Emerging Science, Emerging Democracy: Stem Cell Research and Policy in Taiwan

Jennifer A. Liu University of Waterloo

Science policymakers in newly democratic Taiwan grapple with a central tension of how to construct policies that both conform to international standards and properly represent Taiwan’s people. Based on more than sixteen months of ethnographic research, over a hundred interviews, and archival data, I examine how stem cell research-related policymaking was assembled in Taiwan. I pay particular attention to the intersections of global and local, and to articulations of democracy, sovereignty, and identity as they relate to stem cell research governance. While much has been written on science and democracy in established democratic societies, relatively little has addressed the relationship between emergent democracies and emergent sciences. I suggest that studies in Taiwan as it transitions from technocratic to democratic authority help to make visible the diverse logics and multiple considerations that shape both biotech and its governance in an emergent science democracy.

1. Introduction “You are interested in ethics,” the clinician said, “there are problems with medical ethics in Taiwan.” It was 2005, shortly after I had moved to Taiwan. A little later, a professor told me of a university hospital that served as a site for a transnational clinical trial run by a pharmaceutical company. He

I thank Heather Douglas for convening the excellent workshop that brought together a diverse and productive group of scholars and this series of papers. I also thank most deeply those working on and in Taiwanese science who shared their stories, thoughts, and expe- riences with me, some are named here, many are not. Finally, this research was generously funded by the Fulbright Foundation, a Charlotte W. Newcombe Fellowship, The UC Berkeley STS Center, the California Institute for Regenerative Medicine, and the Lois Claxton Humanities and Social Sciences Endowment Fund. I also deeply appreciate thoughtful input from Adia Benton, Thurka Sangaramoorthy and two anonymous reviewers.

609

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 610 Emerging Science: Stem Cell Research in Taiwan

said that since no informed consent procedure was in place at that time, the hospital had simply obtained employer consent. “That’s why companies want to come to Taiwan to do clinical testing, because you can do anything here— things that can’t be done in the US. That’s why everyone wants to come to Taiwan.” These statements may seem, at first, to indicate a lack of concern in Taiwan for medical and scientific ethics. In fact, they signaled a growing frus- tration and urgency felt by many in the scientific and medical communities that regulation and infrastructure were deeply necessary. These statements thus reflect, rather, a growing concern with matters of bioethics. Science policymaking in Taiwan reflects local concerns about how national science articulates (with) sovereignty, democracy, and identity. While a significant body of scholarly literature examines the relationship between science and society in democratic countries, relatively little addresses the relationship between emergent democracy and emergent science. In this paper, I examine the situated ethics of stem cell research and policymaking in Taiwan at different scales. Policymakers in Taiwan face a central tension between international conformity and accounting for Taiwanese specificity, one prominent strand of which is built around being not Chinese. An attention to the nexus of emergent science and emergent democracy makes visible situated and local considerations that may be understated or taken for granted in established scientificdemocracies. Full electoral democracy began in Taiwan in 1996, and while the government operates autonomously, China still claims Taiwan as its province. The One-China policy denies Taiwan’s sovereignty and blocks international recognition of Taiwan in many venues. In this young democracy struggling with newfound freedoms, stem cell research policymaking has high stakes. It conjoins concerns about science and democracy in ways that are specifictoits geopolitical situation. Taiwanese policymakers grapple with a central question of how they might construct policies that at once conform to international standards and properly represent Taiwan’s people. In this paper, I examine how stem cell research policies were made in a newly democratic society. In addition to providing an important comparative account of science policymaking in Asia, it offers a specific example of how emergent biomedical sciences come to be governed in an emergent democracy under- going a transition from technocratic rule. Stem cell research and policymaking in Taiwan, even as they appear to follow similar paths as those of other countries, have different stakes and are expressive of specific concerns that are configured in relation to multiple others. Specifically, while Taiwan’s science and policies on human embryo research and stem cell research resemble significantly those of other countries, they represent something that is nonetheless uniquely Taiwanese in both what they signify and how they came to be. Taiwanese science

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 611

develops in relation to specifically Taiwanese concerns about modernity, identity, and sovereignty. Modernity is imagined in various ways, but science and democratic governance are important components of any rendering of modernity in a Taiwanese context. Fractious identity debates about what it means to be Taiwanese, and who counts as authentically Taiwanese, are framed mainly to distinguish Taiwan from China. Such debates play out in a context in which Taiwan’s sovereignty, and thus the recognition of its very nationhood, is under constant challenge in international contexts. Taiwan’s stem cell policy is thus not only about regulating science; it is deeply marked by broader political considerations. Examining the ways in which this specific biotech field came to be regulated at a particular time provides an example of the sociality of science as well as the interface of science and emergent democracy. In this paper, I examine the work that went into making the policies and the context in which they were made. First, I offer a very brief review of the literature on democracy and science. Second, I provide a brief overview of Taiwan’s geopolitical situation and recent work done on science policy there. Third, engaging with the concepts of global assemblages and situated ethics, I address the interplay of the local and global in Taiwan’sstemcellpolicy- making. Fourth, I provide three stories relevant to stem cell research policymaking there: one is a comparison of two scientists’ divergent approaches to the ethics of stem cell research progress; the second addresses a public survey; and the third examines the significance of Taiwanese involvement with the development of human embryonic stem cell research (hESCR) guidelines within the International Society for Stem Cell Research (ISSCR). Finally, I suggest that even as Taiwan’s policy documents are in themselves relatively unremarkable compared with those of other countries, they represent a significant shift in science governance in Taiwan and offer an important example of science policymaking at the nexus of emergent science and democracy. This is, then, an account of how Taiwanese policymakers addressed a central concern for science governance—how to construct policies that at once conform to international standards and are appropriate for local publics. This takes place in the context of enhanced engagement from new democratic publics who increasingly demand accountability from their leaders. By adhering to best practices in science governance, Taiwanese science serves to locate Taiwan alongside established scientific democracies, buttressing a Taiwanese modernity while simultaneously distancing themselves from both the “wild Asian ethics” discourses circulating periodically in the West and China’s sovereignty threats.

2. Science and Democracy Since the 1975 Asilomar conference on recombinant DNA research organized by Paul Berg, the relationship between sciences and their various

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 612 Emerging Science: Stem Cell Research in Taiwan

publics has become the subject of a proliferating body of social research. Controversial scientific projects have been subject to greater public scru- tiny and public engagement has become an important marker of democratic science policymaking. Still, relatively little has been written about science policy in newly democratic contexts. Taiwan is a relative newcomer to both democracy and the global knowledge economy; it is, as Chia-ling Wu (2012) notes, a “latecomer” to science policymaking. Such policymaking takes place amidst contentious struggles to define a national identity, one that, for many, is specifically not Chinese (Liu 2010). A burgeoning scholarly literature addresses the relationship between science and society in democratic societies. Now long ago, Robert Merton (1973 [1942]) elaborated his thesis that good science and good (i.e., democratic) politics articulated the same fundamental norms of communitari- anism, universalism, disinterestedness, and organized skepticism. Moving beyond the assumption that good science can be equated only with value- free or neutral science, STS (Science and Technology Studies) scholars have shown that social values inhere in science and science is, indeed, expressive of them (Jasanoff 1998; Douglas 2009). Increasingly over the last few decades, scholars have shown that good science acknowledges public values (Douglas 2009; Thompson 2014) and demonstrates processes and practices of public consultation. This has often been expressed as a shift from a Public Understanding of Science (PUS) to Public Engagement with Science (PES) models. Rather than positioning the public as suffering from a deficit model of scientific understanding as the PUS model often assumes, PES models understand publics as essential contributors to practices of science and as effective stakeholders in citizen-sciences that are increasingly understood to be in- herently social and to have implications for humans and our others in a fragile environment. Specific practices of inclusion have come to be parts of science policymaking in democratic countries (Jasanoff 2005; Epstein 2007; Deng and Wu 2010; Benjamin 2013). Much in the STS literature has examined the science-democracy interface. One fundamental question that underpins this work is the question of how, in democratic societies, we might conduct science in a manner that is adequately representative of broader and multiple publics. Social science scholarship has proliferated on stem cell research, human embryo research, and policymaking in varied national and global contexts.1 Anthropological

1. E.g., Waldby 2002; Sperling 2004; Franklin 2005; Hogle 2005; Bharadwaj and Glasner 2009; Gottweis, Salter, and Waldby 2009; Thompson 2010; Bharadwaj 2012; Prainsack 2011; Benjamin 2013; and Saniei 2013.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 613

work in China offers a rich comparative example of policymaking in a non- democratic context (Rosemann 2011; Song 2011; Zhang 2012). Most of this literature examines the intersections of science and democracy, though, to date, relatively little work has been done on science policymaking at the intersections of emerging sciences and emerging democracies. Such work can help to enrich broader understandings of sciences, democracies, and their varied interactions, and to identify possible blind spots that may exist in studies limited to established science democracies.

