Eubios Journal of Asian and

International Bioethics
EJAIB Vol 14 (2) March 2004 ISSN 1173-2571
Copyright ©2004 Eubios Ethics Institute (All rights reserved, for commercial reproductions).
31 Colwyn Street, Christchurch 8005, New Zealand P.O. Box 125, Tsukuba Science City, Ibaraki 305-8691, Japan

Eubios Ethics Institute World Wide Web: http://www.biol.tsukuba.ac.jp/~macer/index.html

Official Journal of the Asian Bioethics Association (ABA) and the IUBS Bioethics Program

Contents
Editorial: Bioethics for Informed Citizens across Cultures 41
A National Survey of Physicians’ Attitudes toward Protecting
Human Research Participants in Taiwan
- Yaw-Tang Shih et al.
Artificial Insemination and happiness
- Yali Cong
Ethics in Domestic Violence Research
- Omur Elcioglu,Oztan Oncel, Ilhami Unluoglu
Clinical Ethics Discussion 4: Urgent “lifesaving” clinical research 52
- Atsushi Asai and Koichiro Itai
Experimental Medical Treatment for a Terminal Pediatric
Patient: Commentary on Asai & Itai - Frank J. Leavitt
The Development of Health Insurance in Turkey and its
Importance from the Point of View of Medical Ethics
- Ibrahim Basagaoglu and Aysegul Demirhan Erdemir
Biological Views of the Inexistence of Human Races
- Silviene F. Oliveira and Luzitano B. Ferreira
Cyber-pharmacies and ethical concerns over marketing
drugs online
- Vinod Scaria
Actualisation of the 'Philosophical Functionalism' in Bioethics63
- Konstantin S. Khroutski
News in Bioethics and Biotechnology
GE Plants, GE Animals. Design molecules, Biotech & Public 66
Regn. of GMOs, Vaccines & Diseases
AIDS and STDs, Bioremediation, Environmental Issues
Biodiversity, Animal Rights, Brain Function
rDNA, Food Safety, Disease Risks & Drugs
Patents &Business. Birth Control, Embryo Status, Cloning 72
ARTs, Fetal environment, Genetics, Methods
DNA Fingerprinting &Privacy, G.Screening, Gene Therapy 74
HGP, Medical ethics, Law, Scientific ethics
Euthanasia, Organ Transplants, Costs, Internet
Human behaviourome project
ABA Membership, IAB Genetics Network, Conferences
Ordering Information
Send papers to the editor in electronic form if possible.
Please use reference style used in News section, do not use
automatic footnotes or endnotes. Papers are peer reviewed.
Editorial address: Prof. Darryl Macer
Institute of Biological Sciences, University of Tsukuba
Tsukuba Science City 305-8572, JAPAN
Fax: Int+81-29-853-6614
Email: macer@sakura.cc.tsukuba.ac.jp
Deadline for next issue is 15 May, 2004.
page
Editorial: Bioethics for Informed
Citizens across Cultures
42 - Darryl Macer, Ph.D.
Director, Eubios Ethics Institute
48 Affiliated Professor, United Nations University
Email: macer@biol.tsukuba.ac.jp
50
This issue of the journal includes a range of papers from Asia
with a variety of medical ethics questions, revealing the breadth
of activity in different cultures on considering bioethics. I was
recently told that a discussant at an international conference in
57 Europe said that there was no bioethics activity in Asia. As
evidenced by the collection of over 1000 papers on bioethics in
58 Asia now published by Eubios in EJAIB and in conference
proceedings this is far from the truth. Still more action is
59 needed. Another step towards bioethics education is reached
with the publication of a textbook which includes a wide range of
authors from different countries. The 16 long chapters and 25
61 page by page topics in bioethics have been tested in different
countries since early 2003, and trials are expanding to more
countries this year.
A new book has been published by Eubios Ethics Institute,
Macer, DRJ., ed., Bioethics for Informed Citizens across
Cultures (160pp.) There is also an on-line version <http://www.
