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Japan: a new field emerges.

Japan: A New Field Emerges

Under the impact of rapidly evolving medical science, bioethics is emerging as a new discipline in Japan--one in which participants are comparing traditional Japanese values with ethical insights of scholars from around the world. Conferences, symposia, and special committees have provided forums for discussing such questions and a number of significant publications in 1988 reflect not only the topics of major interest, but equally the public contexts in which debate takes place.

Seen as being philosophically grounded in Western individualism, organ transplantation raises many conflicts with traditional Japanese values, particularly the predominant communitarian outlook that stresses group harmony as the primary social good and the belief that the body--living, dying, and dead--is not an entity distinct from the mind or soul. This was made strikingly clear when, in 1986, a surgeon in Sapporo performed Japan's first heart transplant. This celebrated case, in which the same doctor who made the determination of death also participated in the transplant, led to a de facto ban on heart transplants and prompted lively and ongoing debate in the Japanese public and medical community.

An important book, Brain Death and Organ Donation (Japan Medical Association, 1988), edited by Ichiro Kato of Seijo Gakuen University, contributed to this debate in 1988. It brings together material prepared under the auspices of a special committee of physicians and lawyers convened by the Japan Medical Association and addresses ethical issues in transplantation.

The Seminar Committee on Ethics and Philosophy in Medicine of Kitazato University has discussed bioethical issues in health care since 1978 in regular bimonthly seminars. The twenty to thirty participants representing different institutions and fields regularly publish papers in the series entitled The Soul in Medicine. Volume six (1987) includes articles on "The Concept of Life," by Yasuhiko Kakehi, "Medical Anthropology," by Hideo Suzuki, "Reproductive Medicine," by Takashi Wagatsuma, "Clinical Decisionmaking," by Masayuki Fukuma, and "Medical Technology," by Fumimaro Tataku. Some of these authors stress that brain death and organ transplantation must be separately considered, and urge that the doctor-patient relationship be informed by love and generosity as the foundation for bioethics in Japan.

Between 1983 and 1986 under the auspices of the Ministry of Education, Tokyo University organized study groups on "New Medical Sciences and Health Care for the 21st Century," chaired by university president Wataru Mori. Medical Ethics (Nipon-HyoronSha, 1987), edited by Koichi Bai of Kitazato University Medical School, reflects the work of Bai's study group on bioethics. Participating scientists, physicians, and lawyers address ethical issues in the doctor-patient relationship, medical education, medical jurisprudence, and social medicine. Participants' concerns with the concept of human dignity led to their recommendation that a clearinghouse be established to make general information on biomedical ethics available to both concerned scientists and the general public.

This fundamental concern for human dignity in medical care is also reflected in Bioethics for Nurses (Nipon-Kango-Kyokai-Shupan, 1988), edited by Michi Takahashi of the Japan Nurses Association. Articles by Yoshio Kawakita (Chiba University Medical School) and Koichi Bai are designed to enhance nurses' and other caregivers' understanding of ethical issues and decisionmaking in practical contexts, relevant legal doctrine (especially on questions of death and dying), and the role of family members in medical decisionmaking. Other contributions include articles by Fumiko Ohmori of the Japan Nurses League examining nursing perspectives on ethics and patient care, and by novelist Michi Nakajima exploring patients' experiences of terminal illness. Finally, active cooperation between physicians, nurses, and other medical staff to enhance human dignity is emphasized.

Two further noteworthy titles each examine a variety of topics in bioethics, ranging from decisionmaking at the beginning and end of life through organ transplantation, the doctor-patient relationship, and human subjects research to assisted reproduction, genetic engineering, and fetal research. Naomasa Okamoto (Hiroshima University Medical School), Kazuo Baba (Nipon University Medical School), and Toshiyuki Furusho (Kyorin University Medical School) collaborated on the multidisciplinary volume Medical Ethics in Medical Research and Treatment (Tokyo-Igaku-Sha, 1988), which is especially valuable in gathering together formal guidelines, recommendations, and policy statements prepared by and for ethics committees and similar groups.

Over 180 individuals from many disciplines and several countries joined some twenty invited speakers for the 1987 Bioethics Seminar sponsored by Fukui Medical School. Human Dignity and Medicine (Excerpta Medica ICS 774, 1988), the seminar proceedings edited by Jean Bernard of the French National Consultative Committee on Ethics in the Life Sciences and Kinichiro Kajikawa and Norio Fujiki of Fukui Medical School bring together an array of perspectives on critical issues in biomedical ethics. This English-language book is distinguished from many other collections in incorporating comparative perspectives in articles on France, Canada, Thailand, and the United States by Jean Bernard, James Miller, Pinit Ratanakul, and Richito Kimura and James Neel. The contributors, including eleven other Japanese scientists and several foreign scholars call attention to issues of ethics in history, education, and practical problems in medical genetics in the care of the disabled in Japan, especially regarding genetic counseling, prenatal diagnosis, and genetic diagnosis, as well as reproductive medicine.

Thinking of Life: An Overview of Bioethics (Nippon-Hyoron-Sha, 1987) by Richito Kimura of Waseda University's Faculty of Human Sciences also deserves mention. This excellent book for the general public presents many of Kimura's papers and publications, and not only makes selected articles from American bioethics literature available in translation, but also illuminates Western individualistic considerations for Japanese senses. It brings a breath of fresh air to bioethics in Japan, and serves as an example of how individualistic perspectives might be harmonized with traditional Buddhist values.

The latest volume of References in Medical Ethics in Japan (Tokai-Daigaku-Igakubu-Toshokan, 1988) prepared by the Bioethics Committee of Tokai University Medical School, makes it clear that bioethics is a young but rapidly growing discipline in Japan. Published annually since 1986, References catalogues the holdings, in both Japanese and English, of the Tokai University library, and offers a welcome guide to current trends in bioethics.

The foundation has now been laid and the future of bioethics in Japan is secure. No doubt the proceedings of the Council for the International Organization of Medical Sciences' next conference on Genetics, Ethics, and Human Values, to be held in Tokyo in July, 1990, will be only one among many new titles to find their way into the growing bioethics literature in coming years. Kin-ichiro Kajikawa is past president of Fukui Medical School, Matsuokacho, Fukui Pref., 910-11, Japan.
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Title Annotation:bioethics
Author:Kajikawa, Kin-ichiro
Publication:The Hastings Center Report
Date:Jul 1, 1989
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