3. Background and Context In this section, I ﬁrst provide a brief overview of Taiwan’s geopolitical situation and the local contexts in which biotech, policy, and democracy are “in-the-making.” Next, I discuss some of the recent scholarship on science policy in Taiwan that is, indeed, constructing a foundation for studies at the nexus of emergent sciences and democracies.

3.1. Taiwan’sGeopolitics Taiwan’s biotech industry emerges in a complex geopolitical frame, and some political background is helpful. In the seventeenth century European settlements were followed by an inﬂux of settlers from southeastern China and the island’s peoples were subjects mainly of Chinese Imperial rule. Fol- lowing the ﬁrst Sino-Japanese war, Imperial Japan claimed Taiwan as its colony in 1895. Japanese colonial rule ended in 1945 when Taiwan, in contested treaties, was returned to China’s Nationalist Kuomintang (KMT) government. As the Communist Party took over mainland China, the KMT moved to Taiwan and claimed itself as the legitimate government of China. The US government, in a Cold War context, supported the KMT often referring to it as “free China.”2 The KMT imposed martial law from 1949 until 1987, the longest period of sustained martial law in world history. Following a period of reform, full electoral democracy was established in 1996. Since 1949, China’s Beijing government (the Chinese Communist Party, CCP) has claimed Taiwan as its (“renegade”) province. Current electoral politics in Taiwan are divisive and fall very roughly along the lines of those who support closer relations with China (KMT) and those who support an independent Taiwan (DPP).3 For both groups, but especially for indepen- dence supporters, democratic governance and a commitment to human

2. The KMT also referred to itself at this time as “free area” of China ( ; Zìyóudìqū). 3. There are other prominent political parties, and the division I describe is often glossed as “pangreen” (more aligned with DPP politics) and “panblue” (more aligned with KMT politics). See Scott Simon (2010) on indigenous peoples’ voting patterns.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 614 Emerging Science: Stem Cell Research in Taiwan

rights agendas signify an important distinction from the autocratic rule of Taiwan’s past and mainland China’s present. In addition, although official historiographies often represent Taiwan as an island of immigrants, long marginalized indigenous groups are fighting for enhanced political representation (Chao and Johnson 2000; Chiu 2000, Malialiaves 2000; Munsterhjelm 2014).4 Indigenes have been viewed as— and used as—a rich resource for biomedical and genomic research. An aboriginal contribution to a “Taiwanese” genome has been used to bolster identity building projects, using indigeneity to shape Taiwanese unique- ness (Liu 2012). The question of what it means to be Taiwanese occupies a significant space in political discourse and daily life. For many, a unique Taiwanese identity is an important distinction from both the KMT and mainland China’s CCP. Deeply held sentiments fuel often fractious identity debates that also hold firm political traction. This context of ongoing and fractious debates about Taiwanese identity and sovereignty shapes discourses on both science and democracy. These political and identity projects are joined in shaping science policy by biotech’s perceived value as an economic engine. Already by the 1980s, governmental support for biotech development in Taiwan was underway as it was listed as one of the target industries for development (Rei 2010; Tsai 2010). In 2002, the government enacted the “Two Trillion Twin Stars Pol- icy” that sought to establish Taiwan’s biotech alongside its established global success in IT (information technology). In July 2003, Taiwan’s then President, Chen Shui-bian reiterated biotech development as a national priority at the “BioTaiwan Exhibition 2003.” In 2005, the government announced the “Biomedtech Island” project with a goal to develop Taiwan as an Asian hub for biotech and therapeutics. Taiwan’s prior success in IT and semiconductors shaped early approaches to building the biotech industry and continues to influence funding structures and the institutional organization of biotech. Biotech development in Taiwan is thus shaped by many factors. Taiwan joined the global knowledge economy through IT, and now biotech seems to hold the possibility for full inclusion along with an economic incentive. Bio- tech sensibilities are shaped by prior colonialisms, martial law, and current democratization, as well as by exclusion from various international arenas as a result of Beijing’s One-China policy. Such exclusionary considerations

4. During the martial law period (and beyond), Taiwan’s textbooks tended to emphasize and celebrate historical and cultural links to China. Monanen Malialiaves (2000) writes on how even revised textbooks that celebrate Taiwan’s unique history emphasize Taiwan as a nation of immigrants, minimizing the presence, contributions, and claims of indigenous peoples there.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 615

coexist alongside a broader regional perception that local medical vulnera- bilities are not being adequately addressed by Western dominated biomedical research programs. Indeed, biotech in Taiwan is seen as a way to participate meaningfully on the stage of global science while simultaneously caring for a population and an economy. Taiwan biotech thus assembles heterogeneous global and local elements in situated and speciﬁcally meaningful ways.

3.2. Taiwanese Science and Technology Studies (STS) and Policy An active STS intellectual community has developed in Taiwan.5 Some of these multidisciplinary scholars have addressed science policymaking there. Here, I present a partial review of a few of the contributions that are most relevant to stem cell policy. These address questions of democratic policymaking, often drawing upon the policies of advanced democracies and including discussions of deliberative and consultative practices. Each of these papers makes visible specific assemblages of various elements, including people, policies, and local technological capacities in relation to specific projects in Taiwan. This literature is replete with the theme of democracy in general and deliberative democracy in particular. Legal scholars Wenmay Rei and Jiunn-Rong Yeh (2009) examine the role of National Bioethics Commis- sions in relation to deliberative democracy and human embryonic stem cell research (hESCR). Although their paper focuses on examples from the US, the UK and Germany, the authors are building a broader case for deliberative democracy and the role of national bioethics commissions therein. This paper was published in National Taiwan University Law Review, a journal of Taiwan’s flagship university, and thus, even if indirectly, promotes both deliberative democracy and national bioethics committees in Taiwan’s science policymaking. Chung-Yeh Deng, M.D., and sociologist Chia-Ling Wu (2010) conducted a “civic groups forum” exercise in relation to National Health Insurance reform as a way to gauge the effectiveness of such deliberative processes and groups in participatory policymaking. The authors note that relatively few methods for participatory decision making in newly democratic societies exist (2010, p. 896). Yeh (2008) more generally positions Taiwan’s transition from a devel- opmental state to a regulatory state as an outcome of democratic transition, and provides a foundation more broadly for processes of deliberative democracy. Against this backdrop of democratic transition and the rise of

5. See: Taiwan Science, Technology & Society Association http://www.tw-sts.org/; Taiwanese Journal for Studies of Science, Technology and Medicine http://stm.ym.edu.tw/; and East Asian Science, Technology and Society: An International Journal http://easts.dukejournals.org/

