briefing bioethics

professional codes of conduct as the main France reaps benefits and means of regulation (see page 663). In con- trast, France has invented a highly institu- tionalized system for regulating biomedical costs of going by the book progress that reflects the philosophy by which it is legitimized. A stunt show in which a ‘flying dwarf’ had Nowhere has this difference in philosophy Indeed, as far as government action is been projected from a cannon was recently been seen more clearly than in the exchanges concerned, France has been in the avant- shut down in France on the grounds that it over the of (see Nature 385, garde of the bioethics movement. In 1983, contravened ‘ dignity’, a ruling which 810; 387, 754; 388, 320 & 511; & 389, 433; for example, it became the first country to might well bewilder other nationalities, 1997). Arguments by Axel Kahn, a member of create a national bioethics committee, and Anglo-Saxons in particular. (An appeal by the French national bioethics committee, the world’s first comprehensive bioethics the dwarf to the European Court of Justice, that cloning is an affront to human dignity legislation was introduced a decade later. on the basis that the decision infringed his have been dismissed as “rhetoric” by two ‘dignity’ to work, was thrown out on techni- leading British bioethicists. International influence cal grounds). David Shapiro, former executive director Similarly, France has had a major influence In the same way, France’s abstract of the UK Nuffield Foundation on Bioethics, in the drafting of the Council of ’s approach to bioethics, relying on a battery of says that the debate should focus on whether Convention on Human Rights and Biomedi- laws peppered with references to universal cloning is ethical in tangible cases, such as in cine, and the proposed ‘universal declaration principles such as ‘human dignity’ and men unable to reproduce sexually. But Kahn on the human genome and human rights’, ‘human rights’, often baffles observers from says that such arguments are typical of the due to be approved later this year by the countries, including the , with “utilitarian” approach endemic in Britain United Nations Educational, Scientific and little or no bioethics legislation. Indeed, the and other Anglo-Saxon countries, which Cultural Organization (Unesco). French philosophy on bioethics is sharply reduces ethical problems to an “algebraic Nöelle Lenoir, a member of the French opposed to the ‘pragmatic’ approach found equation of the pros and cons” of a particular constitutional court, who played a major in both the United States and the United situation. “If the pros exceed the cons, then it role in shaping the country’s bioethics legis- Kingdom, which tends to address specific is judged ethically acceptable,” says Kahn. lation, is chairwoman of Unesco’s Interna- bioethical problems in an ad-hoc fashion. The Anglo-Saxon tendency is to rely on tional Bioethics Commission, and of the Japan’s bioethics debate lags behind thinking in the West

The word ‘bioethics’ — seimei rinri (life developed by the government, reflecting low which was abolished in 1995, it was illegal to ethics) — is familiar to most Japanese public concern on such issues. abort fetuses which had genetic diseases and people, but its use tends to be different from Darryl Macer of the University of chromosomal abnormalities. Fujiki, who has that in the West. Issues such as ‘brain death’ Tsukuba, who runs the Eubios Ethics been providing genetic counselling in Japan and organ transplants have generated Institute, says one apparent explanation is for 35 years, says that people still have widespread concern. But there is little active that policy makers “are more concerned with preconceived ideas about genetic diseases public discussion of the ethical implications promoting public acceptance than exploring which they are reluctant to discuss. Many of techniques such as and cloning. ethical issues in decision making”. Macer view the lack of debate on such topics — and The political difficulty in confronting the points out that Japan is a paternalistic the delay in reaching a consensus on the need ethical dilemmas raised by new biomedical society, where the views and opinions of for government action — as stemming from techniques was reflected in the debate over ‘experts’ are usually followed uncritically. Japan’s cultural and religious background. accepting ‘brain A survey this year, led by Eubios Ethics Some sociologists and religious groups death’ as death, Institute, revealed that the news about the disagree with this interpretation, saying triggered by cloning of the sheep Dolly had made little opposition to new biomedical technologies is Japan’s first and public impact in Japan. Indeed, the survey based merely on a lack of understanding. But only heart revealed that 30 per cent of those interviewed the government appears relatively transplant, were not aware of research in genetic unconcerned about bioethical issues. performed in technologies, while another 30 per cent were Admittedly some efforts have been made 1968. Still referred generally supportive of such research. The by the government to integrate ethics into to as the ‘Wada rest felt unable to choose between the risk or decisions about and brain transplant’ after the benefit of genetic technologies. death. The and Technology Agency Unlike in Japan, the the surgeon who Norio Fujiki, emeritus professor at Fukui (STA), which is setting up a genome research cloning issue has carried it out, the Medical School, says the survey showed that centre in the Institute for Physical and generated widespread Chemical Research (RIKEN), is planning to protest in Korea. operation ended the Japanese people are generally supportive in controversy of genetic technologies and scientific set up a bioethics section to investigate when the patient died and the medical team research, even though many are poorly bioethical issues arising from the life science YUN JAI-HYOUNG/AP was accused of murder. informed on the subject. “People still find research programmes run by the agency. One result was that organ genetics ‘mysterious’, and have biased and But many are still calling for proper transplantation was put on hold. Only now, misleading ideas,” says Fujiki. guidelines, and for proper education in nearly 30 years later and after heated debate, In principle, the Japanese people say that bioethics. Even the STA’s plan has only been has Japan finally passed a bill allowing the they are supportive of genetic screening — as given ¥8 million (US$65,000) funding, and transplant of organs from brain-dead donors well as of gene therapy. But screening some are concerned that it could end up as a (see Nature 387, 835; 1997). Meanwhile, services are not readily available, and genetic technology assessment committee, rather guidelines or regulations for cloning or counselling is not widely practised. Indeed, than a body that monitors ethical issues handling of human genes have yet to be under the 1948 Eugenic Protection Act, involved in the research. Asako Saegusa

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