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Eubios Journal of Asian and International Bioethics Eubios Journal of Asian and International Bioethics EJAIB Vol 18(2) March 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: Our world views 33 Attitudes of Japanese bioethical educators towards life-sustaining treatment in the Wendland case. A descriptive study 34 - Sachi Chiba, Koichiro Itai, Yachiyo Tsuchiya, Motoki Onishi, Shinji Kosugi, Atsushi Asai Global Health Concerns and Public Health for the Common Good 40 - Leslie Garvey and Ann Boyd Monotheistic Religions' Perspectives on Embryonic Stem Cell Research 45 - Mansooreh Saniei and Raymond de Vries A Reconnaissance of the Cosmos: A Critical Response to Konstantin S. Khroutski’s BioCosmology – Science of the Universal Future 51 - Arthur Saniotis Considerations about Medical Ethics, Education, Medical Portuguese Code of Ethics and AIDS 56 - Maria Cristina Rosamond Pinto Prenatal and preimplantation genetic screening: emerging ethical and cultural dilemmas in South Asia 58 - Amy Patel and Vijay Rajput The Irrelevance of Libertarian Bioethics 61 - Stefano Fait Asian Bioethics Association (ABA) 31 Conferences 62 Ordering Information and Renewal forms online 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: [email protected] Deadline for the May 2008 issue is 1 May, 2008. 34 Eubios Journal of Asian and International Bioethics 18 (March 2008) Editorial: Our worldviews This issue of the journal commences with a survey of the attitudes of medical ethics teachers across Japanese medical and nursing schools towards a case of decision making for life-sustaining treatment. While the findi ngs show diversity, an interesting question is whether personal attitudes towards bioethics dilemmas will lead to differing styles of ethics education. Will the attitudes of medical professionals taught by a teacher favouring withdrawal of life-sustaining treatment be different to those taught by a teacher who does not? Should they? According to the UNESCO Regional Action Plan for Bioethics Education in Asia and the Pacific (Now available in multiple languages on www.unescobkk.org/rushsap), the views of the teacher should not especially influence the diversity of views of the students. However, one could expect some effects if different reference materials were included and cited. Further papers in this issue examine the perspectives of monotheistic religions on embryo status and use of ES cell lines for research if created by embryo sacrifice. Saniotis makes a detailed analysis of the biocosmology papers of Konstantin S. Khroutski, who has often publish ed in EJAIB in the past. We look forward to the response. The arguments discuss a world view that could be said to encompass different religious viewpoints, and make a different approach. The final paper in this issue is a critique of libertarian bioethics, to discuss a further view that could be taken as a basis for bioethics. Garvey and Boyd described how global health concerns for public good have shaped our concern about AIDS, no matter what our religious world view. All of these different viewpoints should be part of the theoretical background of ethics education. Pinto examines the debates on how ethics should affect ethical codes, especially in the Portuguese context. Patel and Rajput describe some issues of genetic screening in South Asia with the advent of growing rates of use of genetic diagnosis. Comments are welcome on all these papers. -D.M. Eubios Journal of Asian and International Bioethics 18 (March 2008) 35 come to exist as a viable option in cases of life and Attitudes of Japanese bioethical death. A common consensus has yet to be obtained with educators towards life- respect to the overall propriety of the withdrawal of medical care, but a variety of past cases shows the sustaining treatment in the presence of a certain level of guidelines. In the Quinlan Wendland case. A descriptive case, which was fought over the withdrawal of medical care for a young woman who had lapsed into a study persistent vegetative state allegedly due to acute drug poisoning, and in the Cruzan case, which was fought - Sachi Chiba over the withdrawal of medical care for a young woman Department of Bioethics, Faculty of Medical and who had lapsed into a similar persistent vegetative state Pharmaceutical Science, Kumamoto University, Japan as a result of a traffic accident, termination of life was - Koichiro Itai granted through the families’ substituted judgment and Department of Social Medicine, Division of Biomedical attestation of the patients’ advance wishes.1, 2 Ethics, Faculty of Medicine, University of Miyazaki, In addition, in the Bouvia case, in which it was Miyazaki, Japan