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 616 Emerging Science: Stem Cell Research in Taiwan

the regulatory state, Rei (2010) provides a critical analysis of Taiwan’s regulation of cord blood storage. Umbilical cord blood has been identified as an important source of stem cells, which are thought to have significant therapeutic potential. In Taiwan, cord blood storage has been mainly viewed as a form of biological insurance and thus while private family banks thrive, public banks remain relatively underdeveloped (Rei 2010). Citing policies mainly from the EU and professional associations that favor public banking, Rei emphasizes how cord blood banking in Taiwan has been framed principally as a consumer transaction. As a commercial enter- prise, it is governed by contract law rather than the Medical Practice Act, with problematic effects for families, physicians, and a broader Taiwanese biosocial community. Medical and science policymaking in Taiwan is shaped in relation to processes and policies carried out in other democratic countries, and they are made in relation to global standards. But they are not merely imported; rather, they are assembled through varied processes of deliberation and in- corporation. Chia-Ling Wu, in her analysis of the regulation of how many embryos can be transferred in a single IVF cycle, positions Taiwan as “a latecomer to policy-making” (2012, p. 725). She describes how Taiwanese policymakers drew strategically on different national (the US, Britain, and other European countries) protocols at different times and justified a Taiwanese approach based upon, among other considerations, local technical capabilities and success rates for IVF in specific time periods. Sociologist and M.D. Jia-shin Chen (2009) analyses HIV harm reduction policymaking in Taiwan, again as a latecomer since harm reduction had been implemented elsewhere decades earlier. He productively uses the analytic of assemblage to attend to the global processes and heterogeneous networks that comprise Taiwan’s policymaking. Assemblage “turns its attention toward foreign and local people, knowledge, practices, and the formal and informal connections that play a part in policy making” (Chen 2013, p. 459). Like bioethical policy more generally, the harm reduction program was global in that it shared common features and crossed national borders. Chen shows how Taiwan’s harm reduction policy was “imported” from Australia and Hong Kong, made through diverse actors and practices, and ultimately taken up in Taiwan in the context of the growing social problems of a rising HIV epidemic, heroin addiction and intense stigmatization, all marked by a long history of opium-related national shame. The scholars above demonstrate that biotech is a complex global assemblage (Ong and Collier 2005) comprising contingent, shifting, and vari- ously territorialized heterogeneous elements. They also emphasize that, even as policies draw upon those of other countries, they nonetheless are

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 617

realized in speciﬁc contexts. The local contexts themselves are also shaped in ongoing relationships to multiple other global sites. Each of these papers thus sheds light on processes of science policymaking in this newly democratic context. Here, I offer another example of policymaking in Taiwan, speciﬁcally in relation to global and local politics and values concerning stem cell research.

4. Local and Global in Taiwan’s SCR Policymaking In this section, I provide an account of Taiwan’s stem cell research (SCR) policies in relation to the politics of SCR in broader international contexts. While the US and UK, in general, serve as reference points in policymaking, specific international cases provide important cautionary tales for Taiwan. Below, I discuss the scientific sharing of a controversial project between scientists in the US and China, and the South Korean Hwang Woo-Suk scandal. The significance of these cautionary tales rests in the vulnerability that they reveal for national science reputations. The national reputation of the US or the UK, for example, would not be threatened by a single act (or actor) of scientific misconduct. In Taiwan, however, and other countries in the region, the reputation of the country is very much at stake.

4.1. Stem Cell Research Politics and Policies Taiwan’s policies on stem cell and human embryo research conform with broad international standards and fit squarely amongst the current policies of various countries including the UK, the US, and Canada. In 2001, however, they remained under discussion and not formalized. Amidst the heated controversy in the US about the use and destruction of human embryos for research, in 2001 then President George W. Bush enacted a ban on federal funding for human embryonic stem cell research (hESCR) exempt- ing existing cell lines. This ban significantly changed the science funding structure in the US. Around the same time, and in part in response to Bush’s ban, several other countries used their relatively more “science-friendly” funding and regulatory policies to promote stem cell research and to recruit scientists from the US. Singapore exemplifies this approach. There, a national push to advance in biotech was bolstered by the recruitment of high-level scientists. As Charis Thompson recounts of her visit to a prominent stem cell laboratory, the “practice of successfully luring major figures from abroad was jovially referred to as ‘serial kidnapping’” (2010, p.112). In the midst of this “brain drain,” many in the US—scientists, policymakers, venture capitalists and public citizens—perceived that more permissive regulatory environments elsewhere would leave US-based scientists behind in what had become the stem cell race.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 618 Emerging Science: Stem Cell Research in Taiwan

Also in 2001, NYU endocrinologist Dr. James Grifo received a call from the FDA effectively instructing him to shut down his research on a controversial technique of cell nuclear transfer for the treatment of certain kinds of infertility (Personal interview 2012). This technique was strongly relevant to embryonic stem cell research at the time. He and his colleague Dr. John Zhang decided to collaborate on this research with a team at Sun Yat-sen University in Guangzhou led by Dr. Guanglun Zhuang (Zhang et al. 2003). In the US, the Grifo-Zhuang collaboration was depicted as a kind of ethical outsourcing and an “end-run”6 around the US restrictions, and many there feared that Asian countries might take over in stem cell research because of a lack of ethical restraint. In China, this research was also viewed as a threat, specifically to the country’s science reputation. In- deed, within a week of the media stories the Chinese government had banned the procedure. Throughout the media frenzy, the US’ science reputation was never in question. In this context, Taiwan’sscientific communities and governmental organi- zations recognized that stem cell research was a potential growth industry. It was both a field that could raise Taiwan’s status in global science and one that required regulation. Although many, in various countries, initially thought that a lax regulatory structure might promote research, by 2005 most research intensive countries had recognized that a clear regulatory structure was an important component of this ethically fraught research. In Taiwan, as early as 2001, Professor In-chin Chen ( ) of the Graduate Institute of Law and Government at National Central University had proposed a set of guidelines for stem cell research in Taiwan (Chen 2001). He, along with several scientists, had early on understood the need for Taiwan’s biotech to conform to international research and ethical standards. In 2002, a set of guidelines based upon Professor Chen’s original draft was adopted by the government, but without any a supporting enforcement mechanism. The guidelines remained effectively a draft document; the document had no teeth. The 2002 guidelines were adopted after two public hearings, one held in Taipei in northern Taiwan and the other in Kaohsiung in the south. These public hearings, however, were effectively meetings of experts: At these hearings, only scientific and medical experts, and representatives of religious groups (ethicists, doctors, legal experts, scientists, IVF clinicians, Christians, Buddhists) were present, with no patients or “common” people participating. (Sleeboom-Faulkner and Hwang 2012, p. 697).

6. This is excerpted from a quotation by Dr. Jeffrey Kahn (University of Minnesota) that appeared in the New York Times. Accessed 1/13/14. http://www.nytimes.com/2003/10/14/ us/pregnancy-created-using-egg-nucleus-of-infertile-woman.html?src=pm

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 619

This kind of “experts first” approach is in line with historical approaches in Taiwan. Under both Japanese and KMT rule, technocratic authority played important roles in governance. As I will discuss later, these older forms of authority are increasingly challenged in democratic Taiwan. And, as Professor In-chin Chen and a small team of colleagues sought to enhance the guidelines, officials at the Department of Health agreed that a public survey should be conducted. I discuss the survey in the next section. In late 2005, I attended a bioethics policy meeting in Shanghai. The famous South Korean scientist Dr. Hwang Wu-Sook was to have been the keynote speaker. It became apparent that he would not be attending and rumors began to circulate about a scandal. Shortly thereafter, news broke that his pioneering success in creating patient-specific human embryonic stem cell lines, published in Nature, had been fraudulent. Not only had he violated the first principle of scientific integrity, but he had also reportedly pressured his female lab scientists into providing their eggs for the research.7 Dr. Hwang’s reported success—and his actual success in cloning the first dog—had catapulted him onto the stage of global science. He had become both a national and a regional hero and had shown those in Taiwan what their scientists might also achieve through stem cell science. Now, after the scandal, they also saw how vulnerable scientific reputations could be for both individuals and countries. I asked several Taiwanese stem cell scientists if such a situation could arise in Taiwan and most feared that it could. In the aftermath of the Hwang scandal, Taiwanese scientists, policymakers, and ethicists (among others) redoubled their efforts to govern stem cell research. One senior scientist expressed his concerns about “another Huang” in China. Huang Guanglun had been performing stem cell treat- ments, which were considered premature and risky by the international community (Song 2010). “Hwang (Huang) scandal” had become plural and in Taiwan it became even clearer that a regulatory structure was an integral component of biotech development; a national reputation was at stake.

