inGermany: A young Turkish patient suffering from low
sperm count was been given medication by a German
doctor. Three days later, he stormed into the doctor’s
office, throws the pills on the floor and shouts ‘what pig
can give a man medicine from a pig to make son’. The
doctor had prescribed a mild remedy containing
substances from pig pancreas. He could have prescribedother and definitely more potent medicines, but had
followed routine medical practice to start with lowest
intervention first. The Christian sect of Jehovah’s
Witnesses does not accept donated blood even insituations of life-and-death based on a strange
interpretation biblical quotes. Physicians routinely
respect those choices of competent adults. The Prophet
Mohamed had not addressed medicines based on pig
tissue or on shellfish, but he had forbidden to eat pork.
Also the prophet had requested to strictly obey the rulesof fastening during the month of Ramadan, but there isa variety of opinions, mostly supportive about the useof necessary medication, foods and liquids during timesof illness. The Roman Catholic church supports organ
donation but criticizes the use of embryonic stem cells
in medical research and future clinical treatment. Who
has the authority to interpret the validity of moral
norms and moral teachings? This is a complicatedquestion. As there are different positions in most moral
cultures in increasingly more and more diverse
continental and global societies, it would be wise to let
the believer or consumer, i.e. the proband or patient,
have the last word whether to accept or refuse certain
medicine or treatment.
Actually, the fact that there is moral discourse on
crucial issues in modern medical research, can serve as
an indicator that reasonable and responsible people canhave different opinions and that they should be allowed
to follow their conscience and concern. Transparency in
information and procedures to provide education are
essential to let people make prudent decisions based on
their personal views and visions, more or less closely
supported by either one of the more influential ethics
teachings and moral communities. E.g., extreme moral
positions want to be informed and should be informed,
if, how, and why certain drugs contain human blood,
pig tissue, or are based on animal research, - competentand informed people have every right not to be
associated, as considered by some,with those‘immoral’ or ‘forbidden’ activities. Also, no one can orshould be forced to involuntarily be involved in animal
research activities in general, or more specifically inresearch on primates or (for pet lovers) in researchusing dogs or cats. Similarly, the respect for moral
autonomy and individual value-based responsibility
requires that we accept people’s wishes not to accept
medicines based on animal research or human researchor containing animal or human substances.

Four Categorical Moral Imperatives
As far as animal experimentation is concerned, thebasic conflict seems to be the use of non-human species
for the benefit of the human species. Basic conflicts
have basic roots; their solution or easement can besupported by basic guidance, which then in special
situations needs to be refined. In a bird-eye’s
perspective, we can differentiate four cultural andethical imperatives governing the individual andcollective or regulatory resolution of the conflict. Theseimperatives are both cultural and moral, in as far as theenframing culture support specific ethical rules andrequirements. These imperatives are also categorical,
not hypothetical, not depending on certain situations,only in a limited way open to re-interpretation or
adjustment.
Imperative I: The Kantian imperative requests
categorically that you always should act according torules and principles which can and have to be
categorically the same for your fellow-humans too. In
another version Kant requests to treat fellow-humans as
ends in themselves not as means only. This is areciprocal position similar to ‘what do you want to bedone to you, do it not to others’. Reciprocal ethics
sometimes works among humans, but it does not workin interacting with animals. It is of no sense if I would
request ‘do not bite dogs, so they will not bite you’.
Also, we would say to an animal ‘treat me not only as ameans, but always also as an end it itself’. We needother imperatives to treat animals ‘ethically’, i.e.
according to value-based principles and virtues
formulated by and for moral people for the humaneinteraction with animals and other forms of life. It will
be a model already mentioned by Kant himself, thereasoning that a limited extension of solidarity andcompassion beyond fellow humans only would
strengthen the moral resolve towards people, and thatbeing cruel to animals would create a slippery slope indecreasing or neglecting moral obligations towards
humans.
Imperative II: Fritz Jahr, a German scientist, in 1927
in an article ‘Bio-Ethik’ [8; 18] extended the Kantian
imperative to all forms of life ‘respect each living being
basically as an end in itself and treat it, if possible, assuch’. Jahr’s bioethical imperative was formulated atabout half a century before von Rensellaer Potter’s‘Bioethics-Bridge to the Future’ book in 1971, thus
implementing the 18th century vision of British
philosopher Jeremy Bentham ‘it may one day to berecognized that the number of legs, the villosity of skin,or the termination of the os sacrum, are reasons equally
insufficient for abandoning a sensitive being .. thereason is not, can they reason? can they talk?, but canthey suffer?’. Most successfully and prominently in ourdays Peter Singer in ‘Animal Liberation’ [22] has held
the same categorical bioethical position. It is not areciprocal imperative, rather an imperative of extending
compassion and care to those who are unable toreprocate or to protect themselves from harm, pain, andEubios Journal of Asian and International Bioethics 18 (May 2008)
suffering, i.e. vulnerable animals and other vulnerable
living creatures. It is a respect owed to humans
themselves that they treat other vulnerable forms of life
compassionately somewhat or similar as they would
treat other humans. They would harm the ‘ahimsa’principle, i.e. violate the ‘single life force’ of which we
all together and everyone individually is a part of,which is most directly understood in all Asian cultures.
Imperative III: The Sanskrit Imperative ‘tat tvam asi’- literally means: it is you, the worm you step on, thefly you kill, the dog you beat, the guinea pig you use inresearch, the calf you raise for consumption, the LeschNyhan mouse you have constructed and infested with acruel human disease, the flower I break and then throw
away carelessly. Other living beings are just like you,vulnerable, mortal, sensitive, scared; relieve theirsuffering; at least, do not contribute additionally to theirsuffering. Here are a few of the ’10 Grave Precepts’ of
the Buddhist Mahayana tradition: ‘1. Affirm life, do notkill.- 2. Give, do not steal.- 9. Actualize harmony, do
not be angry.- 10. Experience the intimacy of things.’
These moral Imperatives are taught to humans, but
include all suffering creatures, ‘all things’. In the ‘do
not kill’ command, supported and enforced by the‘doctrine of reincarnation’, the rebirth of life in otherforms of life depends on experiences in previous lives
and hopes for a final escape from the wheel of karma
and suffering in the great nirvana. This position in its
pure form does not necessarily consider suffering,which is unavoidable anyway, as being bad or in need
to be eliminated. Suffering and caring for those who
suffer are the two most sensitive and mostcompassionate human actions. When suffering has asense and a goal, then the urge to develop high tech
medicines for the elimination of all sufferings and theenhancements of life are futile and not a priority. It is
most difficult to justify any experiment on any living
entity from an extreme purist position supporting this‘it is you’ categorical imperative. But, there are quite anumber of less strict versions of the ‘it is you’ principle.
Philosophical vegetarians have to eat something.
Informed consent or informed contract might broaden
the platform from self experimentation based on thevirtue of compassion with suffering humans and otherliving beings towards a model close to modern clinical
trials, but using animals would be more difficult thenusing people, as they cannot rationally consent into ashared enterprise of compassion and humaneness,
neither for the progress of human medicine nor for the
progress of veterinarian medicine.
Imperative IV: Taoist reasoning mirrors humanactivity and morality to a perceived pre-given harmony,
the One, the Tao, the Way, encompassing each andeverything. Extreme and intense actions and goals are
not harmonious, they destroy harmony or distract fromharmony, they are selfish acts, uncoordinated with lawsof nature, which have to form the laws of individual
attitudes, human communities, and the harmonious

77

interaction of humanity with nature. Intensive care
medicine fighting at the edges of mortality and using
animals for human medicines can be seen as
problematic and counterproductive for promoting
harmonious interactions. Palliative care of the dying
and self-experimenting of dedicated physicianresearchers might be morally superior. Breeding dozens
of varieties of goldfish for fun and human enjoyment
might be more acceptable than breeding transgenic
animals for extreme human research in human diseases.
However, moral and cultural history shows that Taoist
reasoning is closely intertwined in building harmonious
communities and societies upon the model of perceived
heavenly and global harmony. In the usual selective
combination of Confucian and Taoist arguments,
Mencius proposed ‘benevolence-oriented politics’ by
saying that ‘there would be an abundance of grain, if
the sowing season was not missed, an abundance offish, if they were allowed to breed unhindered, and anabundance of timber if logging was conducted on areasonable basis’ [12]. Such a ‘rule of benevolence’towards cultivated nature would ‘much improve
people’s lives’ and create a ‘harmonious society’,defined by contemporary Chinese authorities by‘democracy and rule of law, fairness and social justice,
credibility, vitality and energy, order and stability, andharmony between nature and humanity’. Harmonybased and ideal-nature-based concepts of orientation
have historically and can contemporary allow for well
reasoned and refined animal research for the benefit ofhumans and animals alike. The argumentation,
however, has to be different than the one preferred in
the Kantian or the Jahr model. It is not so much, what
we do, but how we do it and how we live with it; theTao Teh Ching holds: ‘we make doors and windows fora room; but it is these empty spaces that make the room
livable’ [no.11]. Thus, we do animal research, but it is
not this or that rule or design, it is the way we do it,with each other and with the animals. ‘The highest formof goodness is like water; water knows how to benefit
all things without striving with them.’ In concrete term,
this picture is translated into concrete situational ethics:‘In dealing with others, know how to be gentle andkind. In speaking, know how to keep your words. In
governing, know how to maintain order. In transacting
business, know how to be efficient. When making a
move, know how to choose the right moment’ [no. 8]. It
is this concrete Asian strategic realism which translates
general imperatives into situational action guides, notquestioning that countries have to be governed,
business has to be conducted, moves have to be made,but suggesting to do it in a civilized, compassionate andtherefore successful way. Regulatory design andbusiness strategy follow these rules, - a somewhat
different model of being successful and being goodthan the analytical or weltanschauung-heavy Anglosaxon or European model.