disputed that a woman who, although she experienced - Yachiyo Tsuchiya Department of Clinical Nursing, Faculty of Medicine, no impaired awareness whatsoever, was in a state of University of Miyazaki, Miyazaki, Japan complete paralysis aside from a few muscles of the face - Motoki Onishi and right arm and who consciously sought to die of Aomori Prefectural Public Health Center, Japan starvation. This case showed that the patient’s intent to Shinji Kosugi refuse medical care ultimately served as the grounds for Department of Biomedical Ethics, School of Public Health, the withdrawal of life-sustaining treatment.3 However, Kyoto University Graduate School of Medicine, Kyoto, there are many issues surrounding instances where the Japan patient himself or herself does not leave a directive - Atsushi Asai (hereafter denoted as advance directive) while still Department of Bioethics, Faculty of Medical and being of normal competence with regard to what kind Pharmaceutical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan of medical care he or she would receive or refuse, or Email: [email protected] who she would request to serve as proxy to provide against future incidence of a loss of competence. There Abstract are also instances where there is difficulty in The Wendland case where the patient did not suffer ascertaining the credibility of an advance directive or from coma but was not competent is a typical example intra-familial disagreement with regard to the of the difficulty inherent in decision-making regarding withdrawal of medical care, and so forth. life-sustaining treatment. In Japan, no clear policy has In the 2003 Schiavo case in the United States, the yet been set forth as to the grounds on which life- husband and parents of the patient fought over the support should be continued or withdrawn in withdrawal of medical care of a woman who had lapsed complicated circumstances like this. Therefore, we into a vegetative state from a coma due to myocardial conducted a cross-sectional survey on bioethics infarction. At one point, despite that the withdrawal of educators at all Japanese medical (80) and nursing medical care had been granted, the judicial (103) universities and examined ethical judgments determination was overturned due to protests by her regarding life-sustaining treatment in a similar situation parents and citizens groups and tube feeding was 4 to that of the Wendland case. The results showed that resumed some days later. In 2005, during the period 9% of the respondents were in favour of withdrawal, until medical care was withdrawn, the dispute 49% in favour of continuation, and 38% did not answer continued over life-sustaining treatment of a patient that either way, providing diverse reasons. Younger had been in a persistent vegetative state for over 10 respondents tended to support the withdrawal of life- years. support. We also discuss the implications of Japanese Above all, the Wendland case, which has sparked bioethics educators’ views and a need for guidelines to controversy recently in the United States, is a typical promote patient autonomy and her or his best interests. example of the difficulty inherent in decision-making pertaining to life-sustaining treatment. In 1993, Keywords: Wendland case, life-sustaining treatment, Wendland, a then 42-year old man, lapsed into a state Japan, bioethics educators, attitudes of comatose due to a traffic accident. When he regained consciousness 14 months later, he was paralyzed on one 1. Introduction side of his body, was unable to orally ingest food on his Modern medicine emphasizes patient autonomy and own, and was in a state in which sustained self-determination over physician paternalism, and the communication was impossible. At his best, he could concept of quality-of-life (QOL) over vitalism. To put draw simple shapes and follow simple instructions or this into practice, the withdrawal of medical care has respond to simple yes-no questions. He was given the 36 Eubios Journal of Asian and International Bioethics 18 (March 2008) prognosis that he would continue to live for years but therefore, we conducted a questionnaire survey on neurological recovery of any kind was beyond hope. bioethics educators at Japanese medical and nursing His wife, siblings, and daughter, citing that he had universities and examined ethical judgments with previously told them he “did not want them to force regard to life-sustaining treatment of patients in a him to continue living in a vegetative state” and that similar situation as that of the Wendland case. “he did not want to go on living if he could not provide for his family or could no longer talk or connect with 2.
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