5. Three Stories: Two Scientists, a Public, and an International Committee The Zhuang-Grifo collaboration and the Hwang scandals provided important cautionary tales that shaped stem cell policymaking in Taiwan. Sci- ence holds different stakes for differently developed countries especially

7. See Ong (2010) for a discussion of different ways of reading these accounts as vari- ously coercion, donation, or part of a longer historical tradition of scientists participating bodily in research.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 620 Emerging Science: Stem Cell Research in Taiwan

when national reputations are risked. Even within a country, there are different scalar stakes, and different overlapping regimes of value shape Taiwan’s stem cell research. Aihwa Ong’s concept of situated ethics attends to the “overlapping contexts of technology and sociality” and takes place in the “overlaps and ten- sions between multiple ethical regimes” (2010, p. 13). Competing logics are the space of situated ethics. As such, the right thing to do, the right approach, is never presupposed. It is precisely what is at stake—and in formation—in situated ethics and in tracking the multiple layers that comprise an ethical situation or problem. Even as global debates centered largely on the status of the human embryo, the Taiwanese were called upon to account for other values and questions, such as democratic representation, cultural differences, medical inclusion, international reputation, and national sovereignty. The following three stories illuminate some of the spaces of situated ethics in Taiwan in relation to stem cell research. They show the overlapping values and ethical considerations that comprise part of the stem cell research policymaking assemblage there at particular moments.

5.1. Two Human Embryonic Stem Cell Scientists Situated ethics addresses the interplay of multiple registers and traveling sites, but it also operates in a temporal register. The two human embryonic research scientists I discuss here offer clear examples of situated ethics; they both operate in an ethical frame, but the right thing to do is configured differently and results in different practices for each. They prioritize different values, on the one hand of biomedical progress and Taiwanese inclusion and, on the other, of specific bioethical considerations. Even among the experts, the right thing to do is often not clear. As Salter and Salter (2007) suggest, what counts as an ethical issue, or what kinds of practices require regulation, is already fairly stabilized by the time that the policies travel.8 This does not mean, however, that they are taken up everywhere in the same manner. Even within the small scientific community of human embryonic stem cell researchers in Taiwan multiple ten- sions figure into discussions on what the right thing to do might be. Consider the examples of Dr. Lee and Dr. Pan.9 Dr. Lee had been recruited back to Taiwan specifically for his expertise in human embryonic stem cell research. Whereas, before returning to Taiwan he had used human

8. The focus, for instance, on informed consent has been criticized, especially in non- Western contexts, for over-privileging the autonomy of the individual to the exclusion of any consideration for family or (bio)social group. 9. Both Dr. Lee and Dr. Pan are pseudonyms.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 621

embryos in his research almost without thinking, after years back home he still has not used a single human embryo. Another human embryonic stem cell researcher, Dr. Pan, expands his quest to produce “Taiwanese” stem cell lines. Both scientists perceive themselves to be working on projects of ethical significance for both their science and their people, but they possess dis- tinctly different views and practices. For Dr. Lee, this means delaying his research as he searches for bioethical clarity and progress that involves both personal reflection as well as active participation in the development of national policy. He was a member of several committees working on ethics and research protocols, regularly attended meetings and helped to establish the IRB (Institutional Review Board) structure for biomedical research. For Dr. Lee, scientific progress means slowing his bench research in order to get the bioethical and institutional elements in order. For Dr. Pan, it involves pushing forward scientifically to develop “Taiwanese” stem cell lines to include his people, with their unique genetics, in the promise of stem cell therapeutics. Both scientists are engaged in ethical projects, but they are articulated in different registers and draw upon different narratives of progress. Both also engage in the ethical question of how best to include Taiwan and the Taiwanese in stem cell research. For Dr. Pan this is a medical project that requires the inclusion of Taiwanese stem cells. Here, because as Dr. Pan elaborates, “different populations have different genetics” (Interview excerpt 2006) these cell lines do a particular kind of representa- tional duty. They serve to include Taiwanese genetic materials in the stem cell banks and research and to thereby stand in for Taiwanese bodies and people in this specific research and therapeutic repertoire. Representation, in this sense, is understood as the inclusion of Taiwanese publics in the therapeutic project and promise of SCR. For Dr. Lee, the more pressing concern is of a different kind. His concern is with the inclusion of Taiwanese publics in an explicitly bioethical register. He wants to apprehend Taiwanese attitudes toward stem cell research. He wants to know, of a general public, of Buddhist groups, among others, “what do they really think?” and “do they all really think this?” (Personal interview excerpts 2007). Dr. Lee’s desire is to understand what various Taiwanese publics think about his research. With all of the meetings, committee work, and infrastructure building, he is working to make policy that represents, in the sense of “speaking for,” the consensus of the Taiwanese. These two scientists respond differently in that space of situated ethics in which multiple ethical regimes are at play. The individual stories of Dr. Pan and Dr. Lee illustrate a broader tension. At a larger scale, a push toward biotech development in Taiwan is balanced with a need to account

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 622 Emerging Science: Stem Cell Research in Taiwan

for multiple publics in a newly democratic nation. In the realm of stem cell research, policymakers grapple with a central question of how they might construct policies that at once conform to international standards and properly represent Taiwan’s people. In this newly democratic context, biotechnical and bioethical development must at least appear to include representation of Taiwan’sdiverse publics. Democratic governance requires public consultation and representation. In this section, I consider a public survey on stem cell research in Taiwan. This survey becomes evidence of proper scientiﬁc governance because of its claims to public inclusion, even as it reproduces from the international context certain epistemic and practical blind spots.10 In addition to numerous public meetings, advisory groups, and multidisciplinary discussions, a team was assembled to assess public knowledge and concerns about stem cell research. The team was led by two professors, Shui-chuen Lee, a Confucian philosopher and bioethicist, and Duujian Tsai, a sociologist, M.D., and President of the Taiwan Bioethics Associa- tion. Their advisory report, distributed in 2006, included a set of proposed guidelines that are, “in line with international ethical consensus and are aligned with the local ethos and values of Taiwan’speople” (Tsai and Lee 2006, p. 3). This statement captures a central tension and a dual obligation. How might Taiwan make policies that both conform to international standards and properly represent its people? This advisory report was the product of substantial effort including close readings and discussions of select countries’ policies and a philosophical corpus on bioethics and justice by Pro- fessor Lee and his group of graduate students, and by Professor Tsai’s group of scholars, medical workers, and community advocates. The varied expertise and approaches of these two groups conjoin to produce a document that is a serious attempt at a scholarly and representative approach to guid- ing policymaking on stem cell research.

10. One longstanding criticism of survey research has been that participants’ responses are often shaped by the questions themselves and their speciﬁc phrasing. In a section of this survey, two categories were created and assessed, general public (GP) and ethics educators (EE). When asked, “Do you agree with any of the following ways to obtain stem cells for research?” the GP expressed a 46% support for somatic cell nuclear transfer (SCNT), while the EE offered 58% support. A subsequent question asked, “Do you agree with the use of somatic cell nuclear transfer for any of the following research?” and 92% of respondents expressed support for its use “to cure genetic diseases, such as Alzheimers” (Lee and Tsai 2006, pp. 48–50). Using the above excerpts, we could conclude either that approximately half (46–58%) of Taiwan’s people support SCNT-based hESCR, or we could conclude that an overwhelming majority (92%) supports it in some cases.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 623