67 biol.tsukuba.ac.jp/~macer/betbk.htm> Further copies can be
69 obtained from the Eubios Ethics Institute. For teachers involved
70 in the Bioethics Education Project, this book is free. I can send
71 multiple copies for trials in classes if teachers will send feedback
from these trials. The textbook signals the second year of a
73 project on bioethics education teaching, see the site
<http://www.biol.tsukuba.ac.jp/~macer/betext.htm> We still
75 welcome further chapters, and translation of materials are being
76 made available as they are sent to me.
Please note that the CD/DVD and teaching resources, and the
77 proceedings of the ABC5 conference are still under preparation
79 for on-line, CD and printed versions. Please monitor the web
site as these files will be added. Please note that it is an open
project, and anyone who has teaching resources that they
would like to share into this open-access resource free of
copyright for teachers to download, modify for their particular
class needs and culture, and share back into the common
resource, is welcome to join. Many languages are desired.
There is also a yahoo listserve on bioethicseducation, as well as
a students discussion listserve. Please join the project, and the
international bioethics education network that had its first
meetings in mid-February, 2004 during ABC5/TRT9 conference.
42 Eubios Journal of Asian and International Bioethics 14 (March 2004)
A National Survey of
Physicians’ Attitudes toward
Protecting Human Research
Participants in Taiwan
- Yaw-Tang Shih*, M.D., Dr. P.H.
Director, Division of Health Policy Research
National Health Research Institutes, Taipei, Taiwan, R.O.C.
2F, 109, Min-Chuan East Road, Sec. 6
Taipei 114, Taiwan, R.O.C.
- Shu-Fang Shih, M.B.A., M.S.
Research Assistant, Division of Health Policy Research
National Health Research Institutes, Taipei, Taiwan, R.O.C.
- Nan-Shen Chen, M.S.
Research Assistant, Division of Health Policy Research
National Health Research Institutes, Taipei, Taiwan, R.O.C.
- Szu-Hsien T. Lee, Ph.D.
Assistant Professor
Department of Humanities and Social Sciences
National Defense Medical Center, Taipei, Taiwan, R.O.C.
- Cheng-Shing Chen, M.D., Ph.D.
Chairman, Daniel Executive Holding Corp, Taipei, Taiwan,
R.O.C.
- Matthew Tayback, Sc.D.
Professor, Department of International Health
The Johns Hopkins School of Public Health
*Address all correspondence to: Dr. Yaw-Tang Shih, Email:
annsshih@nhri.org.tw
Abstract
To understand the attitudes, awareness, subjective norms
and intention of physicians toward human research participant
protection (HRPP), we surveyed 2,425 physicians between
September 2000 and January 2001 in a cross-sectional survey
of 11 medical centers and medical school hospitals in Taiwan.
Response rate was 81%. Physicians’ attitudes, awareness,
subjective norms and intention to comply with HRPP
requirements were measured via a self-administered
questionnaire. We found that while 90% of respondents had
never heard of IRB, Nuremberg Code, Declaration of Helsinki,
Belmont Report, U.R.M.S.B.J., or JIRB, more than 78% of total
respondents showed strong response in 4 items of behavioral
belief about the significance of HRPP in intervention studies.
Around 22% did not recognize IRB reviews as important for
those intervention studies not regulated by the existing Medical
Care Act. In the measure of physicians’ beliefs toward HRPP
as related to interaction studies, over 59% favored requirements
that research participants be well informed and that informed
consent be obtained. Only 43% believed an IRB review was
unimportant in conducting an interaction study. Physicians
report that they place more attention on selecting patients
carefully than on fully informing research participants, obtaining
informed consent or submitting a proposal for IRB review.
Based on our regression results, physicians’ attitudes were
highly correlated with their intent to be involved in IRB reviewed
process.
The results of our study suggest that physicians in Taiwan
are not now generally aware of HRPP. Attitudes about
protecting research participants varied among different types of
studies. This consistent lack of awareness combined with a
lack of official regulation shows that the HRPP system in Taiwan
may not now be able to adequately protect the safety and rights
of human research subjects. In addition, our evidence shows
that by changing physicians' attitudes towards HRPP, we may
accelerate progress in developing, improving, and implementing
HRPP.
Key Words: Human Research Participants Protection; Ethical
Review; Informed Consent; Physicians; Attitude; Behavior.
