(The paper presented at the session "Chinese and East-Asian Bioethics" in the Fourth World Congress of Bioethics, November 6, 1998, Tokyo, JAPAN)
Takashi TSUCHIYA, M. A.
Lecturer, Department of Philosophy
Osaka City University
Osaka 558-8585, JAPAN
E-mail: tsuchiya@lit.osaka-cu.ac.jp
What I want to explain here is how bioethics has been recognized and conceptualized in Japan. In addition, I would like to tell how we Japanese can contribute to the development of the global bioethics.
1. Two Bioethics in the United States Introduced into Japan
Among the different positions on the nature of bioethics in the United States, I found two schools with prominent influences on Japan. One of them was V. R. Potter's ecological bioethics, and the other was so-called "biomedical ethics".
V. R. Potter's Bioethics: Ecological Bioethics
Potter coined the term "bioethics" in 1970 (Potter 1970; Reich 1994). He proposed the new discipline of bioethics as "the science of survival," which "would attempt to generate wisdom, the knowledge of how to use knowledge for social good from a realistic knowledge of man's biological nature and of the biological world." (Potter 1971, p.26) He had been worried as to whether humankind could survive the ecological catastrophe which has been caused by recent exploitation of the natural resources and environment of the earth. He thought humankind must survive, and in order to do so, we must develop a new "wisdom" based on biological knowledge.
However, now most people probably regard Potter's bioethics as not bioethics but a kind of environmental ethics. Potter's bioethics was overwhelmed by another bioethics, bioethics as biomedical ethics (Engelhardt 1988; Reich 1994; Reich 1995).
Biomedical Ethics: Medical Bioethics
Just when Potter began advocating his bioethics, another "bioethics" was born independently in Washington, D.C. (Reich 1994; Potter 1988). It was bioethics as "biomedical ethics," which Potter later called "medical bioethics" (Potter 1975; Potter 1988). The Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics, now called the Joseph and Rose Kennedy Institute of Ethics, was established in 1971. Although the field of medical bioethics had been gradually emerging since the 1960s, and the Hastings Center was established in 1969, the Kennedy Institute was the first institute bearing the term "bioethics," and its scholars tried to establish "bioethics" as a disciplinary field. The books like Bibliography of Bioethics (Walters 1975), Encyclopedia of Bioethics (Reich 1978), Contemporary Issues in Bioethics (Beauchamp and Walters 1978), and Principles of Biomedical Ethics (Beauchamp and Childress 1979) contributed greatly to public comprehension that bioethics was an established field of research. This is one reason why "medical bioethics" was able to become the mainstream conceptualization (Reich 1994).
Although the Potter's book was translated into Japanese and published in 1974 (Potter 1974), it drew little attention at that time. In the early 1970s in Japan the term "bioethics" had not yet been translated into Japanese. It was simply transliterated as "Baioeshikkusu". The English term was translated into Japanese for the first time as "Seimeirinri" in 1977, which has been publicly used from 1978 (In Japanese "Seimei" means "bio" or life, while "Rinri" usually means an ethic) [SEE OHP]. Although the debates on heart transplantation, abortion, and prenatal diagnosis drew broad public attention in the early 1970s, these debates were not considered as "bioethical," because there was little knowledge of bioethics in Japan. Even in the United States bioethics was just developing, and Japanese scholars and journalists thought that there is no literature legitimating it as an established field. The comprehensive works by the scholars of the Kennedy Institute were just what had been awaited, and among others the publication of the Encyclopedia in 1978 was considered to legitimate the introduction.
2. The Early Introduction (1979-1984)
In 1979 bioethics began to be introduced into Japan [SEE OHP of the statistics]. There were two distinguished "introducers," namely Taro Takemi, who had been the president of the Japanese Medical Association for 25 years, from 1957 to 1982, and Rihito Kimura, who came to the Kennedy Institute in 1980.
Takemi wrote an article on Japanese medical ethics for the first edition of the Encyclopedia (Takemi 1978). He also seemed to sympathize with the Potter's bioethics, since he had long been proposing his "Seizon no Rihou (the study of human survival and existence)". He then began and continued proposing "Seizon-Kagaku (the Survival Science)" until his death in 1983. According to Takemi, "Baioeshikkusu" or "Seimeirinri" is a system of new ethics, which integrates ethics for people in general and ethics for the medical profession. It must not be the old, negative ethics which dictates only "ought not" but a new, positive ethics which can cope with the development of modern science and which is prior to rights and duties (Takemi 1980a; Takemi 1980b).
On the other hand, Rihito Kimura gave many lectures on bioethics around Japan in the beginning of the 1980s with photo-journalist Akihiko Okamura. Kimura and Okamura took notice of the fact that the U.S. bioethics had been formed under the deep influence of the human rights movements in the 1960s. In order to protect patients and subjects in Japan, they stressed this aspects of bioethics. According to Kimura, "bioethics is a human rights movement and public policy making, which concerns not only medicine but also all aspects of Bios (life)."(Kimura 1987, p.11. translated by Tsuchiya)
Though both Takemi's and Kimura's bioethics were the original ones and no precise introduction of the U.S. bioethics, most Japanese have regarded them as introducers of bioethics, since the channels of information were limited in the early 1980s.