Here, I focus mainly on the public survey that informed the advisory report. As the authors indicate, human embryonic stem cell research is simply not a matter of much public attention in Taiwan.11 This is sub- stantiated by my own data as well as by the dearth of public commentary on stem cell research on the Ministry of Health website relative to other issues such as brain death (Sleeboom-Faulkner and Hwang 2012). The series of workshops and public meetings that inform both the report and the policy recommendations were attended largely by the same group of experts and spokespersons representing specific interest groups. The survey was thus conducted to access a broader public and to assess their opinions. In the survey, five groups were defined and consulted: a general population (including university students and government workers from across Taiwan); medical resource users (including organ donors and recipients, infertility and rare disorder patients); medical personnel; academics (including 31 surveys from law firms); and religious representatives (including Christianity, Catholicism, Buddhism, Daoism, and Islam). The teams collected a total of 533 surveys drawn from across Taiwan and the authors specify the various demographic information obtained demonstrating that the surveys contain information on a wide-swath of Taiwanese people. Levels of education varied, as did occupations and religious affiliations; however, the survey sample is skewed toward those with relatively high educational or professional qualifications. The questions posed in the survey sought to assess public understandings of the human embryo as both a scientific and an ethical object, as well as participants’ understandings of the science and therapeutic potential of stem cell research. One underlying goal was to gauge public support for human embryonic stem cell research (hESCR) and the related technique of somatic cell nuclear transfer (SCNT) that held promise for the creation of patient specific stem cell lines. As Sleeboom-Faulkner and Hwang (2012) suggest, SCNT was an ethically ambiguous technique in Taiwan at that time. It was not explicitly prohibited by existing regulations, but nor was it considered ethical by the standards of medical ethics. In the wake of the aforementioned Hwang scandal, whose work centered on SCNT, clarity was required. In the end, the 100-page Advisory Report included a literature review of the relevant bioethical, policy, and scientific corpus, and an analysis of the results of the 553 surveys conducted. The authors concluded that the

11. As Wenmay Rei (2010) notes, however, there has been enthusiastic reception of cord blood banking, which is a source of human (non-embryonic) stem cells.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 624 Emerging Science: Stem Cell Research in Taiwan

policy recommendations therein are appropriate both internationally and locally.12 In democratic societies, public representation and consultation increasingly make up part of the process that legitimates both the bioethical policies and the science itself. Public consultation and survey, however, are specific ethical instruments that require foundational work. That is, assembling and representing publics relies upon rhetorical and practical work. Whom does a public consultation in Taiwan (or anywhere) represent? While the public consultation suggests that it represents Taiwan’s peoples’ local values, one scientist working on hESCR wonders how representative the results really are: In Taiwan the major problem is there is no common consensus. You don’t know the common consensus of the public. And the issue, as I’ve told you before, is it seems that not too many people care (about SCR). They maybe care about their stocks, or the house prices, but not too many people care about this issue. But everybody that works in this field, they really want to know what is the public opinion. They want to know. Myself, I want to know. I really want to know, what do they think about this. But personally I think that it’s probably very difficult to know. This issue has never really been in the public domain for discussion. Even the people in the DOH (Department of Health), they’ve called for public meetings for this, but I always see the same faces joining the meetings. The same faces. So I don’t know [emphasis added] (Interview excerpt 2007). These concerns are not unique to Taiwan. Stem cell research has been known more for controversy than for consensus, and publics are rarely singular. Diversity of opinion is inherent in the publics even when a consensus is created. This scientist, like the authors of the report, suggests that there is a public whose opinion can be known and from which a consensus might be derived. Consensus at the level of the nation, however, is not easily reached in diverse and democratic states. The public consultation and advisory report are used to create a set of proposed guidelines that are aligned with the local ethos and values of Taiwan’s people. Like surveys more generally, it

12. The recommendations include, for example, the provision that human embryos may be used for research, but only up to fourteen days of development. This is when the for- mative streak begins to form and has become a standard cutoff point in international human embryo research guidelines. The recommendations prohibit chimeric embryo production, reproductive cloning, the implantation of any such embryos, and they include provisions for beneﬁt sharing.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 625

is not self-evident who the publics in the consultation and in the meetings are, even as they are categorized and demographic information recorded, the people and the specific ways in which they might “speak for” a whole population must be assumed. Publics are not self-determining. They are constituted in relation to the projects that engage them (Hayden 2003). Rather than representing a public opinion or even a consensus, they represent certain people speaking for publics that they themselves constitute through a set of participatory practices and rhetorical strategies that have been pre-authorized internationally as instruments of public representation. Public surveys and consultations are everywhere imperfect and problematic instruments; elisions and silences are inherent in them and their representativeness is always necessarily partial. They remain, however, important indicators of appropriate and democratic science governance. According to the survey, 92% of participants agree that the government should organize a committee to monitor stem cell research, citing the avoidance of ethical breaches as the major reason for the creation of such a committee. Of those who disagreed that the government should create such a committee, however, nearly half (47%, or 3.8% of the total) agreed that such a committee would have no effect. The proposed guidelines, because of their specific role and requisite concision, necessarily obscure the doubts and the dissent of those holding minority opinions. Thus even as the survey and the broader document can claim to represent Taiwan—to be “aligned with the local ethos and values”—they, like democratic participation more generally, entail specific exclusions and elisions. Thus they represent a composite public, but the existence of a measureable public opinion remains an open question.13 Notwithstanding, the Advisory Report is the result of a serious and thoughtful attempt at understanding Taiwanese attitudes towards stem cell research. The survey is illustrative of the ways in which public consultations are increasingly seen as necessary components of ethical science. Public consultations appeal, especially in relation to controversial new

13. John Dewey (1927) suggested that a public only comes into being around an issue of signiﬁcance. Thus a public opinion does not precede—epistemically or ontologically— the emergence of something as an issue. Pierre Bourdieu (1979) suggests that public opinion is produced through the process of polling and thus public opinion polls produce public opinions rather than simply reporting them. Furthermore, in political polls or those requir- ing more knowledge, non-response rates increase, thus suggesting that in such polls, “public opinion is just the sum of particular individuals’ private opinion. It is nothing but the opinion of those who feel themselves legitimate enough to express an opinion on political matters” (Pilmis 2006, 3). And, Marilyn Strathern (2002) shows how a Canadian ethics panel, in an explicit attempt to account for Canada’s heterogeneous publics, ultimately comes to rely upon the commissioners’ deferral to their own moral reasoning.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 626 Emerging Science: Stem Cell Research in Taiwan

practices of biotech research, to notions of democratic and accountable governance. Thus, public consultation and participation have become built into conﬁgurations of ethical science, especially when human bodies and collective futures are seen to be clearly at stake (Jasanoff 2005; Reardon 2005; Hayden 2007; Caduff 2010). The Report provides a partial assessment of Taiwan’s public and it speaks for that public. The document and those actors who created, conducted, and participated in it become part of the heterogeneous assemblage that both made and responded to stem cell research as a “matter of concern” (Callon 2004; Latour 2004). The survey assembled actors territorialized in Taiwan and sought to be responsive to local concerns and considerations; it sought to include Taiwan’s communities in the making of research guidelines. It also drew upon broader global elements and simultaneously was part of the global assemblage in which Taiwan’s policies were made. As I discuss next, the survey results circulated into a speciﬁ- cally international arena at the International Society for Stem Cell Research (ISSCR).