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

Imperatives and maxims are not refined and detailed
prescriptions for single actions, rather general guides
for differentiating between competing goals and risks
and for choosing prudent solutions within a larger
picture. The quotes on ‘harmonious society’, again notfrom a classic philosopher but from an acting Chinese
minister show the actual relevance of classicalteachings for contemporary orientation and policy
decisions on the highest level [12], in particular given
the extreme destruction of environment in the Chinese
industrial and social revolution and the loss of selfunderstanding attitudes during the cultural revolution.
As far as different parts of the world are traditionally
guided by different cultural and moral systems ofreference, it would be useful and successful to address
major concerns towards animal experimentation in
those traditionally dominant terms. However, as a resultof globalization and exchange of cultural and moral
convictions and ethics regulation by national bodies inmore and more pluralistic societies and by transnationalorganizations, those transnational principles such as theprinciples of modern bioethics can and need to be
applied as well. Even though these four categoricalimperatives seem to be widely apart from each other,
they are an expression of value-based concern for good
moral action and cultivated and educated conduct by
individuals and in moral and cultural communities. In
practice and when applied to real-life situations, they
are somewhat flexible, taking a special technical andmoral situation into account when balancing different
visions and obligations; as Thomas Aquinas would say‘quanto magis ad particularia descenditur’, - the more
we face concrete real-life and differentiated challenges,
we may not dispose of principles and virtues, but wehave to adopt and refine them to the concrete challenge.
Research Design
Different countries have regulated animal research,based on principles of ‘no harm’ or ‘low harm’; not all
animal are covered and animal research ethics rare islinked to research on human subjects. But animal
research ethics can follow the same model as humanresearch ethics, but need to implement a few concepts
based on the different situation of animals and humans
as probands and patients.
Four plus one basic principles: At the end of WorldWar Two and after the cruelties in humanexperimentation by the Germans and Japanese, theBelmont Report in the United States established four
principles of common morality which could be
accepted by all fractions and moral communities in apluralistic society such as the US: respect for humans:autonomy, nonmaleficence, beneficence, justice.
Nonmaleficence, the old ‘primum nil nocere’ do-noharm principle, and beneficence, the old ‘bonum facere’do good principle in eliminating suffering, healingdisease and improving the craft of medicine, were age
old principles in all medical cultures; I have detailed
that elsewhere. Both principles ‘mutatis mutandis’ canbe translated into animal research ethics. However, as
animals in research are not the beneficiaries nor their
species (except in veterinarian research) are thebeneficiaries, but as risks, and sufferings are associatedwith being a subject in research, harm will be done, butharm must be minimized. ‘Minimal harm’ has to be theprinciple; also, it needs to be remembered that harm,
directly or as side effect, in practice rarely can be
avoided neither in clinical research nor in clinicaltreatment. Also, the ‘good’ for research animals isdifficult to determine; it would have been best for themnot to be used in research. Therefore the ‘do good’should be differentiated into ‘keep happy’ or ‘do as
good as you can’. The principle of respect forautonomy, such as e.g. detailed in informed consent, isrelatively new and part of the individualistic postenlightment culture of the West, replacing traditional
medical paternalism. It cannot be used in animal
research, but the concept of ‘respect for the
proband/patient’ can be used. Respect for animals in
research would need to remember basic features of all
forms of life, vulnerability, pain, suffering, angst etc.
Thus replacing the autonomy principle by the ‘respect
and concern for vulnerability’ principle would be thechange of choice. Justice in human experimentationmeans that probands and patients should not be chosenbecause they are easier to get for reasons of poverty,
low level of education, desperation, or because they
belong to a minority group or are otherwise easy to
exploit. Similar principles of fairness can and should be
used in selecting special species or individuals foranimal research. Thus, the four principles in animal
research could read: respect for animals: vulnerability,
minimize harm, keep happy, be fair. We have todifferentiate harm and happiness in the researchsituation. I add a fifth principle, which I call the‘minimax principle’. As concrete situations never are
confronted with only one single technical or moral
issue, balancing various aspects, risk, benefits, costs,
and uncertainties is basically the business of research
design and implementation. We want to balance moral
risk, uncertainty, cost, and benefit the same way we dowith technical variables. We want to minimize what we
do not like and at the same, as much as possible
maximize the benefits and goals [16:205-214; 17:302338].
Differentiating harm in animal research: Harm canhave different forms, from severe physical harm tomental and psychological suffering, from pain todiscomfort to the absence of enjoyment, to loneliness,feeling alone and abandonment, harm to life andsurvival. Other harm is directly related to breeding or
conditioning design: genetic or other disorders or
weaknesses resulting from breeding, disease resulting
from infecting animals with human diseases, harm bycrossing species borders by conditioning animals as
carriers of human diseases or changing their genetic
setup even more to make them suppliers of specimen,
tissue or organs for human benefit. Also harm, pain,Eubios Journal of Asian and International Bioethics 18 (May 2008)
and suffering definitely is different between species.
But we don’t yet know enough about those speciesspecific forms of pain, of harm and suffering. It
definitely would be wrong to introduce human harmparameters into the animal kingdom. Based on speciesspecific differences, biologists differentiate roughly
between microbes, insects, annelids and vertebrates.
Quality and quantity of pain, comfort and discomfort isdefinitely different in these groups. Based on
incomplete knowledge in nerve existence andsensitivity, we cannot define or determine what pain
means to microbes, but there must be some form ofcell-discomfort or distress associated with situations ofstress, which in vertebrates and humans we would call
pain. Insects have diverse or separate nerve systems,
some more or less independent or integrated; howshould we define pain? Annelids have sectoral, but also
somewhat interrelated nerve systems; how do we define
pain or compare their nerve associations with pain as
we feel it? Vertebrates have central nerve systems,
similar to humans; but already in humans individual
recognition and anticipation of pain is different; how
are these features species-specific similar or different.
Do we owe more compassion to species which havebecome cultural companions to us over thousands ofyears of breeding and cultivation, dogs and cats? What
do we know about the pain-and-suffering features oftransgenic animals suffering from human diseases; how
do they cope; how do they feel; how scared, lonely,desperate are they? And what about primates, about
their emotional and sensual stress in research,
additional to physical pain and captivity stress?
Unfortunately, we do not know much, not enough toreduce unnecessary stress and suffering, not related
directly to the experiment, which might influence theresearch. Also, different forms of pain associated withresearch might produce other outcomes in animals thanin humans. What seems to be very clear is, that speciesspecific normal-life conditions, happiness and absenceof harm requires more than regulations on the size of
captivity containers, species-specific foods and drinks.
Some species are sensitive to light, smell, noise,loneliness, day-night cycles, - do we know enoughabout these species specific sensitivities and harmfeatures, - and if we know, do we or are we willing to
reduce those harms, which are unrelated to the researchitself?
A case study regarding regulatory uncertainty on
which animals to protect and on what grounds:
Regulations by the USDA did not include rats, miceand birds. The US District Court of the District ofColumbia found that the definition ‘animal’ in the US
Animal Welfare Act was arbitrary and in violation of
the Act itself; it ordered USDA to change the rules; but
a US Court of Appeals in the District of Columbia
overturned the verdict on the ground that the plaintiffs‘did not demonstrate constitutional standing to sue
and/or a statutory right to judicial review under the79

Administrative Procedure Act [2]. Only in 2000 the
USDA agreed to regulate rats, mice and birds [2;http://www.labanimal.com/col/ reg1100.htm]. Theseand other legal quarrels demonstrate very visibly ourcultural and moral uncertainties in dealing with animals
and which principles and value to use in guiding animal
research [1; 3; 7; 10; 11].
Our deficient knowledge in pain-and-harm featuresof the ‘lower levels’ in the animal kingdom might becaused by a lower level of concern for in species
welfare having other models of neuronal signaling as
compared to ours and those of vertebrates. In fact,
animal research ethics, animal protection regulation andlaw, and animal welfare committees are primarily
concerned with the welfare of vertebrates, and evenmore so with non-human primates. Except generalconvictions about the universality of suffering by
Buddhist thought and harmony visions in Taoism, there
is not much distinct and analytical reflection andassumption about pain in animals with nerve structuresless centralized than those of vertebrates. How do wehave to translate nerve conductivity in non-centralized
animals into ethical concern and the language ofcompassion. In national and international regulations of
medical research, microbes and insects are covered forthe protection of human beings from infection and forthe protection of the environment to avoid escape orrelease. Even animal rights activists do not seem to caremuch about the welfare of microbes, flies, andmosquitoes; also, they seem to care more about miceand rats in research than the fate of mice and rats in thewild or in the city. The absence of regulation of animal
research based on moral concern for the entire animal
kingdom is a fact which needs further ethical andcultural inquiry at another time; we will come back tothis when discussing options in minimizing risk andmaximizing benefits in animal research. The EC reporton animal welfare committees rightly calls for replacing
animal research by ‘non-sentient material’ [5:13].
Is Drosophila less sentient than a guinea pig or a
primate? Drosophila can learn and remember situations
in which sugar makes her happy and the absence ofsugar unhappy; how would you translate ‘happiness’and ‘memory’ of Drosophila into the ‘sentient’language? What are the sentient levels of viruses andbacteria and living tissue cells? Research regulations
routinely do not address the ‘sentient’ level of cells,
microbes, and insects. Do they represent the nonsentient material the EC is speaking about? Buddhists
and Hindi would disagree at least as far as visible living
beings such as insects are concerned. How to define‘sentient’ and ‘non sentient? Are there levels of
sentiency, how can they be described in scientific terms
and how can they be translated into moral terminology?
These uncertainties call for future interdisciplinary
research projects between biologists, physicians,
neurologists, ethicists and theologians in theformulation of assumptions about pain and suffering in80

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

the animal kingdom, which in turn might support or
modify the design of existing research models andselection of species for specific research.
The EC community research report suggests toanalyze and assess the ‘ethical assumptions andframeworks of AWC’s’ [5:39] in order to find out about
differences and shared assumptions; this would be aworthwhile project also to identify futureinterdisciplinary research into pain-and-suffering inanimals of all level in the animal kingdom. A recent
study on the ‘Interpretation and Application of the 3
R’s by Animal Ethics Committee Members’ [20] shows
inadequate understanding of the basic principles as aresult of poor training but also differences inrecognizing, defining, and reducing animal pain. An
interdisciplinary research project is urgently needed andshould be conducted on a global scale, studying andintegrating assumptions in AWC’s worldwide andcomparing those with existing or developing attitudes
towards all forms of life and assumptions about animal
research in different moral communities and by ethics
experts of different background.
Human cultures, irrespectively to generalcompassion with animals, have sometimes been very
insensitive to animal pain and harm. Cock fights, dog
fights, some forms of bullfighting and horseracing are
examples that for fun and excitement we make animals
feel pain or even being killed. But the middle-class girlloving and playing with her guinea pig, a night animal,
all day long is not different from a family keeping adachshund in an upstairs apartment, over time ruining
his spine, or other families overfeeding bulldogs
destroying their vulnerable cardiovascular system orothers keeping German shepherd dogs suffering hip
problems resulting from overbreeding. Of course, we
kill (and even eradicate) viral and bacterial pathogens,we kill insects who carry them, rats and mice for ‘good
reasons’ i.e. for the benefit of human life and health.
Indeed, treatment of animals in research is embedded inthese and other cultural attitudes towards animals ingeneral and house pets in particular. Sometimes
probably animals in research are better off than theirbrothers, sisters, and cousins in chicken houses orhouseholds.
Of particular sensitivity is research using non-humanprimates. There are strong objections against any use of
primates in research benefiting humans. Two recent
British 2006 studies took two different and opposing
positions, one by UK Medical Research Council andthe Wellcome Trust and the other by G Langley for the
British Union for the Abolition of Vivisection and theEuropean Coalition to end Animal Experimentation[21; 9]. These arguments are not reconcilable andindicate that a lasting cultural divide will be with us fora long time, based on different cultural and moral
assumptions. The only solution to this divide seems to
be to accept and let people choose for themselves while
the public discourse continues in a hopefully
understanding and compassionate manner. If we value