Introduction
Medical scientists devote their whole careers to the
prevention and treatment of disease, and thus to the
improvement of human health. However, prior to the 1960s,
relatively little attention was given to standards and practices of
bioethics in human research (Moreno & Lederer, 1996). Since
that time, a prolific literature has accumulated on ethical
standards for human research, in particular on clinical trials.
Much of the research is macro-level analysis. Some reviews
,
deficiencies of regulations or policies (Shalala, 2000) (McCrary,
Anderson, Jakovljevic, Khan, McCullough, Wray et al.,
2000),(Amdur, 2000),(Moreno, Caplan, & Wolpe, 1998), others
provide an analytical framework for evaluating ethical factors in
clinical studies (Emanuel, Wendler, & Grady, 2000). Based on
such reviews, several reform proposals have been proposed
, ,
(Shalala, 2000) (Bodenheimer, 2000) (Moreno, Caplan, &
,
Wolpe, 1998) (Rennie & Yank, 1997). However, as emphasized
in the US National Bioethics Advisory Commission 2001 report,
few empirical studies address the significance of reform and
evidence-based policymaking. In addition, very little has been
done to study investigators' attitudes toward HRPP. Regulation
has been used as a tool in protecting human research
participants, but recent studies have shown that the role of
investigators or physicians’ attitude should not be overlooked
,
(Moreno & Lederer, 1996) (Anonymous, 1996). Povl Riis (Riis,
1995) pointed out that a scientist’s moral values and behaviors
is one important ethical demand.
While ethical issues surrounding human research have
been intensively researched and discussed among the
members of the international medical community in particular,
there remains a gap between medical advancements and the
protection of participants in human research in Taiwan. Before
the 1986 Medical Care Act (MCA), there was no official
protection of participants’ rights in clinical trials. This Act only
covers the trial studies of new drugs, new medical techniques or
new medical devices that involve human participants. In 1993,
the Department of Health (DOH) required a local clinical trial
report in order for a new drug to be registered. In 1996 DOH
developed Guidelines for Good Clinical Practice (GCP). Only in
2000, when the first drug clinical trial liability insurance policy
was approved by the Ministry of Finance’s Department of
Insurance, was a policy created to assure compensation for
research injuries as stated in the GCP.
The "Joint Institutional Review Board" (JIRB) was jointly
established in 1997 by five medical centers and the Cancer
Research Alliance. The JIRB was established with the intention
of facilitating trial research approval. The idea was that if a trial
were conducted in a hospital that participated in the JIRB, and
that trial was approved by the JIRB, then it would not be
necessary for the investigators to obtain the approval from the
hospital, itself. Otherwise, the investigators would need to obtain
approval from the hospital where the trial was to take place.
Only in 2000 did government-funded research require IRB
approval. At this time the DOH began to require IRB approval
with grant application. Because government-funded agencies
used the term “human experiment” in their grant application
announcements, these policies are only considered applicable
to clinical trials using human participants. Therefore, the
regulations and guidelines extend to other research only to the
extent that investigators or their institutions voluntarily follow
them.
With the increases in R & D in medical science and
technology, and with Taiwan’s 2002 accession to the WTO, the
government, IRBs, research institutes, universities, and
professional associations will be required to pay increasing
attention to human research participants protection. Since the
individual research investigator is an important key factor within
the HRPP system, the main objective of this study was to
survey the awareness and attitudes of physicians regarding the
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
protection of participants in human research. By assessing
these measures, the behavioral factors that might influence the
prospect for successful implementation of a HRPP policy can be
identified.
Methods
Participants
A total of 2,425 physicians were surveyed between
September 2000 and January 2001. Because Taiwan’s MCA
specifies that only teaching hospitals are permitted to conduct
human experiments, according to the hospital accreditation
report in 1999 only 12 hospitals were eligible. Of those, 11 were
willing to participate in our survey. The participants of this study
were physicians who had worked in these medical centers or
medical school hospitals since at least 2000. Because new staff
members are normally not familiar with institutional policy, this
study excluded the residents who self-reported that they had
worked for less than one year in a medical setting.
Instrument
A self-administered anonymous questionnaire was
designed to measure a physician’s awareness, attitudes,
subjective norms and intention to comply with HRPP
requirements. In order to assure reliability and validity of the
measurement instruments, the original questionnaire was then
administered to two pilot groups from June to August 2000 in
Taipei Medical University – Municipal Wan Fang Hospital.