5.3. Taiwan at the ISSCR Dr. John Yu returned to Taiwan in 2002 from a long career in the US after having been recruited by Nobel Prize winner, Yuan Tseh Lee, who at the time was President of Academia Sinica, Taiwan’s ﬂagship research institute. At Academia Sinica, Yu had been actively developing the Stem Cell Research Group as well as broader institutional and policy mechanisms. The Taiwan Society for Stem Cell Research (TSSCR) was founded under Yu’s leadership. Taiwan Society for Stem Cell Research (TSSCR) was established in 2005. The TSSCR aims at providing opportunities for close interactions among researchers in Taiwan and also with other international stem cell societies and networks. The society includes all stem cell investigators from major research universities in Taiwan.14 At this time, many stem cell researchers felt that there was not a critical mass of stem cell scientists in Taiwan, and the TSSCR was meant to consolidate the research community. The issue of critical mass and scale are central to Taiwan’s biotech more generally, as noted by a legal scholar: “With Taiwan biotech, we’re a small country, so we can’t do it American style. So, we have to try it—give it one try, one shot and see if it works” (Personal interview excerpt 2012). The logic of “one try, one shot” requires

14. http://www.tsscr.org.tw/en_ver/about.htm

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 627

that things be done correctly from the outset. Policies, funding, institutional capacity alike must be in line for Taiwan’sonetry. In this regard, and in stem cell research specifically, Taiwan’s representation in the International Society for Stem Cell Research (ISSCR) takes on increased significance. As I describe below, Yu’s participation signaled a Taiwanese contribution to building international science policy that also included Taiwan as a sovereign country. In this instance, Taiwan is both valued (as sovereign) and has value (for its contribution to the process). As we have seen, Lee and Tsai’s national survey was an instrument for re- commending guidelines while also certifying their suitability for a Taiwanese public. The survey was concerned with the representativeness of its findings. The Advisory Report also informed ISSCR guidelines, which, in turn, quickly became an important touchstone for Taiwan’s policy enactment. But as I discuss, at this international level, there is representation without a specific concern for representativeness. In December of 2006, a few months after the publication of the Taiwan Advisory Report, the International Society for Stem Cell Research (ISSCR) issued a set of guidelines for human embryonic stem cell research on their website, and in February 2007 published a synopsis of these guidelines in Science.15 Dr. John Yu was Taiwan’s representative to the ISSCR and was a member of the task force that produced the ISSCR guidelines. The ISSCR task force came fairly quickly to consensus on the international guidelines. Bioethicist and Director of Case Western Reserve Uni- versity Stem Cell Ethics Center, Dr. Insoo Hyun, was also a member of the ISSCR task force that established the guidelines. They were on a compressed time line, he explains, so they knew they “couldn’t have an enormously large group of people and still keep on track timewise.” He recounts that they tried to get “a pretty fair representation from different countries where there’ssignificant SCR activity.” They explicitly were not attempting a global representation strategy including, for instance, “a representative from South American or Eastern European countries, because these regions were not that active in SCR” (Personal interview excerpts 2010). In effect, he explained, they determined committee members based on ISSCR membership. So, task force committee membership privileged countries with significant SCR activity and specific membership. What is meant by international in this context is thus the range of countries engaged with SCR significantly and with ISSCR membership, but not necessarily all interested countries.

15. http://www.isscr.org/docs/default-source/hesc-guidelines/isscrhescguidelines2006. pdf

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 628 Emerging Science: Stem Cell Research in Taiwan

In terms of cultural representation, Dr. Hyun explains, the committee was careful not to frame it: … like John Yu was presenting the Taiwanese perspective. Each country’s representative wouldn’t be bringing the cultural perspective per se. But that they would know if there was something either in existing guidelines or law, or culturally important. (…) So, the basic philosophy was to include people who represent research-intensive areas, who don’t necessarily represent cultural expertise, but will know basic perspectives or specific regulations (Personal interview excerpts 2010). Thus, Hyun describes the approach taken by the task force as one that recognizes that while there is no singular cultural perspective in each country, each country’s representative(s) can nonetheless address prominent critical features. The task force did not aim to represent every country nor to represent diverse publics within any of the participating countries; they did not aim for representativeness at these levels. Rather, the approach suggests that the country representatives, with their technical expertise and specific cultural familiarity, could produce meaningful consensus. And, at the ISSCR, Taiwan’s “basic perspectives or specific regulations” were elaborated both through Yu and in the Advisory Report. Following the announcement of the ISSCR’s guidelines in December 2006, Taiwan’s Department of Health released official national guidelines in August of 2007 (DOH 2007). These guidelines comply with those of the ISSCR. The ISSCR guidelines, themselves assembled to some degree with both Yu’s expertise and the Advisory Report, provided an important foundation for the formalization of Taiwan’s own national guidelines. Taiwan’s resultant policies thus clearly conform to international standards; they fit squarely into the center options 3 and 4 of Salter and Salter’s five category framework (2007, p. 572).16 Dr. Yu’s role at the ISSCR signaled more than just an exchange of information and consensus building. It held deeper political and personal

16.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 629

values. There, on this international stage of science, cultures of science and a need for consensus came to outweigh national political agendas. Where- as, in global politics, Taiwan is often excluded by Beijing’s One-China policy, at the ISSCR a deliberate agreement was made within the task force to treat China and Taiwan as separate entities. This was a coup for Taiwan. For Yu, this was also a personal victory of sorts. In 2007, he had brieﬂy withdrawn from a meeting in Japan, organized by Professor Hiromitsu Nakauchi of the University of Tokyo, when he saw in the preliminary program that he was listed as coming from “Chinese Taipei,” a common label- ing practice at the time. Since then, he says, the problem has been resolved; at such meetings even in China now, participants’ name tags list only their cities, and Dr. Yu has no objection to a nametag that reads only “Taipei” (Personal interviews 2007, 2013). At the ISSCR taskforce, the question of Taiwanese sovereignty was set aside. The ISSCR website states the task force was made up of representatives from fourteen countries, and Taiwan is included as one of these countries. Now, Yu becomes one scientist among others with a speciﬁc familiarity of one country among others, included equally on an international stage of science. As Hyun’s statements above suggest, the ISSCR recognizes that cultural differences matter in science policymaking. None- theless the task force was able to produce a consensus on how best to govern hESCR in an international frame. Situated ethics here recognizes the issue of scale. These are guidelines, they have no enforcement mechanism and they make no claims to authority over sovereign policies. They offer, however, a deliberate consensus on what might constitute best practices and thus offer a template for how to practice modern ethical hESC science. Ethics here are situated in terms of adjudicating interests, but also in acknowledging the limitations of their own scope.

5.4. Discussion These are stories of situated ethics. Values are articulated in different ways, sites, and practices, and they circulate at different scales. Even in a place without a clear critical mass of stem cell researchers, and even fewer human embryonic stem cell researchers, there are very different approaches as to which values count, for whom, and to what ends. The story of two scientists shows different modes of inclusion and representation that are both framed as different kinds of ethical problems. The Advisory Report survey seeks to represent and “speak for” a broader Taiwanese public in order to identify speciﬁc sites of resistance, local concerns, and to assess public ap- proval. Like all surveys, this one presupposes a particular kind of public whose opinion is knowable. And the accompanying guidelines, as always, represent consensus that necessarily elides certain objections. The survey

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 630 Emerging Science: Stem Cell Research in Taiwan

does, nonetheless, successfully construct such a stem cell public for Taiwan. It also authenticates the subsequent policies by having a public survey to refer to as an enactment of a modern democratic mode of responsible governance. And Taiwan’s presence at the ISSCR task force, through Yu, shows situated ethics operating in an explicitly global register. As Hyun clearly states, the task force is not claiming complete representativeness; there are fourteen countries and none is assumed to have a singular cultural perspective. These examples show that aspects of science and governance are produced in assemblages comprised of local and global shifting elements that can come together and disperse; they assemble a basic level of agreement on best principles and practices at a specific time. By attending to the different scales we can see that the assemblages shift, and construct and articulate different specific concerns and values within varied fields; these include within a scientific field, a national survey, an international committee. Taiwanese science and publics—and their specificinclusions—are expressive of different values in different meanings and modes of inclusion.

6. Conclusion Jia-shin Chen uses the metaphor of transplantation to capture how harm reduction policies imported from Australia and Hong Kong into Taiwan nonetheless relied upon forms of local compatibility (2013, p. 459). Chen calls this a medical/botanical metaphor. It is also an ecological metaphor. How might international policy take root in Taiwanese soil and become part of a larger system? Policies on stem cell and human embryo research were made in Taiwan by transplanting elements of international policy including speciﬁc expertise, instruments, discourses, knowledges, relationships and people. These take root in Taiwan in the multiple layers at which they must represent Taiwan and its people as modern, sovereign, democratic and ethical. It is through the layered articulations—connections and utterances—that human embryo and stem cell policy came to be assembled in Taiwan.