the moral autonomy of fellow humans and of different
and specific moral communities, then we have to accept
that they will have different positions in regard to
support animal experimentation and to be involved inanimal experimentation themselves, or accept the realand potential benefits from animal research such as
medicines or medical products.
Cultivating animals: Selecting and breeding or evencrossbreeding or genetically manipulating animals forresearch is just one part of using and shaping animals
and other forms of life for the use of humans, humanculture and humanity. For millennia, we have bredanimals for farming and grazing, transportation,
hunting and the protection of house and property. We
have even been successful with selected interspecies
breeding such as breeding mules. Varieties of goldfish
have been bred for fun, varieties of dogs for different
tasks and services, including for dogfights and forleading blind fellow humans. Some uses of speciallybred animals have disappeared or minimalized, butthese varieties are still kept in environment unfriendly,
even unhealthy for their life and wellbeing, such as
hunting dogs in city apartments or dachshunds inprivate homes with staircases. To directly design andcreate special species for studying human diseases inanimal models or for changing enzymatic and otherfeatures in animals so that that organs might beharvested as replacement for human cells, tissue orentire organs falls in line with those traditional indirecttechniques. When dachshunds had been bred for
hunting dachs and fox, then the creation of transgenic
animals for the study of human diseases follows thesame pattern of using animals and modifying animals
for human benefit [16:205-214; 19; 21].
Design principles in animal research: The ethicaldesign of research using animals for human benefit
could follow a set of principles which have been provento be successful guidance in medical treatment andresearch, and in treating fellow humans in general. I
mention four: compassion, vulnerability, solidarity andthe minimax principle. These four principles can beused for both purposes, selecting the most appropriate
animal model or species and selecting the proper courseof research to reduce stress and harm. Compassion
requires the reduction of unnecessary species-specificfeatures which are not related to the specific research,rather to captivity and the artificiality of theenvironment. Vulnerability requires the reduction,compensation or treatment of distress and pain
associated with specific research, also an awareness of
new and very unique features in vulnerability oftransgenic animals or animals carrying human diseases.
The principle of solidarity may suggest compensating
for distress and suffering by offering favors which do
not or only minimally have an impact on research
results. Compassionate killing is required by principles
of compassion and solidarity. The minimax principle
addresses a prudent balance of risk and benefit for the
animal in ethical terms as part of the overall risk-benefit

Eubios Journal of Asian and International Bioethics 18 (May 2008)
calculations of the project itself. Salvi has suggested toaccept animal cloning for clinical research but insupport of profit motives in meat production [19].
Case discussion: Let’s say that Drosophila andprimates are both good models to study
neurodegenerative diseases in humans. In such a case
we have to find out, which aspects of research can bedone with insects and which we unavoidably have to
use primates. There would be a preference in the designof research on Alzheimer to put as much burden andsuffering unto the drosophila probands, and as less as
possible on the primates. Such a minimax solution
would first of all be in line with century-old traditions
that family and friends come first - in this case primates
whose sentiments, fears and pain features we seem toknow better than those of the insects. Secondly, it
would protect what we know, minimize pain andsuffering of animals quite close to us humans in thehierarchy of life. Drosophila has other forms of painand distress, but those experiences of pain in insects
and other forms of life, such as bacteria, are more
remote from us, similar to those of a flower, I havepicked and put into a vase on my living room table formy enjoyment. The assumption that a different pain
experienced by drosophila has to be interpreted as painof lower quality and quantity might be totally wrong;
we would need to have more biological studies andmore philosophical reflection and compassionate
prudence and wisdom for an improved assessment.
Fritz Jahr in 1927 already had such a research project[8; 18]. This would require to re-appreciate and to reconfirm traditional character traits for ethicalprofessional conduct in medicine and medical researchon the crossroads of physiology and psychology.
A good doctor, a good researcher, a good animal
welfare officer: Following our model to translate basic
principles and virtues in medical treatment and medical
research into animal treatment and animal research, we
can use character traits, virtues, and role models inphysician’s ethics to delineate character traits, virtues,
and role models for researchers in animal
experimentation. For this purpose, I just quote without
further interpretation famous 17th century Confucian
doctor Yang Chuan: ‘Trust only those doctors who
have the heart of humaneness and compassion, areclever and wise, sincere and honest’. I could use othermore modern lists of physician’s ethics as a blueprint,
but the list of doctor Yang Chuan contains virtues
which are indispensable and essential for responsible
physicians in the care of their patients, and they are
rarely addressed or even mentioned or supported inmodern medical ethics, medical law and medical
regulation. It is easy to re-write Dr. Yang Chuan’s
advice: ‘Trust only those researchers who have theheart of compassion to all living beings, are clever andwise, sincere and honest’. It would be good, if
creativity, smartness and cleverness in research design
and implementation, wisdom and prudence in review

81

and in choosing between options, and above all honesty
and trust would play a bigger role in research training
and governance and would be honored appropriately.
Just playing by the rules of regulation and oversight andprotecting oneself and one’s team from violating thoserules on paper is not enough to be a good doctor and/or
researcher and to earn the trust of other stakeholders
and the community.
The 7-R Approach: Reduce, Refine, Replace,
Rehabilitate, Respect, Review, Relate
How can and should insights into cultural and ethicalprinciples and requirements be introduced into animal
research? Questions to be asked include: Whatalternatives to animal research do exist, which can orshould be developed?; how can harm be minimalized
by refining design and implementation of research?; arethere less pressing ethical issues when animals are usedin veterinary research rather than in research benefiting
human. These questions have already been introducedby national regulation in most countries; also,transnational bodies such as WHO, the EU andassociations of industry and research have alreadyissued regulation or self-regulation, guidance or
guidelines; other countries have no regulations or
regulations less clear or detailed and are tempting
animal research teams to perform cruel experiments in
those countries. It is my thesis that precise, open, anddetailed Animal Welfare programs in researchcompanies will contribute to more acceptable projects
internally and to a better corporate profile in the public.
Seshadri and others [21] have discussed the unfortunate
facts that biomedical research, including experimenting
with transgenic plants and animals, have foundcountries with low or no levels of regulation; a goodand publicly visible corporate strategy and commitmentof research companies will be able to counter the flightinto such havens.
Animal research, of course, must follow external
guidelines and regulation, but corporations also must
set their own internal rules and principles, guided by
specific corporate concern and mission. Of course, inorder to be effective and trustworthy, corporate
guidance and guidelines should be of global relevanceand authority. High levels of self-regulation are always
better than external regulation, as direct responsibility,
immediate and direct capability for improvement,
adjustment or refinement, self-interest and self-esteem
are part of self-regulation. Animal welfare committees[AMC] on the local and national level have alreadybeen introduced in many companies and recommended
by regulatory and oversight bodies. Novartis has
subscribed to the widely used and noncontroversial 3
R’s (reduction, refinement, replacement of animal
research), originally proposed by WMS Russell and RL
Burch in 1959 [14]. The 3-R approach has become thegolden standard since by the EFPIA [6], the Council ofEurope Convention ETS 123 and most recently

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

successfully been used in a report by an EC Community
Research report ‘Animal Welfare Committees in theEuropean Research Area’ [5]. As already mentioned,
the Indian CPCSEA (Committee for the Purpose ofControl and Supervision of Experiments on Animals)
proposed and implemented a 4 R’s set of principles –Replacement, Reduction, Refinement, Rehabilitation[13]; I use this 4 R’s model to propose an extended 7
R’s model for the use in animal research ethics andcorporate governance on a global and corporate level.
The 7-R approach: I suggest to use the wellintroduced and widely accepted 3-R model as a basis
for the development of an improved and extended
corporate 7-R model. In as far as animal
experimentation is the result of a similar R approach to
reduce, refine and replace human experimentation as
much as possibly can be done responsibly in thedevelopment of safe and efficacious drugs andinterventions for humans, it in itself relates closely to abroader moral strategy of reducing impact of subjects inresearch while keeping the goals and standards of
medical research high. In the words of the EC report,
the three principles require ‘to Replace the procedure
with a method or strategy which uses non-sentientmaterial, to Reduce the number of animals used in theprocedure, and to Refine the procedures so as to makeanimals suffer less’ [5:13]. Of course, in order to beeffective, the 3-R or 7-R model must be supported
strongly by internal corporate policy, also not been
confronted
withfinancialoradministrative
shortcomings if the ethically better option is considered
to be the option of choice. The 7-R approach includes
the Replace, Reduce, Refine principles and the IndianRehabilitation concept, but adds three more principles:
Respect, Review, Relate, - either complementing or reenforcing goals and methods already expressed in theuse of the first three principles. Of particularimportance will be the integration of animal research
into the overall corporate strategy, profile, ethics, andgovernance. It is more than a symbol when drug
companies provide for rehabilitation and retirement
centers for primates who have survived medical
experiments for the sake of humans. Here are theadditional three principles for implementing corporate
ethics and governance beyond national andinternational rules and regulations, establishingresearch based drug companies as good corporateneighbors, also being concerned about the welfare ofanimals in research.
Respect: A special emphasis should be laid on
species-specific forms of harm, pain, distress, as they
are related to the captivity environment and to theresearch itself. Compassion and species-specificvulnerabilities need to be addressed and may lead tomore refined species-specific refinements or even to arare change of the animal model or an alreadyestablished research design. A deliberate Respect for
Animals principle will also allow recognizing specificlocal sensitivities in regard to animal experimentationin general or the use of specific species or the moral
and cultural acceptability of certain forms of research.
Cosmetic research for the human benefit but associatedwith painful experiments on animals might not be
acceptable in many cultures. Experiments for thedevelopment of medicines based on pigs in researchmight not deliver drugs which can successfully be soldin Muslim countries; transgenic animals might beperceived as against the harmony of nature, unnatural
as they carry disease and pain reserved for the humanrace.
Given the controversies regarding animal research,
respect has two sides: respecting the animals in acompassionate way and respecting different moral
assessments of individual fellow humans and moral
communities. Different interpretations of compassion
and of our respect for forms of life in general and ofanimals and animals in research in particular are basedon different assumptions; it would be unjust, unfair, andunreasonable to differentiate between lower and higher
levels of argumentation or commitment or respect forhumans and/or animals. We live in a world, diverse andrich in different values and value priorities. Moses
Mendelsohn, a great European enlightened philosopher
and devoted Jewish Rabbi once said: ‘Brethren, if you
really want to be close to God [wahre Gottseligkeit],
then let us not lie about consensus, when diversity
seems to have been the plan and goal of the providence.
No one of us feels precisely the same as his fellow
human; why do we cover ourselves in the mostimportant fields of life like masquerade [Mummerei],when God gave each of us his own individual face?’[16:233]. The Respect principle allows each of us, anddifferent moral communities, to hold different opinions
on animal research and the use of medicines derived
from animal research and animal products.
Review: Animal Welfare Committees are theinstrument of choice to review and to improve animal
research on the local level and to reconcile different
approaches and to set standards on the national ortransnational level. Corporate AWC’s (Animal Welfare
Committees) are indispensable as only they candevelop, to experience, and to set standards on a global
level and refine general corporate animal welfare policy
for the local ethical and cultural environment. It is
important that an open internal corporate discourse on
methods, uncertainties, risks, shortcomings, and goals
in animal research can be held and continued without
financial or other pressure. As important is thecommunication-and-cooperation with outside partners
in research, the information and exchange ofexperiences, the sharing of basic guidelines andprocedures, a similar process of review and governanceas is practiced in-house; also joint training sessions arevery important. Corporate AWC’s have to have accessto all expertise within the corporation, preferably
directly via members of AWC’s or via consultants. But
corporate AWC’s need also outside expert advice; suchan advice can be provided by experts in ethics andEubios Journal of Asian and International Bioethics 18 (May 2008)
culture or by members of moral communities, - the socalled and in IRB’s reviewing CCT’s in humans wellestablishedandwellreceived‘community
representative’. If necessary for internal corporate
reasons, professional expertise in ethics and cultural
attitudes can also be provided by outside consultants. It
is my experience that ‘lay people’ from the outside(these lay include the so-called experts) provide a
useful service within the committee as they introduce
language and arguments which then can be directly
integrated into the committee reasoning and decision
making process. Lay people ask questions of ignorance
which never will be formulated by pure andprofessional expert groups.
Relate: Animal research and animal research ethics
are an integral part of medical and pharmacologicalresearch, including research in veterinarian medicine. It
is beneficial for animal research as well as for thecompany to relate issues, solutions, even uncertainties,
as transparently and as simple and well reasoned as
possible. Interrelating corporate policy, corporate
ethics, and corporate profile from the top level with all
sections and department and with animal research lab’s
is the preferred design to develop and to guarantee one
corporate mission profile. Such an integrated and well
supported corporate mission profile serves a double
purpose: leadership, encouragement, pride, andresponsibility internally, and respect, understanding andsupport externally by the public and various moral
communities, by the media, lawmakers and regulators,
also by the outspoken critics of medical
experimentation and in particular foes of animal
experimentation. Towards ideological enemies ofanimal research only serious concentration on the basic
mission of the corporation - of which animal research isfor ethical and practical reasons one of the parts - will
be persuasive and convincing and will show the
shortcomings of simplifications by critics and theirdisrespect for suffering fellow humans and the great
achievements and goals of modern medical research. In
general, the Relate principle relates corporate profileand mission, research experience and design, corporate
communication, cultural and ethical concern,stakeholder relations, and public opinion andinformation to each other, - not only a beneficial
service for the corporation and the public profile, butalso for improved future research design by integrating
more and new input from internal and external sources
into research design and policy. For national legislation
and regulation it would need to relate rules andregulations to cultural and moral traditions,fundamental right issues, professional expertise, market
rules, and public opinion and expectations. Similarly,
international governance bodies would need to relate
their recommendations and standards to global andlocal cultures, basic rights, market mechanism, andprofessional duties and possibilities.

