Taking Life and Death Seriously - Bioethics from Japan: Volume 8

In order to design a Japanese approach to bioethics, it would be necessary to reflect on the history of bioethics in Japan. There are three major historic periods of bioethics in Japan. In the first period, medical law research in Japan started as early as bioethics research in the United States. In the second period (1980–1990) bioethics in Japan developed both its institutional structure and research production. Bioethical research by ethicists and philosophers was also launched in full swing. The third period (1990 to the present) can be characterized as highlighting genetics research and bioethical policies.

Bioethics and environmental ethics have been largely separated, in principle. However, the two types of ethics do overlap when dealing with significant issues such as human embryos, animal experimentation, and responsibility to future generations. In this paper, the possibility of synthesizing these two ethics through the concept of care is considered. Accordingly, the range of the object of the concept of care is similarly broadened. Moreover, after considering the serious defects of care-based theory, a care-based position, which regards human rights or their substitute as a complement to care, is advanced. This position can be said to be a Japanese approach to bioethics.

Human dignity is perceived dually, as active dignity when people dare in pursuit of a life worth to live, and as passive dignity because they are human beings. A human is regarded as “a being interrelated with”, not as an individual, in Japan. Person, human rights, body, and life are in reality supports of human dignity. Traditional Japanese could compensate for such ignorance of the essential concepts in their own ways. One must live in between “a being interrelated with” and an individual, being aware of one's own responsibility. Here lies the basis of human dignity.

Our moral thinking sometimes focuses on the possibilities given before birth. However, depending on circumstances, some children might never be brought into the world. The problem is how to consider the viewpoint of such children. In regard to this problem, while Parfit lays stress on the estimation of the state of the world, Steinbock emphasizes the importance of the parental responsibility. However, it seems that the viewpoint of the child itself is still important and not fully covered by these two approaches. Therefore, the best thing we can do now is to go back and forth between these two approaches.

The progress of genetic medicine has given rise to recent changes in the field of health care, such as expected benefits and potential risks for patients and their relatives. Individual genetic information can unlock many secrets within the genetic family and, sometimes the community to which he or she belongs. Therefore, the traditional duty of confidentiality owed by a health care professional to a patient has been challenged by the more serious discussions based on new genetics. Clinical geneticists providing genetic services must be aware of such complicated situations and whenever possible offer support to the patient (client) and their family members. Excluding eugenics and nonscientific perspectives, the Japanese government renamed and reworked “The Eugenic Protection Act” into the “Maternal Heath Protection Act” in 1996. From 1995 to 2003, the Japanese Society of Human Genetics (JSHG) revised guidelines for genetic testing three times. This process attempted to clarify indications for genetic testing, to focus on protection of individual genetic privacy and to deepen respect for familial relationships and responsibilities. The survey involving 221 JSHG approved clinical geneticist (response rate 54%) revealed that during last 5 years the number trying to do “non-directive” rather than “directive” counseling increased significantly. Although there is still in confusion on certain issues, such as data disclosure to relatives, the global bioethical view of new genetics is gaining Japanese geneticists’ acceptance.

Health professionals are in an ethical dilemma. The patients should be assumed as competent. Involuntary treatment is a violation of human rights. Therefore incompetent patients should be protected. However, one cannot determine a patient's incompetency without testing him/her, which is a violation of the assumption of competency. Thus, we propose two different types of uses for competency tests. One is to measure the appropriateness of information disclosed,but with a poor test result the information should be repeated. Another is to measure the competency of the patients when making major decisions. A poor test result will be followed by the designation of a proxy so that incompetent patients can be protected.

Care for the elderly is the most pressing problem now facing Japan. For maintaining a long and healthy life, it is important to refine the self-care of people and to create a well-balanced system of support involving health care, welfare, nursing care, and medical treatment. Mutual support within each local community is also indispensable for restructuring care-minding areas. Due attention should also be paid to the ethical aspects concerning care of the elderly. This chapter attempts to reflect on the brief history of the care for the elderly in Japan.

We wish to die peacefully in a manner suited to our values and taste. We also wish to be attended at our deathbed by people whom we love and try to find meaning in death. Here, I evaluate nursing of dying patients with regard to alienation of life and death from our daily living, problems concerning the judgment of death, how to die in a manner that fits the person's values and taste, and nursing for spiritual healing with traditional views of life and death, and cultural background of attending dying persons of the Japanese.

Natural selection is the mechanism of evolution originally proposed by Charles Darwin. This process is driven by mutation and death. Therefore, “individual death” is a critical event for evolution of species. Analogous to the significance of individual death in species evolution, recent biological observations have revealed that “cell death” is an important event for maintenance of individuals and offspring. Cell death is caused not only by injuries and pathological conditions, but also by programed intracellular signals. This type of programed cell death is called “apoptosis.” Apoptosis signals are regulated in mitochondria, eukaryotic organelles of symbiotic origin, and play a critical role in survival of individuals by eliminating some cells.

This paper focuses on the citizens’ movement for promoting shizensou that has arisen since the early 1990s in Japan. It ascertains the social backgrounds of the movement, which originally began as an attempt to preserve nature, and the proponents’ view of the next world and their views on nature. This analysis includes social factors such as demographic trends toward the nuclear family. Furthermore, based on written newsletter reports on shizensou, this paper will examine views of the next world, and indicate that their views are animistic. Finally, I will argue that present-day shizensou is a revitalization of the custom of scattering of the ashes, which was performed in ancient Japan, but it also involved other new elements.

Through an analysis of the HIV-Tainted-Blood Affair in Japan, this paper explores why pharmaceutical companies act in a socially irresponsible manner. The paper suggests encouraging members of these corporations to become more conscious of their responsibility to society by developing themselves as professionals. The analysis shows that drug disasters are not caused only by a particular “special villain,” but by the structural conflict between medical professional ethics and the profit making motivation of pharmaceutical companies. In other words, the behaviors of pharmaceutical companies fall into the interstices of professional ethics.

The internationally well known Minamata disease caused by methyl mercury poisoning, which has been described as a great tragedy of the modern Japanese state in the 20th century, in terms of a particular history of the “soul” narratives and practices is discussed. These narratives and practices are sometimes excluded from the authentic narratives in the state. I am exploring a historical vision connecting to the future of the Minamata disease victims as the “souls” of the Minamata disease after the “Final Settlement” in 1996. The paper's goal to suggest the “souls” of the Minamata disease is becoming out of place and it was articulated to some local people who experienced tragedies in the colonial or post-colonial situations.

Minamata disease was first officially recognized in May 1956. Its earliest victims were small children. Environmental contamination most rapidly and seriously affected the physiologically weak among the residents. However, the outbreak of the disease in humans was preceded by abnormalities in the natural environment such as massive death of fish and shellfish, and the abnormal behavior and death of cats. It used to be considered that poisoning was caused by direct exposure to a toxic substance, and that toxic substances did not pass the placenta. Minamata disease is an indirect poisoning by methyl mercury through the food chain as a result of environmental contamination, and is the first known disease to cause abnomalities in the fetus due to a toxic agent passing through the placenta. Minamata disease, therefore, had implications in various fields. Namely it also stirred up legal, ethical, and eugenic arguments concerning fetal protection. This report reviews the course of Minamata disease, and evaluates its impacts. “Minamata Studies” has three intellectual and scientific missions to change the social systems that caused the disease; to pursue environmental justice; and to explore the possibility of an environment that permits coexistence not only of all humans, but of all living things.