6.1. Making Policy As in other countries, much of hESCR policymaking in Taiwan occurred through meetings of various experts. However, expertise itself is often contested. The KMT built itself as a modern, educated, and sophisticated party and claims responsibility for Taiwan’s economic miracle and, more broadly, for developing Taiwan as a modern nation. It is also the party that ruled by martial law for thirty-eight years. Taiwan’s history of autocratic rule, unstable sovereignty, and recent democratization undermines facile acceptance of older forms of expertise and authority.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 631

In a newly democratic mode, many Taiwanese no longer uncritically accept technocratic expertise. While Taiwanese experts trained in the West are still often granted significant cultural capital and leadership positions, Western experience is multivalent. Counter narratives of local modernity- making through individual and national self-determination serve as challenges to transnational and scientific experts and expertise. Taiwan continues to change rapidly and Taiwan’s people are increasingly influenced by self-conscious movements of nation-building and identity-making. In some circles, such narratives of self-determination are gaining traction, and expertise and authority, in both their imported and local forms, are increasingly subject to challenge. In the course of my fieldwork I heard many times, “Weareafreecountry.” I witnessed many protests each of which seemed to be a public demonstration of such freedom and a clear mark of distinction from mainland China. I re- member vividly one midday protest as I walked toward National Taiwan Uni- versity’s prestigious hospital; protesters chanted in Mandarin, some with bullhorns, for a free Tibet, while carrying signs demanding the same in both Chinese and English. This democracy, this freedom, not only serves as an important distinction made in contrast to mainland China, it also serves as an important marker of Taiwanese modernity. Taiwanese publics, now freed from both martial law and colonial rule (although still subjects of the One- China policy), become the authors of their own futures. They challenge the rule of experts, require substantiation of claims to expertise, and insist on public accountability on the part of their authorities both political and scientific. In 2007, then President Chen Shui-bian, (of the DPP) in the face of corruption scandals endured repeated calls for his resignation. A legal scholar told me: Because the people have been emancipated! Now there is no unchallengeable authority in Taiwan. Even the President! He is everyday criticized, under fire! So, you can imagine, it’s hard for the scientists to claim so high an authority as before (Personal interview excerpt 2007). More recently, the current President Ma Ying-jeou (of the KMT) is also under fire. A different legal expert says: The KMT was supposed to be the party of economic expertise, experts in economy, but now it’s the worst ever. Ma is the worst president ever. This is according to record low indicators (Personal interview excerpt 2012). The roles of authority and expertise have shifted dramatically since democratization began. A law Professor locates clearly the decline of

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 632 Emerging Science: Stem Cell Research in Taiwan

scientific authority within more general changes in Taiwanese society. Speaking on the controversy generated by a national biobank project, he says:17 Before democratization, the researchers, the scientists, were accorded very high social esteem, so they just did what they wanted to do as long as they didn’t get involved in political controversies… That said, times have changed! (Personal interview excerpt 2007) In these changed times, Taiwanese publics insist on greater accountability from their leaders, including their scientists. These publics are demanding to be heard in ways that were impossible under martial law. In such a political climate, claims of experts are not self-justifying and government officials, scientists and other scholars know that they must conform to standards of other democracies in biomedical research policymaking. Experts know that they must be accountable to Taiwanese publics. They know that they are also accountable to a broader global community of science. As I have discussed above, both Taiwan’s policies on stem cell research and the processes from which they were derived conform to standards from established democratic countries. These processes included expert panels, public consultations, a public survey, the development of the TSSCR, participation in the ISSCR, and finally the formal adoption of guidelines in 2007. They were accompanied by infrastructural development including centralized and institutional IRBs and funding structures. The resultant policies clearly reflect international standards. But they do more than this. The policies articulate specific ideas about what it means to be Taiwanese. Salter and Salter’s aforementioned framework, for instance, is useful for making international comparisons, but as they are aware, it obscures both the work and the meanings that stem cell policies inhere. Much has been written on stem cell research and policymaking, but relatively few studies have addressed specifically how policies have been made in diverse sites that study the interaction between international and local policies and cultural elements in globalizing sciences. That is, as Chia-Ling Wu suggests, in biomedical policy-making neither “an encompassing global force” nor “a pre-existing local path” can be assumed (2012, p. 726). Finally, I suggest that even as Taiwan’s policy documents are in themselves relatively unremarkable, they represent a significant shift in science governance in Taiwan and offer an important example of science policymaking

17. Fan and Lin (2011) offer an instructive and relevant discussion of the Taiwan Biobank. Neither is the speaker of the subsequent quotation.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 633

at the nexus with emergent democracy. The authors of the Advisory Report identified a central concern for science governance in Taiwan: how to construct policies that at once conform to international standards and that properly represent Taiwan’s people. This conformity to international standards—of both bioethics and public consultation—also serves to represent Taiwan’s people as scientifically and politically modern and ethical. Democratic science policymaking faces a central tension; science is supposed to be universal, but democracy (and medicine) need to account for specific locals. Fundamen- tally, this paper contributes to the literature on science and democracy by providing an account of science making in an emergent democracy. It is an account that brings together an emerging field of biomedical science and an emergent democracy in a still-developing country, and shows the overlapping regimes of value in science policymaking therein. The rich and contingent assemblages that comprise the spaces of science and policy in Taiwan, as it transitions from technocratic to democratic authority, highlight the complex, variable, and often competing values that are more easily overlooked in science-democracy studies in established democracies.

References Benjamin, Ruha. 2013. People’s Science: Bodies and Rights on the Stem Cell Frontier. Palo Alto: Stanford University Press. Bharadwaj Aditya. 2012. “Enculturating Cells: The Anthropology, Substance, and Science of Stem Cells.” Annual Reviews Anthropology 41: 303–317. Bharadwaj Aditya, and Peter Glasner. 2009. Local Cells, Global Science: The Rise of Embryonic Stem Cell Research in India. London: Routledge. Bourdieu Pierre. 1979. Public opinion Does not Exist. Pp. 124–129 in Com- munication and Class Struggle. Edited by A. Mattelart and S. Siegelaub. New York: International General. Caduff, Carlo. 2010. “Public Prophylaxis: Pandemic Inﬂuenza, Pharma- ceutical Prevention and Participatory Governance.” Biosocieties 5(2): 199–218. Callon, Michel. 2004. Disabled Persons of All Countries, Unite! Pp. 308– 313 in Making Things Public: Atmospheres of Democracy. Edited by Bruno Latour and Peter Weibel. Cambridge, MA: MIT Press. Chao, Kang, and Marshall Johnson. 2000. “Nationalist Social Sciences and the Fabrication of Subimperial Subjects in Taiwan.” Positions 8 (1): 151–177. Chen, In-chin [ ]. 2001. Abstract of “Human Embryonic Stem Cell Research Regulations” [ ]. Accessed October 21 2013. http://readopac1.ncl.edu.tw/nclserialFront/search/summny_list.jsp? sysId=0004706395&dtdId=000040

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 634 Emerging Science: Stem Cell Research in Taiwan