83

7-R Moral Risk Reduction Guide in Animal
Research
In implementing animal research ethics into research
design and corporate policies, action guides could be
drafted for Corporate Profile, Regulatory Compliance,
and Communication Competence. This best would bedone in-house with critical assistance from ethics
experts and experts from moral communities. Here is a
Risk Reduction Scheme, which I have developed forother fields of integrating moral risk reduction into
professional risk assessment and for the identificationand possible reduction of uncertainties [13; 16; 17]. In
this form, I have minimally modified for use in animal
experimentation, in which animals are stakeholders but
lacking the competence to be partners in decision
making and design.
Research ethics risk reduction scheme:
1. Identify data and issues
1.1. Collect technical (medical) data
1.2. Collect animal data
1.3. Collect value data
1.4. Discuss data relations
2. Develop alternative options
2.1. Establish reasonable options
2.2. Refine options using 7-R principles
2.3. Identify risk-and-harm features
2.4. Discuss 7-R principles
3. Present preferred option
3.1. Present research risk/benefit in selection
3.2. Present animal harm/risk feature
3.3. Discuss with stakeholders using 7-R’s
3.4. Discuss medical and moral uncertainties
4. Justify your selection
4.1. Summarize reasons for selection
4.2. Review AWC ‘s review using 7-R’s
4.3. Formulate objections to your selection
4.4. Review in light of corporate profile
Implementing the 7-R Corporate Profile andGovernance
Animal research and animal research ethics are an
integral part of the corporate mission in safe andefficient medical research and in the development ofefficacious medicines for humans and animals. It is
important that this overall mission guides and governs
animal research internally and externally. A global
corporate neighbor needs to have one global
personality, virtue, and moral and professional profile.
But this profile has to adjust to local sensitivities,
cultures and customs, where those are particularly
concerned with specific sensitive issues. If we as
individuals are sensitive and cultivated, we individually
will have to adjust to other customs, preferences andexpectations, if we want to be perceived as educatedand cultivated, as good neighbors, probably evenfriends. Similarly a civilized and cultivated corporate
personality has to behave well without changing one’s
character for the reason to impress others or to be more

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

profitable. One has to share values and explain actions
fairly and coherently. Of course, regulatory compliancewith national rules, customs, guidelines, regulations,laws is a must, so is the respect for international rules
and guidelines. But as no one lives by respecting rules
and regulations alone, corporations should develop their
specific character and their special culture exceed ortranscending those customs or rules to become a wellrespected corporate neighbor, friend, helper.
Important for individual persons as well as corporate
persons is a certain level of communication,competence and openness. Corporate persons tend to besuspicious of others, individuals, other corporations,pressure groups, the media; openness and dialogue, fairreasoning and arguing about what the mission is, why it
is important, how it will be implemented, and what
problems will have to be confronted, - that is the best
way to deal with friends and foes, - both are
stakeholders and partners in the local as well as in the
global community. Communicative competence is morethan reasoning; it includes personal involvement andcompassion inside the company and outside. Much canbe learned in training, in finding a mutual language andidentifying mutual or different concerns, moral andtechnical. And much will be learned in communicationin-trust and cooperation-in-trust with partners andstakeholders, not a last with patients and prospective
patients, - indirectly also in dealing with animals in acompassionate way which is more than most rules
require.
Compared to the progress in methods and schemes ofanimal experimentation based on the traditional of
Reduction, Refinement and Replacement, there has
been no progress in methods and ethics of humanexperimentation, in particular as far as Controlled
Clinical Trials are concerned. We are still using the 50+
years old model of soft-paternalistic informed consent
and placebo groups, not introducing contract models forprobands, researchers and sponsors due to theinflexibility of regulatory agencies. Also, we do notmake use of recent pharmacogenetic knowledge
regarding different types of drug metabolizers based on
individual P-450 enzyme properties for individualized
drug development and application. Extending the 3-Rmodel towards the 7-R model for corporate governanceand ethics will provide an even less controversial modelin comparison to still unchanged outdated models inhuman experimentation supported by WHO, CIOMS,
national regulatory agencies and subsequently by drug
companies who have to follow regulatory rules[16:119-125; 17:302-338]. Unfortunately there does notseem to be any intention or moral concern ininternational and national oversight bodies andregulatory agencies for replacing unfortunate andoutdated schemes of clinical pharmacological researchon human subjects.
Jacob Burckhardt, the enlightened European thinker
from Basel would agree with the saying of the Tao The
Ching: ‘We make doors and windows for a room; but itis these empty spaces that make the room livable. Thus
while the tangible has advantages, it is the intangiblethat makes it useful’ [no. 11]. For our purposes we
could say: We make rules and regulations for animal
research; but it is our attitudes and compassion whichmake research livable; and we should add: let’s review,refine, and replace outdated regulatory models andschemes in human experimentation as well.
References
1.

Academy of Medical Sciences/Medical ResearchCouncil/Royal Society/Wellcome Trust (2006) Study into
the use of non-human primates in research. London;
http://www.nhpstudy.com.
2. Animal Legal Defense Fund vs. Secretary of Agriculture;
Decision May 20, 1994]. Only in 2000 the USDA agreed
to regulate rats, mice and birds. Federal Supplement(2781:797-806
1992)
[see
also:
http://www.labanimal.com/col/ reg1100.htm
3. Animal Welfare Information Center, USDA;
http://www.nal.usda.gov/awic.
4. Bishop LJ, Nolen AL (2001) Animals in Research and
Education: Ethical Issues (Scope Note 40, National
Reference Center for Bioethics Literature), Washington
DC; bioethics.georgetown.edu.
5. European Commission (2005) Animal welfare committees
in the European research area. Luxemburg: EC: EUR
21786.
6. European Federation of Pharmaceutical Industries andAssociations (1999) Policy statement on the use ofanimals in research and development. EFPIA, March
1999.
7. Ingham KM, Schmitt G (2005) Novel IACUC outreacheffort to facilitate animal protocol submission and review.
IACUC [Contemporary topics in laboratory animal
science] 44(2):72-74.
8. Jahr F (1927) Bio-Ethik. Eine Umschau ueber die
ethischen Beziehungen des Menschen zu Tier und Pflanze.
Kosmos.Handweise fuer Naturfreunde 24:2-4 [Reprint in
Sass HM (2007) Fritz Jahr’s bioethischer Imperativ,
Bochum: ZME, 33-40.
9. Langley G (2006) next of kin. A report on the use of
primatesinexperiments.
London; http://www.buav.org/campeigns/primates/report.
htm.
10. Mack POP, Ng TH, Song IC (1994) Anaesthesia foranimals in experimental research. Ann Acad Med
Singapore 23:470-474.
11. Mann MD, Prentice ED (2004) Should IACUC’s review
scientific merit of animal research projects. Lab Animal
33(1):26-31.
12. Pan Yue (2006) Humanity and nature need to exist inharmony. China Daily, July 27, p. 4.
13. Pereira S, Tettamanti M (2005) Ahimsa and alternatives –the concept of the 4th R; the CPCSEA in India. ALTEX
22:3-6.
14. Russell WMS, Burch RL (1959) The principles ofhumane experimentation techniques. London.
15. Sass HM (1996) Verantwortung und ethische
Basel:
Ciba
Herausforderung.
ciba.genethik.
Communications, Juni 1996.
16. Sass HM (2006) Differentialethik, Muenster: Lit.
17. Sass HM (2007) Bioethics and Biopolitics. Xian
(http//press.fmmu.sn.cn).

Eubios Journal of Asian and International Bioethics 18 (May 2008)
18. Sass HM (2007) Fritz Jahr’s 1927 Concept of Bioethics.
Kennedy Inst Ethics J 17(4)279-295.
19. Salvi M (2002) To what extent should animal cloning bepermitted. EJAIB 12(2)59-63.
20. Schuppli CA, Fraser D (2005) The interpretation andapplication of the 3 R’s by animal ethics committee
members. ATLA 33:487-500.
21. Seshadri S, Kathiravan K, Ignatimuthu S, Janarthanan S(2002) Commercial introduction of transgenics indeveloping countries – some points to ponder. EJAIB
12(2)57-59.
22. Singer P (1990) Animal Liberation. New York, 2nd ed

Igratefully
acknowledgecomments
andcommunications with Animal Welfare Officers at aconference in Basel, Switzerland.