Nevertheless, despite these introductory efforts, the Japanese mass media still would not use the term Seimeirinri or Baioeshikkusu in the news on biomedical issues. They preferred the term Raifu-Saiensu (the Life Science), which was more popular in Japan in the early 1980s.
3. In the Mass Media and Establishment of Academy (1985-1988)
It was in 1985 when the term "Seimeirinri" became popular in Japan. The events like the publication of the report of the "Seimei to Rinri ni kansuru Kondankai" (the Special Advisory Board on Life and Ethics of the Japanese Ministry of Health and Welfare) (Kosei-Sho Kenko Seisaku Kyoku Ijika 1985) and the foundation of the Seimeirinri Kokkai Giin Renmei (the Diet Members' League for Bioethics) (Seimeirinri Kenkyu Giin Renmei 1985) let the mass media use the term Seimeirinri officially for biomedical issues. In 1985 the Japanese public came to regard issues in bioethics as issues in Seimeirinri or Baioeshikkusu at last.
In the late 1980s, there appeared two noteworthy activities on bioethics in the academic literature, namely the historical analysis of the U.S. biomedical ethics by the historians, and the translation and summarizing of English-language literature in biomedical ethics by philosophers. Reading the translations and summaries many students, including myself, began studying biomedical ethics and have become researchers in bioethics. These academic researchers and some journalists gathered and founded two nationwide societies for bioethics, the Nihon Seimeirinri Gakkai (the Japanese Society for Bioethics) and the Seimeirinri Kenkyukai (Bioethics Research Society). In this way bioethics was developed into an academic field of research in Japan by the end of 1980s.
CONCLUSION
As a result of these process of introduction and development, roughly speaking there are three different interpretations of the nature of bioethics in Japan [SEE OHP of the Genealogy]. The first is that "Seimeirinri" (or "Baioeshikkusu") is a new system of ethics. This interpretation is influenced by Takemi's approach. The second interpretation considers "Baioeshikkusu" as a human rights movement. This understanding is based on Kimura's interpretation, and is popular among the advocates of patient's rights. The third interpretation is that "Seimeirinrigaku" or "Baioeshikkusu" is the interdisciplinary field of research on the life sciences and medicine. This is shared mainly among academic researchers.
However, I think Japanese bioethics has not yet been established as a disciplinary field. It has no distinguished methodology and principles yet. We have tried to import the principles of the western bioethics, but there are explicit and implicit resistance. Some scholars say that Japanese people cannot accept those principles, since we have very different cultural values from the western values like autonomy and human rights. They propose that the Japanese bioethics should be based on the east-Asian values such as "Wa (harmony)" and "Jin (benevolence)". But I entirely disagree with them.
I believe the principles of the Japanese bioethics must be established not on the Japanese or east-Asian cultural values, but on the self-examination of our deed in the past. The principles of the western bioethics is a creature of its particular historical process. For example, the concept of informed consent has its origin in the Nuremberg Code, which was made in the examination of the Nazi-Doctors who performed brutal human experimentation. In contrast to it, in Japan there has been no accusation, no trial, and no judgment on the Japanese doctors who performed much more cruel and deliberately-planned experiments on Chinese, Russian, Mongolian, and Korean people in the northeast China before and during the World War II [SEE OHP of the pictures of the replica]. At least 3,000 people were said to be murdered, and no subjects were survived.
I am very sorry for such a atrocious deed of our nation and medical profession. I must deeply apologize to these victims and their families.
One reason why the Japanese doctors have never accused is that the United States covered up for them in order to monopolize the data of the experiments for the biological warfare. But, in addition, it was the east-Asian values such as harmony and respect for authority which played a significant role in preventing the public investigation after the war.
I believe the Japanese biomedical ethics must be established upon the self-examination on this shameful historical fact. We have duties to make clear what had been done, to analyze why it could happen, and to draw the principles for preventing such an atrocity forever. And I firmly believe that this is the only way for us to contribute to the development of the east-Asian and the global bioethics in a true sense.
ACKNOWLEDGEMENT
I am most grateful to all the participants of the Tuesday Luncheon Seminar at the Kennedy Institute of Ethics on September 30, 1997, who gave me a lot of precious comments on the previous version of this paper . I sincerely thanks to the Professors who gave me the editorial comments and discussed with me on the subject, Professor Tom L. Beauchamp, my mentor at the Kennedy Institute while I stayed there from the March of 1997 to the February of 1998, Professor Rihito Kimura, Professor LeRoy B. Walters, the director of the Kennedy Institute, and Professor John Torbin. I also thank my colleague Japanese visiting scholars at the Institute at that time, Mr. Isao Morikawa, Ms. Kyoko Ichihara, Ms. Mika Sugiura, Ms. Tomoko Adachi, and Mr. Toshitaka Adachi for giving me helpful comments on the first draft. Of course they are absolved of responsibility for any errors that may appear here.
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