Chen, Jia-shin. 2009. Assembling Harm Reduction Policy in Taiwan.PhD diss., University of California, San Francisco. Chen, Jia-shin. 2013. “Taiwan’s Harm Reduction Policy.” EASTS 6 (4): 454–64. Chiu,FredY.L.2000.“Suborientalism and the Subimperialist Predicament: Aboriginal Discourse and the Poverty of the State-Nation Imagery.” Positions 8 (1): 101–149. Deng, Chung-Yeh and Chia-Ling Wu. 2010. “An Innovative Participatory Method for Newly Democratic Societies: The ‘Civic Groups Forum’ on National Health Insurance Reform in Taiwan.” Social Science and Medi- cine 70: 896–903. Department of Health (Taiwan). 2007. “Policy Instructions on the Ethics of Human Embryo and Embryonic Stem Cell Research” ( ), August 9, 2007. Available at: http://www. tsscr.org.tw/ﬁles/Guideline%20for%20Human%20Embryo%20and% 20Embryonic%20Stem%20Cell%20Reserach_TW.pdf Douglas, Heather. 2009. Science, Policy, and the Value-Free Ideal. Pittsburgh, PA: University of Pittsburgh Press. Epstein, Steven. 2007. Inclusion: The Politics of Difference in Medical Research. Chicago: University of Chicago Press. Fan, Chien Ta and Wan-Shiuan Lin. 2011. “The Legalisation of Ethical Governance in Taiwan Biobank Development.” Asian Bioethics Review 3 (2): 85–99. Franklin, Sara. 2005. Stem Cells R Us: Emergent Life Forms and the Global Biological. Pp. 59–78 in Global Assemblages: Technology, Politics, and Ethics as Anthropological Problems. Edited by Aihwa Ong and Stephen Collier. Malden, MA: Blackwell. Gottweis, Herbert, Brian Salter and Catherine Waldby. 2009. The Global Politics of Human Embryonic Stem Cell Science: Regenerative Medicine in Tran- sition. London: Palgrave. Hayden, Cori. 2003. When Nature Goes Public: The Making and Unmaking of Bioprospecting in Mexico. Princeton, NJ: Princeton University Press. Hayden, Cori. 2007. Taking as Giving: Bioscience, Exchange, and the Politics of Beneﬁt-Sharing. Social Studies of Science 37 (5): 729–758. Hogle LF. 2005. “Stem Cell Policy as Spectacle Ripe for Anthropological Analysis.” Anthropology News October: 24–25. Jasanoff, Sheila. 1998. The Fifth Branch: Science Advisors as Policymakers. Cambridge: Harvard University Press. Jasanoff, Sheila. 2005. Designs on Nature: Science and Democracy in Europe and the United States. Princeton, NJ: Princeton University Press. Latour, Bruno. 2004. “Why has Critique Run out of Steam? From Matters of Fact to Matters of Concern.” Critical Inquiry 30 (2): 225–248.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 Perspectives on Science 635

Lin, M, H.K. Tseng, J.A. Trejaut, H.L. Lee, J.H. Loo, C.C. Chu, P.J.Chen,Y.W.Su,K.H.Lim,Z.U.Tsai,R.Y.Lin,R.S.Lin,and C.H. Huang. 2003. “Association of HLA Class I with Severe Acute Respi- ratory Syndrome Coronavirus Infection.” BMC Medical Genetics 4(1):9. Liu, Jennifer A. 2010. Making Taiwanese (Stem Cells): Identity, Genetics, and Purity. Pp. 239–262 in Asian Biotech. Edited by Aihwa Ong and Nancy Chen. Durham: Duke University Press. Liu, Jennifer A. 2012. “Aboriginal Fractions: Enumerating Identity in Taiwan.” Theme issue, Enumeration, Identity and Health, Medical An- thropology 31 (4): 329–346. Malialiaves, Monanen. 2000. “Ah Neng’s Critique.” Positions 8(1):179–199. Merton, Robert K. 1973 [1942]. The Normative Structure of Science. Pp. 267–278 in The Sociology of Science: Theoretical and Empirical Investi- gations. Edited by Norman W. Storer. Chicago: University of Chicago Press. Munsterhjelm, Mark. 2014. Living Dead in the Paciﬁc: Contested Sovereignty and Racism in Genetic Research on Taiwan Aborigines. Vancouver: UBC Press. Ong, Aihwa. 2010. “Introduction: An Analytics of Biotechnology and Ethics at Multiple Scales.” Pp. 1–51 in Asian Biotech: Ethics and Commu- nities of Fate. Edited by Aihwa Ong and Nancy N. Chen. Durham, NC: Duke University Press. Ong, Aihwa, and Stephen J. Collier. 2005. Global Assemblages: Technology, Politics, and Ethics as Anthropological Problems. Malden, MA: Blackwell. Pilmis, Olivier. 2006. “Does Public Opinion Finally Exist? The Use of the ESS Survey to Test Pierre Bourdieu’s Theory.” Paper presented at the ESRC Research Methods Festival. Oxford, 17–20 July. Prainsack, Barbara. 2011. “Overcoming Embryonic Exceptionalism? Lessons from Analyzing Human Stem Cell Research Regulation in Israel.” New Genetics and Society 30 (3): 267–77. Reardon, Jenny. 2005. Race to the Finish: Identity and Governance in an Age of Genomics. Princeton, NJ: Princeton University Press. Rei, Wenmay and Jiunn-Rong Yeh. 2009. “Promises and Pitfalls of Using National Bioethics Commissions as an Institution to Facilitate Delibera- tive Democracy: Lessons from the Policy-making of Human Embryonic Stem Cell Research.” National Taiwan University Law Review 4(2):69–105. Rei, Wenmay. 2010. “Toward a Governance Structure beyond Informed Consent: A Critical Analysis of the Popularity of Private Cord Blood Banking in Taiwan.” East Asian Science, Technology and Society: an Inter- national Journal 4(1): 53–75. Rosemann A. 2011. “Modalities of Value, Exchange, Solidarity: The Social Life of Stem Cells in China.” New Genetics and Society 30 (2): 181–192

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021 636 Emerging Science: Stem Cell Research in Taiwan

Saniei, Mansooreh. 2013. “Human Embryonic Stem Cell Science and Pol- icy: The Case of Iran.” Social Science & Medicine 98 (100): 345–350. Salter, Brian and Charlotte Salter. 2007. “Bioethics and the Global Moral Economy: The Cultural Politics of Human Embryonic Stem Cell Sci- ence.” Science, Technology, & Human Values 32 (5): 554–581. Sleeboom-Faulkner, Margaret and Seyoung Hwang. 2012. “Governance of Stem Cell Research: Public Participation and Decision-Making in China, Japan, South Korea and Taiwan.” Social Studies of Science 42 (5): 684–708. Song, Priscilla. 2010. “Biotech Pilgrims and the Transnational Quest for Stem Cell Cures.” Medical Anthropology 29 (4): 384–402. Song, Priscilla. 2011. “The Proliferation of Stem Cell Therapies in Post- Mao China: Problematizing Ethical Regulation.” New Genetics and Society 30 (2): 141–153. Sperling, Stefan. 2004. “Managing Potential Selves: Stem cells, immigrants, and German identity.” Science and Public Policy 31 (2): 139–149. Strathern, Marilyn. 2002. “Externalities in Comparative Guise.” Economy and Society 31 (20): 250–267. Thompson, Charis. 2010. “Asian Regeneration? Nationalism and Inter- nationalism in Stem Cell Research in South Korea and Singapore.” Pp. 95–117 in Asian Biotech: Ethics and Communities of Fate. Edited by Aihwa Ong and Nancy N. Chen. Durham, NC: Duke University Press. Thompson, Charis. 2014. Good Science: The Ethical Choreography of Stem Cell Research. Cambridge: MIT Press. Tsai, Daniel Fu-chang. 2004. “The Morality of Inclusion: A Response to Duffy.” Journal of Medical Ethics 30: 504. Tsai, Duujian, and Shui Chuen Lee. 2006. “Public Attitudes and Recom- mendations for Stem Cell Research Policy. Technical Report.” Tsai, Yu-yueh. 2010. “Geneticizing Ethnicity: A Study on the ‘Taiwan Bio-Bank’.” EASTS 4 (3): 433–55. Waldby, Catherine. 2002. “Stem Cells, Tissue Cultures and the Production of Biovalue.” Health 6 (3): 305–323. Wu, Chia-Ling. 2012. “IVF Policy and Global/Local Politics: The Making of Multiple-Embryo Transfer Regulation in Taiwan.” Social Science & Medicine 75: 725–732. Yeh, Jiunn-Rong. 2008. “Democracy-driven Transformation to Regulatory State: The Case of Taiwan.” National Taiwan University Law Review 3 (2): 31–59. Zhang, J., G. Zhuang, Y. Zeng, C. Acosta, Y. Shu, and J. Griffo. 2003. “Pregnancy Derived from Human Nuclear Transfer.” Fertility and Sterility. Vol. 80 (Supplement 3): 56. Zhang, Joy Yueyue. 2012. The Cosmopolitanization of Science: Stem Cell Gover- nance in China. New York: Palgrave Macmillan.

Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/POSC_a_00225 by guest on 01 October 2021