Assisted Reproductive
Technology in Cultural
Contexts- Bolatito A. Lanre-Abass, Ph.D
Lecturer, Department of Philosophy, University of Ibadan
Ibadan, Nigeria
Email: bola_abass@yahoo.com

Abstract
Recent developments in Western bioethics andbiomedicine have called for the need to be culturesensitive in handling certain bioethical issues. As aresult of this anthropological turn in bioethics andbiomedicine, there are cultural differences in moral
attitudes such as disclosure of terminal illnesses,
reproductive technologies, stem cell research, prenatal
screening, genetic screening, therapeutic cloning, organtransplant, brain death, physician assisted suicide andso on.
This paper offers an examination of the socioculturally framed ways of dealing with Western and
African bioethics particularly as it relates to assisted
reproductive technology. It focuses on the ethical issues
surrounding assisted reproductive technology from an
African perspective making special reference to theirreligious beliefs by drawing on the Christian andIslamic culture. Effort is made to distinguish between
Western and African approaches to assisted
reproduction stressing the fact of cultural diversity inissues relating to these reproductive techniques. It
argues for the need to take social and cultural meanings
embedded in various bioethical issues into
consideration in arriving at different conclusions about
issues in assisted reproduction in order to give room foradequate understanding.
The paper concludes by emphasizing the need toacknowledge cultural diversity in bioethics giving

85

reasons why this diversity is crucial and suggesting
ways of handling this diversity.
Key words: Assisted reproductive technology, Cultural
diversity, Artificial insemination by donor (AID),
Artificial insemination by husband (AIH), In Vitro
Fertilization (IVF) and Surrogate Motherhood.
Introduction
Certain procedures developed by researchers inembryology, obstetrics and medicine, have altered or
replaced natural human fertilization which involves thewell known method of conception through heterosexualintercourse and initial gestation in utero. Among theseprocedures is artificial insemination by husband or
sperm donor and in vitro fertilization using sperm of
husband or donor and egg of wife or surrogate mother.
This arrangement has raised many ethical issues inAfrican culture and has been a source of conflict inreligious ethics. Central to this conflict is the claim that
this arrangement involves a third party in the sexual
relationship, posed possible social and physical risks tooffspring and displaced the traditional mode ofconception and childbearing (Fletcher, 1986:535).
As a result of these conflicts, this paper examines the
ethical issues surrounding assisted reproductive
technology in Western and African cultures. It focuseson offering an account of assisted reproduction asembedded in Western culture as distinguished from theAfrican culture. For the African, there appear to be
widely shared expectations regarding motherhood. This
norm contrast with that in the western world whereassisted reproduction is practiced and widely accepted.
This therefore paper offers a comparative analysis of
assisted reproductive technology in Western culture andAfrican culture focusing not only on Africa’s societal
norms and values but also their religious beliefs. It
argues that given the whole idea of cultural relativism
in ethics, moral principles derive their validity from
cultural acceptance. Hence each culture’s moral
principle should be seen as unique to such culture. The
paper concludes by emphasizing the need toacknowledge cultural diversity in bioethics andsuggests ways of handling such diversity.
Many Africans conceive of bioethics as a Western
phenomenon. This is particularly so when bioethicalissues and questions are framed in such a way thatmakes it universally acceptable to all reasoning beings(Gbadegesin, 2001:24). The perception then is thatbioethics is dominated by the West. This perception
applies to the focus of research in bioethics in the West.
So far as this issue of focus is concerned, there seems to
be a conflict between what is of concern to the Westand its technological breakthroughs, and what is ofinterest to African culture. For instance, through the useof the new assisted reproductive technology which
Africans view as Western, biological motherhood has
been separated into competing components of genetics

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

and gestation, a separation which has given rise todisputes over motherhood and its meaning in Africa.
So many social values promote assisted
reproduction. A major one is the societal expectationfrom couples which sees having children as a naturaland normal part of life. The consequence of this is thatinfertile couples are under pressure to reproduce andthus seek help through assisted reproduction. Many
African women frown at the Western technique ofassisted reproduction because it is alien to the
traditional mode of conceiving and carrying apregnancy. Also, this technique extends the boundaries
of intimacy and of traditional notions of familial
kinship patterns by dispersing what was once thoughtof as a unified entity (mother) and making it into
something without a definitive aspect or dimension(Grayson, 2000:100).
However, the implications drawn from the social
value promoting assisted reproduction are numerous.
First, assisted reproduction has been described as apositive response to the needs of the infertile (Frith,
1998:817). Due to the frustration of infertility, Western
medical science has responded by developing
techniques designed to alleviate this health problem.
Also, this medical technique is seen as mechanisms forextending people’s reproductive choices; a benefit for
both the individual and the society. Assisted
reproductive techniques has the advantage of providing
benefits for society as a whole because these techniques
can help prevent genetically inherited diseases andadvance scientific knowledge about the humanreproductive system that could have, as yet unforeseen
benefits (Frith, 1998:820) . Lastly, some techniques(such as AID or egg donation) can also prevent thebirth of children at risk of congenital diseases known tobe carried by one of the parties who wishes to parent
and other approaches such as surrogacy can protect
women at risk of harm from pregnancy (Purdy,
2001,163).
Forms of Assisted Reproductive Techniques
Assisted reproduction is of various types. One form
is AID and egg donation in which sperm is obtained
from a man who is not the prospective mother’shusband, and is placed in her with the aim of initiating
conception. In spite of the likelihood of inadequate
screening for sexually transmitted diseases which isoften a major problem of this technique, AID is
described as a beneficial and well-established practicethat can make up for male infertility and prevent serious
genetic diseases (Mahowald, 1993). There is also egg
donation by a woman. This requires hormonallystimulating a woman to produce multiple eggs;
monitoring this development requires frequent blood
tests and sonograms. If the stimulation is successful, theeggs are then retrieved from the donor by passing aneedle through her vaginal walls (Purdy, 2001: 165).
Although this technique has been described as risky(Holmes, 1988), it has offered respite to some womennotwithstanding.
Similarly, IVF technique requires a woman who
desires a child either to undergo egg retrieval or toacquire an egg from a donor. Sperm (usually thehusband’s sperm) is then introduced to the egg in a
Petri dish (Walters and Singer 1982). To increase
fertilization rates, especially where sperm is known to
be deficient in some way, a single sperm may be
injected through the outer membrane of the egg wall.
Any resulting embryos are placed in the woman’s
uterus when they have grown to four or eight cells;
often multiple embryos are introduced to raise the odds
in favour of pregnancy (Purdy, 2001:165). The woman
then receives frequent injections of progesterone until
the twelve-week point if she becomes pregnant.
Although the success rate is low different clinics havedifferent rates of success and some versions of IVF(such as that undertaken with egg donation) have better
results (Consumer Reports 1996). Many people haveexpressed concern about the welfare of the offspring of
IVF. Yet hundreds of thousands of IVF babies are born
every year.
Another reproductive technique is surrogacy.
Sometimes described as contract pregnancy, it involves
impregnating one woman to gestate a baby who is to beraised by another woman (Purdy, 2001:168). Rodney
Mowbray (1994:849) identifies three forms ofsurrogacy. The first occurs when sexual intercourse isused by the husband of an infertile woman toimpregnate another woman for the purpose of bearing achild for the couple. A second method involves using
artificial insemination of the surrogate with sperm
provided by the prospective father. A third method, invitro fertilization, uses sperm and eggs provided by thegenetic parents to produce an embryo (a test-tube baby)
that is then implanted into the surrogate. The last
method which is sometimes referred to as gestationalsurrogacy is the most complicated form of contract
pregnancy; it raises the ethical question of whether
genetic relationship or gestational relationship bestows
motherhood on a woman.
Modern assisted reproductive techniques call into
question the main idea of personal identity, intimate
relationships and the beginning of life. By dividing
biological motherhood into two components ofgestational and genetic motherhood, the negative
consequence involves degrading pregnancy andexacerbating class differences and racial inequality(George, 1988:27-33).
For many couples however, procreation now
includes the participation of additional parties such as
health care professionals, surrogates, donors, andincreasingly, the state. No longer belonging to therealm of private acts and decision making of couples,the procreative process of assisted reproduction has
become a collaborative process that takes place in the
public spaces of the laboratory and the clinic. Withinthese public spaces, assisted reproductive techniquesEubios Journal of Asian and International Bioethics 18 (May 2008)
such as artificial insemination, in vitro fertilization,embryo transfer and surrogacy allow a multitude ofindividuals to participate in a couple’s attempts toconceive (Grayson, 2000:100). Also, not only is birth aprocess mediated by the intervention of physicians but
conception has become a more complex drasticallymediated process as well. The ‘private, all of love
intimacy, and secrecy’ of creating a child, has become a‘public act, a commercial transaction and aprofessionally managed procedure’ (See Grayson,
2000:100).
Because the advent of Western reproductive
techniques have succeeded in splitting reproduction
into three components parts, (genetic, biological andsocial), this split raises numerous religious, social andethical issues and consequently different responses
from various religious sects in different cultures.
Gbadegesin (2001) sees the need for these responses foraccording to him, ‘every culture, even the mosttraditional one, must develop a response to the newtechnologies in health care’ (Gbadegesin, 2001:25).
Within the African culture, religion is the opium of thepeople. It is the lens through which Africans view
various issues. Unlike the Western world where scienceand religion are separated, in Africa, religious factors
play crucial roles in technology assessment. Responses
vary among the Roman Catholics and the Protestants on
the one hand and the Muslims on the other. Thissuggests the fact of cultural and religious diversity.
Hence the need to examine these variations from thereligious perspectives of the African culture.
Assisted Reproductive Technologies in Cultural
Contexts
Within the African culture are people of different
religious sects and cultural attitudes. It is sometimes
difficult to separate culture from religious beliefs. For
centuries, a fundamental concern of African women has
been the struggle over reproduction. African women
have been carefully trained to want motherhood, toexperience themselves and their womanhood, their very
purpose in life through motherhood. But in spite of theartificial reproductive technique which was invented toserve as respite to the infertile African woman, thetypical African woman still considers infertility adisability. For her, the experience of pregnancy is ofutmost importance. Hence assisted reproduction seems
inadequate as a technological device because it erases
the whole idea of mothering experience and destabilizes
the African traditional notion of the family. Franklin(1995:334) explains that the emergence of assisted
reproductive technology that conflates with anddisplaces nature has disrupted naturalizing assumptions
made about the categories of ‘mother’, of ‘family’ andof ‘nature’ itself.
While infertility is not considered a form of disability
in the western world because of the available choice ofassisted reproduction, in Africa, infertility is often

87

viewed as a form of disability. As Deane Wells(1987:374) claims, ‘the inability to bring into the world
one’s own genetic children in Africa is a disability inthe same way as is shortsightedness’ Disability in thiscontext implies reproductive impairment. Impairment
can be defined as ‘the expression of a physiological,
anatomical or mental loss or abnormality--- an
impairment can be as a result of accident, disease orcongenital condition’ (OTA, 1982). The issue of
infertility is so important to the African woman yet
assisted reproduction fails to offer respite because it
detaches an African woman from the bodily
experiences of pregnancy that she would actually wantto undergo. In Africa, pregnancy is linked to theessence of being female for only in pregnancy is theorganic functioning of one human individual
biologically inseparable from that of another (Warren,
1992 212). Hence a typical African woman would want
to experience pregnancy and childbirth. This explains
the uniqueness of the gestational and genetic
components of motherhood in African culture.
In Africa, the basis for determining natural parentage
is genetics and gestation. It is also considered adefinitive form of motherhood for the African woman
because total ownership depends on gestational andgenetic ancestorship. The African woman, like most
women anywhere, prefers the gestation of her fertilized
eggs in her body rather than the laboratory or in another
woman. For her, what sits in her womb in form of the
fetus is quite different from what sits in her mind interms of the surrogacy arrangement with another
woman somewhere. This seems to set the surrogacy
arrangement on a par with the experience of pregnancy
for the African woman. There is therefore need toreflect on the many ways in which the intrauterine
environment and maternal behavior during pregnancy
can influence fetal and later child development toacknowledge that the genetic and gestational
components of motherhood need not be separated.
Apart from the fact that the new methods of assisted
reproduction separates motherhood into two
components and as a result abstracts the experience ofpregnancy from the desiring mother, it also alters the
traditional conception of the family; a practice which isalien to Africa where respect for biological ties isemphasized.
Modern artificial modes of reproduction threaten to
produce greater emotional difficulties for family
members affected or pose more serious ethicalproblems than those already arising out of longstanding practices such as adoption and artificial
insemination. Although it is easier to keep secret from achild, the circumstances surrounding artificial
insemination and egg donation, such secrets havesometimes been revealed with terrible emotional
consequences for every member of the family involved.
Alison Ward (1988) for instance compares the impact

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Eubios Journal of Asian and International Bioethics 18 (May 2008)of surrogacy on children to both situations. According
to her,There will always be pain for these children. Just as
adoptive parents have learned that they cannot love thepain of their adopted children away, couples who raisechildren obtained through surrogacy will have to deal
with a special set of problems. Donor offspring rarely
find out the truth of their origins. But some of them do
and we must listen to them when they speak of theiranguish of not knowing who fathered them, we must
listen when they tell us how destructive it is to theirself-esteem to find out their father sold the essence of
his lineage for forty dollars or so, without everintending to love or take responsibility for them. For
children born of surrogate contracts, it will be evenworse: their own mothers did this to them (see Chesler,
1988)
An anthropologist notes that ‘the family in allsocieties is distinguished by a stability that arises out of
the fact that it is based on marriage , that is to say, on
socially sanctioned mating entered into with theassumption of permanence’ (Charo, 1988:104). If we
extend the notion of socially sanctioned mating toembrace socially sanctioned procreation, it is evident
that the new artificial means of reproduction call for
careful thought about what should be sociallysanctioned before policy decisions are made. In an
attempt to explain what the family stands for inWestern culture, Patricia Hill Collins (1990) tries tomake a case for the possibility and necessity of morediverse definitions of mother and, by extension, offather and of family which will accommodate thedifferent methods used to reproduce and introduce
babies into families. Her argument is that we shouldfind ways to acknowledge rather than diminish or
ignore the participation of all parents in the process of
assisted reproduction even if the effects is to destabilize
previously held notions of the family. Redefining the
traditional conception of the family brings us back to
the problem of destabilizing the family unit created byreproductive technology.
Another ethical issue is that artificial reproductive
techniques improperly treat children and women’s
reproductive capacities as commodities (Corea, 1985
and Holder, 1985). For instance, surrogacy not only
reduces children to consumer durables and women to
baby factories, it constitutes an unconscious
commodification of children and of women’s
reproductive capacities; all of which is foreign toAfrican culture. This arrangement substitutes market
norms for some of the norms of parental love. Most
importantly, it requires us to understand parental rights
no longer as trusts but as things more like property
rights – that is , rights of use and disposal over thethings owned (Anderson 2007:244).
The most disheartening aspect is the surrogate act ofleasing out wombs to other women as a means ofincome; the consequence of which is the introduction of
the norms of commerce into parental relationship.

Margaret Radin (1987) for example condemns paidsurrogate motherhood as devaluing women in general,mothers in particular and children universally bymaking them ‘completely monetizable and fungible
objects of exchange’, meaning that any one may bereplaced by any other and has no individual value in
itself, so leading to ‘an inferior conception of humanflourishing’(Radin, 1987:1849). Treating children as
commodities is not only degrading but also an
unacceptable practice in Africa.
However, different African religious attitudes torelations between human beings and their perceived
divine creator, influences responses to assisted
reproductive
techniques.
In
many
Christiancommunities in Africa, for instance, it is considered
offensive and a condemnation that one should assume
to ‘Play God’ with human conception and birth as animpertinent human arrogation of divine power andauthority. In other religions such as Judaism, there is aperceived partnership between humans and their divine
creator so that individuals’ God-given-gifts’ of skills
and initiative are properly employed in scientificadvancement and in the cure or overcoming of medical
impairments including artificial reproductive technique.
In this tradition, the divine creator is described as acting
in ways of beneficence, mercy and compassion and ‘thehuman being is required to imitate God in this respect’(Steinberg, 1994:67). It is important to point out that it
is typical of the Western tradition to attempt to ‘play
God’ through various technological and scientificinnovations.
However, religion permeates the whole aspects of the
lives of Africans who hold various religious beliefs
about assisted reproduction based on the Islamic andChristian injunctions in the Holy books (the Qur’an and
the Bible). The typical African makes reference toreligious arguments by citing the Bible or Quran in his/her approach to assisted reproductive technique on the
one hand, or traditional African societal norms andvalues of motherhood on the other.
“Be fruitful and multiply”. This biblical injunction
occurs first in the context of the divine words of thecreator to the newly created human beings (Genesis
1:27-28). Having offspring carries on and supports thework of creation. Procreation is good from theperspective of Christian ethics, both as divinely
sanctioned and as a participation in creation (Demarinis
and Dyck, 1986:499). Also viewed as good, as divinely
sanctioned and created is the companionship of maleand female, described biblically as destined toward a‘one flesh’ union as wife and husband (Genesis 2:1824, Ephesians 5:31). These two purposes of marriage
and sexual intercourse, the procreative and unitive are
generally affirmed in Christian thought and action,
now, as in the past. It is noteworthy to point out that
Western assisted reproductive technique undermines
these unitive and procreative purposes of marriage
when a third party is involved making every act ofmarital sexual intercourse public. The Roman Catholics

Eubios Journal of Asian and International Bioethics 18 (May 2008)
in Africa rule out AID and AIH as attempts to havechildren without the loving and unitive act of sexualintercourse with one’s spouse.
The Roman Catholics view assisted reproductive
technique as an unwanted interference with nature andwhat is perceived as God’s will. According to them,this technique is a deviation from normal intercourse
and in separating the unitive and procreative aspects ofsexual intercourse, the reproductive process is devalued( Frith, 1998:822). Also, to introduce a party into theprocess of procreation is seen as defiling the sanctity ofmarriage and the family. Closely related to this is thetreatment of the embryo. For the Roman Catholics,
Western assisted reproduction puts the embryo at risk.
Health problems might turn up as they develop(Holmes, 1988:140).
However, among some Roman Catholics, moral
theologians and others, as reflected in Vatican council
II, it is marriage that is intended to be procreative notevery marital act. This is the generally held protestantpoint of view. However, there are Protestants as well as
Roman Catholics who see AID as a threat to therelation that should exist between wife and husband:they should both bodily and lovingly contribute to theiroffsprings (Demarinis and Dyck, 1986:501).
Even within the Christian sect, diversity exists as tothe issue of procreation. Some protestants who approveof AIH and AID emphasize the spiritual, psychologicaland physical bonds between the couple using artificial
insemination and the child that results. In short, nurture
rather than the one-flesh bond between two people isaccented (Demarinis and Dyck, 1986:501). Although
Roman Catholic ethical teachings and warnings against
AID have dominated ethical debates on Westernassisted reproductive techniques, significant opposition
to their teachings also arise from some Protestantsources.
Joseph Fletcher (1986) was an early challenger of theprevailing negative view of AID in religious ethics.
Basing his challenge on Christian personalism, heemphasizes placing higher values on the personal
relationship of husband and wife than their biologicalrelationship by supporting AID as a morally validmeans to overcome infertility. Fletcher viewed thepractice of levirate marriage (Deuteronomy25: 5-6) as aclear biblical exception to an exclusive claim ofhusband-wife reproduction. Further, he stressed that
AID emancipated human beings from natural causalityand determinism, therefore providing more humanly
satisfying goals and relief of the emotional deprivationof childlessness (Fletcher 1186: 537). Indeed for
Fletcher, we are more human in artificial reproduction
than in natural reproduction.
Another major argument put forward by Fletcher insupport of AID was that the protection of anonymity ofthe donor by physicians effectively discounted the ideathat a third person was personally involved in thesexual relationship. The outcome of a desired

89

pregnancy outweighed in Fletcher’s view, the minimal
chance that anonymously donated sperm would bewrongly interpreted by husband and wife as a real
intrusion in their sexual relationship (Fletcher,1986:537).
However, Edward Reichman (2004) has suggested
adopting assisted reproductive techniques on a case-bycase basis provided they do not entail Torahprohibitions. For him, the fact that the obligation to
procreate, ‘be fruitful and multiply’ is the very first
Mitzuab (commandment) in the Torah reflects its
significance in the Jewish tradition. He identifies the
procurement of the male reproductive seeds as a major
legal obstacle that pervades all discussions of assisted
reproduction. The prohibition against wasteful emissionof male reproductive seeds (that is outside the contexts
of natural intercourse) guides many of the rabbinic
discussions on this issue. The majority opinion allows
sperm procurement to treat infertility, since the ultimate
objective is to produce a child and to thereby fulfill thecommandment to ‘be fruitful and multiply’. This is notdeemed a wasteful emission.
Most authorities allow any interventions, such as
artificial insemination or in vitro fertilization, using the
gametes of a husband and wife and consider the
resulting progeny to be the couple’s legal child. Whenintroducing donor gametes, however, either sperm or
egg, authorities disagree as to the permissibility. Issues
such as legal adultery and bastardy, the definition ofmaternity in cases of a gestational host (that is a woman
who serves only as the gestational mother, while theegg was donated from another woman), andpsychological manifestations weigh heavily in rabbinic
discussions (Reichman, 2004:98).
In Islamic discussions, seeking treatment for
infertility is encouraged since it aims for the good of
procreation. Though the aim is good, the means ofachieving it that involves assisted reproductive
techniques elicits debate. From an Islamic perspective,
IVF is only permissible under certain conditions. The
woman’s oocyte may only be fertilized with her
husband’s sperm only if they are still married. There
must not be a third party such as an anonymous donor
or a surrogate mother. Islamic teachings absolutely
prohibit insemination of the woman’s egg with thesperm of another man who is not her husband. Islamicscholars have addressed this issue of using sperm
donors and have declared it comparable to adultery(Mirza, 2004: 109). They therefore regard it as agrievous crime and a great sin. Similarly, surrogacy isentirely illegitimate. As the Holy Quran states, “noneshall be their mother except those who gave birth”.
The act of giving birth bestows motherhood in Islam.
The implication of this is that surrogacy or egg
donation is not recognized in Islam. Donna Bowen(2001:233) describes the act of giving birth as detailed
in the Quran. According to him, the act of bringing
forth new life from the womb of the mother is the only90

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

process leading to birth in the conception of the fetus.
The Quran emphasizes the sacrosanct nature of life andthe honorable roles of mothers. Women who conceive,
give birth and sustain infants through the period of
lactation are referred to as mothers in the Quran and arenoted with respect. Muslims are therefore commandedto ‘honor the mothers that bore you’(Quran4:1) and toshow kindness to parents for with much pain his motherbears him and he is not weaned before he is two yearsof age (Quran31:14).
The implication of the above is that motherhood is
not separated into genetic and gestational component, aconsequence of Western assisted reproductive
technology. Such separation is not mentioned andhence not recognized in the Quran. The womb isrecognized as the only female reproductive organ, theuterus by extension and the importance of kinship andblood relationships (Hermansen, 2001: 522). The use of
the term ‘womb’ in the Quran most often refers either
to the generative function of the female reproductive
organ (Q 2:228, Q3:6, Q13:8, Q22:5,Q31: 34) or to theimportance of the bonds of kinship. Some of the aboveverses mention womb in the context of the legal
implications associated with conception and birth. A
consistent pattern of interpreting the Quran is to readthe references to conception, birth and humandevelopment as evidence of God’s creative majesty andcare for human kind. The early life stages and aspectsof human biology mentioned in the Quran include
conception, fetal development and growth, childbirthlactation and weaning.
In Quran 23:12-14, reference is made to fetal
development and growth. Explanations of these verses
express the view that ‘sperm’ and ‘firm lodging’ referto sperm within the female reproductive tract, more
specifically within the uterus. Prior to fertilization,
sperm bind to the zona pellucida or outer covering of
the ovum. Following such lines of interpretation,‘alaqa’ could be a reference to this, that is to sperm‘clinging’ to the ovum. However, alaqa is alsointerpreted by some exegetes as ‘blood clots’ and taken
to refer to ‘something that clings to the uterus’. For
those modern commentators who then extrapolate thisinterpretation scientifically, the ‘blood clot could betaken to represent the fertilized ovum or early embryo
implanting itself in the endometrium or uterine lining(Abdul Fadl Mohsin, 2001:231).
Nowhere is it stated in the Quran that fertilization
using another man’s donation other than one’s husband
is allowed. Similarly, no explicit reference was made to
the act of implanting an embryo in another woman’s
uterus. These are acts which are allowed only between
legal couples who consequently are described asparents in the Quran. Terms designating ‘parents’ in the
Quran are’ walidani and ‘abawani’ respectively. The
dual form of Walid , “father, one who begets a child:(the passive al-mawlud lahu indicates “to whom thechild is born”; Walida mother, one who brings forth achild (Giladi, 2001:20). Natural aspects of parenthood

are particularly identified throughout the Quran withmaternal functions, pregnancy, giving birth,breastfeeding and weaning (see Q16:78,Q39:6,
Q53:32,Q 58:2). Maternal emotions of love andsolitude find emphatic expression in the Quranic storyof Moses (Q28:7-13, Q20:38-40). As reproduction is
implicitly presented as the goal of marriage (Q4:1,
Q7:189), God made parents the reason for the servants
to come into existence (Q4:36, Q6:151,Q17:23-24,Q
31:13-14) .
The above Quranic references to conception andbirth is not an indication that Islam opposes technology.
In fact almost all sources, classical and modern, agree
that the Quran condones, even encourages theacquisition of science and scientific knowledge. Most
sources also argue that doing science is an act ofreligious merit, and to some, even the collective duty of
the Muslim community. The purpose of rejecting somescientific views is not to promote alternative ones or toassert the authority of the Quran at the expense of thevarious fields of scientific knowledge. But ‘the ultimate
challenge in any religion or spiritual group is to be able
to apply its teachings to the world in which its believers
live. And issues relating to biotechnology are
undeniably relevant to people of all faiths and religion’(Mirza, 2004:105).
Also, African religious and cultural beliefs
concerning assisted reproductive technique do notsuggest the devaluation of this technique. Rather it is areflection of cultural diversity arising from religious
divergences. Culture is an important aspect of people’s
lives and embedded as part of people’s culture is theirreligious beliefs. Diversity exists about various
bioethical issues and this is expected and should beallowed. Bioethical deliberations are like a ‘theatre’
which has its own cultural roles. Engelhardt (1996:vi)
calls it ‘a babble of conflicting bioethics’ with the word
babble illuminating the phenomenon of diversity ofmoral perspectives. Diversity constitutes both the most
specific fact or feature of modern ethical thinking inbiomedicine or bioethics and a challenge to it.
Engelhardt wrote:
Moral diversity is real. It is real in fact and inprinciple. Bioethics and healthcare policy are yet totake this diversity seriously. Taking diversity seriously,
Engelhardt diagnosed the danger there is a swarm ofalternative ethics ready to give rise to a babble ofconflicting bioethics. This circumstance constitutes thefoundational moral challenge of all healthcare policy. It
brings the very field of bioethics into question(Engelhardt, 1996:vii)
The above suggests recognizing the importance ofdiversity. Going by Engelhardt’s historic account of thevalue of diversity, he tries to conceive of means tograsp what is common in different things by trying toprovide an account of morality that should guideindividuals when they meet as moral strangers tofashion healthcare policy. His aim is therefore to offer
theoretically grounded guidelines that order chaos ofEubios Journal of Asian and International Bioethics 18 (May 2008)
public moral attitudes, making fruitful collaboration of
strangers possible.
Lending support to the value of diversity, Pavel
Tishchenchenko et. al. explain that bioethics looks likea kind of a competition of storytellers or tragic poets inantic theatre. Public (spectators) is the agency that
grants gifts (awards) of recognition to those whosestories mostly fit their internal moral predispositions. It
is the way of permanent co-evolution of public moral
identity and ideology of biotechnological progress.
Differently put, bioethics theatre presents a specificform of cultural selection of competing for survival ,multiplicity of moral values, styles of life, and world
visions, and on the other hand, multiplicity ofbiotechnological projects ofsolution of humanproblems. This way, humanity achieves contingent,open to reappraisal normative structures that order andstabilize the stream of scientific progress inbiomedicine (Pavel Tishchenchenko, et. al. 2006:226) .
Continuing in the same vein, Pavel Tishchenchenko,
et. al. (2006:8) describe bioethics metaphorically as a‘dining table’ with place settings offering different
menus: different methods (descriptive, evaluative andnarrative), different ways of questioning power
relationships (participatory, communicative, political)
bring their ingredients together, find suitable recipes
and set their part of the table nicely. They prepare ameal, to which a range of guests (those concerned,
those involved, those affected) is invited. According tothis metaphor, bioethics must be an open moral
reflection, taking the plurality of cultural perspectives
into account at all levels of scientific and hermeneutic
methodologies. A key motif for understanding how
different methodologies can work together is thepluriperspectivity of moral phenomena. They are social
life-born not theory-born.
The recognition of diversity about bioethical issues
however calls for ways of handling such diversity.
First, there is need to acknowledge the fact that‘culture’ is an important aspect of people’s lives andthat the features of a particular culture are unique tomembers of that culture alone. From this assumption,
whatever beliefs, ideas, and values shared by all
members of a particular culture will be seen as
definitive of it. This underlying assumption can then be
applied to various bioethical issues. Since bioethicalissues cut across cultures, culture is intrinsically related
to bioethics, hence bioethics should be seen as a social
phenomenon. A reflective, culturally informed
bioethics also questions bioethics actions in relation to
cultural and social institutions (Elliot 2004 and Sharpe,
2002).
There is also need to pay attention to the variations invalues and customs among different classes, genders,races and religions. It is noteworthy to point out thatcross-cultural explanation of bioethical issues isimportant in disclosing apparently different moral
standards and moral practices among different cultures.

91

Every culture has gone through processes of making its
societal norms and values suitably specific. It is also an
obvious fact that not all cultures have given the sameanswers to the same problems and often, many answers
have emerged from within the framework of manydifferent cultures such as the Western and African
cultures on assisted reproduction. In all cultures, theinterpretation and specification of norms, thereconstruction of traditional beliefs, the balancing ofdifferent values and negotiations are essential on an
ongoing basis (Hoshino, 1997:28).
Coupled with the above is the need to respect every
ethnic group or community’s value system andworldview. All cultures are equally worthy of respect
hence we cannot make objective judgments about
cultures rather only ones from our particular cultural
point of view. Gbadegesin (2001:26) has suggested atranscultural bioethics, a form of bioethics which is not
specific to any single culture, but forms an arena of
discussion in which people from diverse cultures can all
take part on an equal footing. This according to him is
important not only because bioethical issues transcend
any single culture but also because transcultural
bioethics facilitate intercultural understanding.
Also, since each culture finds its own uniquenesswithin its own cultural identity, it is imperative toacknowledge and not deny the differences that exist
between cultures. There is therefore need to create
international networks which effectively guide those
aspects of science and technology which affect our lifeand death, including procreation but which will not lose
sight of diversity in people’s cultural beliefs. This
becomes imperative because ethical reasoning on thesame bioethical issue can justify different ethicalconclusions. For instance the process of assisted
reproduction generates ethical debates about issues
concerning the beginning of life and alternativetechnique of procreation in every culture. But while it isacceptable and widely recognized in the United States it
is not acceptable in Africa because it falls short ofAfrican cultural values relating to pregnancy andchildbirth. We are again faced with the issue of cultural
diversity.
Again, there is need to acknowledge the fact thatbiomedical developments carry with them social andcultural meanings that must be taken into consideration
if the accompanying bioethical dilemmas are to beunderstood. Also, since bioethics is a specific form andconcept of medicine just like predictive medicine andregenerative medicine, in order to be sensitive to these
dimension of bioethics, bioethics should include a‘cultural approach’ (see Daniel, 1999; Patricia andBarbara, 2004). Whether it is acknowledged or not,cultural diversity is real in principle and in practice andhence a major challenge to bioethics.
Thus this paper has examined recent developments inthe field of Western bioethics. It offered a comparative
analysis of assisted reproductive techniques in western

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

and African culture focusing on African societal norms
and values including their religious beliefs. The paperargued for the need for culture-sensitivity taking into
cognizance not only the facts of diversity anddifferences in the Western and African approaches toassisted reproduction but also the fact that a particular
culture can only be understood on its own merits andnot another culture’s. I invite comments from Asian,and other, readers on their comparisons to African
culture.
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Eubios Journal of Asian and International Bioethics 18 (May 2008)

Bioethical Dilemmas in a
Pakistani Context- Muhammad Ilyas, Mukhtar Alam* and Habib Ahmad
Department of Genetics, Hazara University Mansehra,
NWFP, Pakistan.
*Correspondence: Dr. Mukhtar Alam, Visiting Faculty
Member Department of Genetics, Director, Research andPlanning, Hazara University, Mansehra, Pakistan.
Email: rp.director@gmail.com
URL: www.hu.edu.pk/genetics

Introduction
Since the dawn of the Industrial Revolution in the
18th century, science has had a profound effect on theway humans interact with, and act upon nature, largely
through its applications in new technologies. On one
hand science has brought about technologies that help
save human and non-human life. Some of the dramatic
examples are the kidney dialysis machine, artificial
valves for sufferers of coronary heart disease,
antibiotics, vaccines, new varieties of crops and a wide
range of other drugs. At the other extreme, science canalso breed technologies that are designed to deliberately
hurt or to kill. The bitter fruits of this research include
chemical and biological warfare, and also nuclear
weapons, which are by far the most destructive
weapons that the world has ever known.
Both the constructive and destructive technologies
bred by science raise complex ethical questions. This isparticularly true in the fields of biology and medicine
where technologies such as genetic engineering,cloning, and in vitro fertilization give scientists theunprecedented power to bring about new life, or todevise new forms of living things. To address these
ethical questions raised by technological advancements
in biology a new subject i.e. Bioethics has emerged.
The term ethics is derived from Latin root Ethos i.e.
character or Ethikos meaning arising from habit. Ethics
is actually a branch of Philosophy concerned with thenature and ultimate value and the standards by whichhuman actions can be judged right or wrong. It has
sometimes been defined as a “particular systems ofprinciples and rules concerning duty” [1].
Bioethics is “a means by which we organize complex
information and competing values and interests andformulate an answer to the question 'What should I
do?” According to Darryl Macer, Bioethics can be
defined as “the study of ethical issues and decisionmaking associated with the use of living organisms”[2].
Bioethics deals with the ethical implications of bothbiological research and the applications of that
research. Although ethical issues have been faced in
medicine and biology since ancient times, the large
scale introduction of new technologies in recent times
has reemphasized old issues and introduced new ones,

93

such as the withdrawal of life sustaining medical
treatment, prenatal diagnosis, storage of frozen humanembryos and the use of human and animal fetal tissue
for scientific research. Needless to say, these arecomplex issues which warrant in-depth analysis by wellinformed scholars. There is absolutely no doubt that the
study of bioethics can be enormously useful in focusing
attention on problems that need to be confronted.
However at the other extreme, it can become a namecalling argument between competing schools of thoughtsuch as the “pro-biotechnology” and “antibiotechnology” which may reduce discussions toepithets and clichés.
The bioethical questions are in the form of ethicaldilemmas. A dilemma implies that “there are goodreasons for mutually exclusive alternate solutions to the
problem”. Disagreements on bioethical issues will
always persist because we shall never have a single
theory or method for resolving dilemmas because wederive our moral values from many sources such as
religion, law, culture etc. However, we can work
towards resolution of ethical disagreements through thefollowing.
i.
Obtaining objective information.
ii.
Providing definitional clarity.
iii.
Using examples and counter examples.
iv.
Adopting a code of conduct.
v.
Analyzing arguments.
Bioethics in Pakistan
New technologies pertaining to human health (e.g.
Organ trade, Organ transplantation, reproductive healthetc) plant / animal genetic improvement (e.g. Genetic
Engineering, Tissue Culture, Cloning etc) and Industry(e.g. Cloning, Genetic Engineering) are recent
introductions into Pakistan. Currently, however anumber of organizations are actively involved inresearch in these areas. The introduction of these newtechnologies have highlighted the bioethical dilemmas
associated with them.
Bioethical issues are sometimes raised by relatively
low tech developments such as the introduction of “thepill” and other contraceptives technologies. Although
not many people in Pakistan are bothered by the ethicalquestions associated with gene therapy for example,
however, the use, abuse or non use of contraceptives
have proved to be a divisive issue in Pakistan. The
government, worried by explosive population growthrate has encouraged the use of contraceptives, however
there have been opponents to the use of contraceptives
since there very introduction.
In early days contraception was imagined asprohibited by the religious leaders and society. Manybaseless rumors have been heard. Some were against
the methods of birth control and others were against
about the idea. But with the passage of time thosepeople were guided through training and workshops.
Many government and non government companies

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

were established for working on contraception. But still
there is a controversy about contraception.
We are proud of living in the age of ‘enlightened
moderation’ , and brag about being the civilized lot,
yet, when it comes to a choice between a baby boy anda girl , the majority of the couple opt for the former.
According to a newspaper report 7000 girls are
exterminated in India, largely because female fetuses
are aborted after the sex determination tests. Female
foeticide is also common in our country Pakistan as
males are considered an asset in our society as well.
Morally, legally, ethically and on religious basis
abortion is illegal because it is said that it’s a kind of
murder of a human. And Islam forbids it. But on theother hand if a girl is pregnant in case of rape what will
be her position in the society and who will be theresponsible person for look after the baby born? Undersection 338 abortion is illegal but it is allowed incertain cases when mother is medically unfit. But still
there are 45 illegal centers in Pakistan who openly
provide abortions.
Another bioethical issue which has emerged inPakistan is the organ transplantation and the organ tradeassociated with it. Last year a newspaper reportshocked Pakistani people which was “66% of the 2,000transplants performed in 2006 were for foreigners
which has given Pakistan a bad name as the ‘organbazaar of the world’’. More than 50,000 Pakistanis areawaiting organs. About 2/3rds of those are awaiting
kidneys alone. Other organs in need include lungs,
pancreas, heart, and intestine. About half of thoseneeding an organ transplant will never receive one, andmost of those who do must first wait several months or
years. Many people each day die waiting for organtransplants, and a new name is added to the Transplant
Waiting List every day. The organs to be donated by
the donors should be used in the country. A wellorganized committee must be there to handle all the
related aspects of organ transplantation and donation,and that must also be responsible for the making therules and regulations for the organ donations andtransplantation.
Such other issues have also been raised by the media
all over the world, but in our country they have notbeen introduced yet, like issues about stem cells
research, cloning, GMO’s and other advancetechnologies.
The Rising of Bioethics in Pakistan
In 1984 Aga Khan University Karachi became thefirst Pakistani university to introduce biomedical ethics
in the curriculum of medical students. Later on similarcourses were also introduced into curriculum of the
Nursing School of the same University. In the late
1990s, a journal “The Pakistan Journal of Medical
Ethics” was started. However the same could not be
published on sustained basis and is intermittently
published.

There is a growing realization and a keen interest in
highlighting, debating and addressing bioethicalquestions. Most international scientific journals are also
demanding ethical review of research. Internationalorganizations such as GFBR are also attempting tocreate awareness in developing countries such as
Pakistan. The GFBR selected Karachi, Pakistan as thevenue for their annual meeting held in 2006.
In 2002, the Pakistan Medical and Dental Council(PMDC) published a Code of Ethics for medical
professionals. The code was designed in the light of theIslamic Moral and socioeconomic principles. The basic
principles already referred to have also been
incorporated in the code. PMDC has also recommended
that education in bioethics be made part of the curricula
in medical institutions.
In 2004, Government of Pakistan approved a
National Bioethics Committee (NBC) in the Ministry of
Health. The NBC is “an advisory body dealing with all
aspects of Bioethics in the Health sector in the
country”.
A Center for Biomedical Ethics and Culture (CBEC)
has been inaugurated at Karachi University. The centre
functions to explore the role of cultural social andreligious norms in shaping indigenous value systems
that are seminal components of human moral
comprehension”[3]. CBEC is also training many
professionals in bioethics.
Some of the religious institutions have also showedinterest in bioethics in Pakistan. “This discussion is
examined in light of law and the two major sources of
guidance for Muslims i.e. Holy Quran and the Sunnah
sayings and the ways of life of the Holy Prophet(P.B.U.H)” [4].
Conclusion and Recommendation
1. In a country with low literacy rate one should expect
low level of awareness about Bio-ethics issues.
Awareness needs to be created at all levels so thatpeople can formulate a “considered opinion” rather thanblindly following others.
2. Bio-ethical issues should be openly debated throughprint and electronic media, Seminars, conferences andworkshops should be held to encourage interaction
between experts, academicians, researchers, students,
policy makers etc.
3. The curricula of educational institutions including
Universities, colleges and schools should include
advanced or introductory courses on bioethics.
4. Every professional organization, whether it is related
to Biological sciences or not must have their own Codeof Ethics like Pakistan Medical and Dental Council(PMDC).
5. The government should know its responsibilities andshould provide the necessary legal and regulatory frame
work for dealing with bioethical issues and concerns.
The government should institutionalize consultations
among all state holders including legislators, policy
makers, technical experts, Public representatives,

Eubios Journal of Asian and International Bioethics 18 (May 2008)
farmers and industry.
6. Ulemas and religious scholars should be consulted
for their opinion while formulating laws or rules andregulations concerning bioethical issues.

95

IAB Genetics & Bioethics Network: On-line
The complete address list is updated on the Internet. Send allchanges to Darryl Macer. There will be a session at the IAB World
Congress of Bioethics in Croatia in September 2008, and please
send paper topics to Darryl Macer. There will also be a session onArts, Drama and Bioethics, which papers are also solicited for.

References
1.

Morgain.
2001.
EthicsandEtiquette.
http://www.sacred-texts.com/bos/msg0002.htm
2. Macer, D. 1997. Bioethics. Biotechnology andDevelopment Monitor 32: 25.
3. Moazam, F. and A. M. Jafarey. 2005. Pakistan andBiomedical Ethics: Report from a Muslim Country.
Cambridge Quarterly of Healthcare Ethics 14: 249–255.
4. Nasim, A. 2002. Bioethical Issues: An Islamic
Perspective. Presented in the workshop on Asian
Genomics: Cultural Values and Bioethical Practices, atLeiden, March 28-29, 2002. The Netherlands.

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

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

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

News in Bioethics & Biotechnology
http://eubios.info/NBB.htm
International Bioethics Education Project News
<http://groups.yahoo.com/group/Bioethicseducation/>)Ninth Asian Bioethics Conference (ABC9): Healthy andProductive Life in Harmony with Nature, 3-7 November,
2008, Jogyakarta, Indonesia. Hosts: Indonesian National
Bioethics Commission.

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

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