Five domains were assessed in the final questionnaire and
used in this study, including socio-demographic data,
awareness, attitudes, subjective norms, and intentions. The
socio-demographic variables consisted of age, gender,
education, medical specialty, current job position, medical ethics
courses taken, and research and ethics review experience.
There were 6 items on HRPP awareness. Data for these
items were collected on a 3-point semantic-differential scale, i.e.
“never heard of it”, “heard of it but not familiar”, and “heard of it
and familiar.”
A total of 8 items, rated on a 7-point scale, were generated
to assess physicians’ attitudes toward HRPP. Each physician
rated the importance of these 4 items: participants’ risk and
research benefit; obtaining informed consent; fairness in
selecting research participants; submission of proposal to an
IRB. For each one they also rated the importance of the legal or
moral consequences of not considering these four items. The
attitude score was generated by the sum of the multiplication of
each belief and corresponding evaluation item (Ajzen &
Fishbein, 1980).
Subjective norm scores were also rated on a 7-point scale,
coded -3 to 3. Physicians rated their normative beliefs about
how much importance their colleagues or peers gave to having
a research proposal go through the IRB review process. Then
they were asked their own attitude toward these actions of their
peers. Questions about whether their colleagues or peers
would inform hospitals or patients before conducting research
had choices also coded from 1 to 7. The subjective norm score
was then calculated by summing up the products of normative
belief and motivation to comply and the scores of further
questions asked for each person.
Physicians’ intention regarding HRPP was also measured
on a 7-point scale. It was determined by asking, “Before
conducting a study in the future, how likely would it be for you to
have the research project reviewed by the (J) IRB or the Ethics
Review Committee (ERC)?” and “Before conducting a study in
the future, how likely is it that you would obtain the informed
consent of the patients or participants in advance?”
Because of the limited effect of MCA on HRPP, physician
responses to attitudes, subjective norms and intention may vary
depending on the kind of study. Therefore, the study questions
were divided into four kinds of research: (1) intervention study –
regulated by Taiwan MCA; (2) intervention study – not regulated
by MCA; (3) interaction study – observation; and, (4) interaction
study – survey.
43
Procedure
An official letter was sent to each hospital before
conducting the survey to solicit the hospital’s support. A one-day
training program was held in each hospital so that each of the
126 nurses or administrative staff serving as the facilitators
could go through the process of obtaining informed consent
from physicians, distributing questionnaires and collecting
responses. Administration of the questionnaires was smooth.
This research was approved by the JIRB in October 2000.
Statistical Analysis
Statistical analysis was performed using SAS software.
Univariate analyses were performed on each variable.
Cronbach α coefficients were calculated to determine the
internal consistency of the measures. Two tailed t-tests were
applied to test whether, after multiple comparison adjustment,
the physicians’ attitudes, subjective norms, and intention
differed at a 5% level between intervention and interaction
studies. Multiple regression analysis was used to test the
independent associations of awareness, attitudes, and subject
norms with participants’ intention of complying with the IRB and
obtaining informed consent.
Results
Characteristics of Participants
Surveys were distributed to 2,425 physicians between
September 2000 and January 2001. There was an 81%
response rate.
Major descriptive statistics of responding physicians are
given (Table 1). Participating physicians had a mean age of
36.5 years and 86% (2,086) were male. Sixteen percent of
them held advanced research degrees (MS or PhD), and 52%
were attending physicians. Twenty-five of the physicians had
experience conducting research in other countries, and 4.5%
had experience in ethics review. Most physicians had taken
medical ethics courses that were elective or required by their
schools. Of those who met our inclusion criteria mentioned
above, 81% could be contacted.
Except for measures of awareness and subjective norms,
Cronbach α coefficients were calculated for all four research
studies. Four measures had a high internal consistency (Table
2).
Physician Awareness of HRPP-related Information
Over 90% of physicians were unfamiliar with international
ethics codes or standards (Table 3). JIRB was the most familiar
term, perhaps because it is the domestic review board for
human experiments. Over 90% of physicians, however, were
unaware of its existence. The Belmont report was the least
familiar of the terms, at only 0.9%.
Physicians who had been IRB members or were active IRB
members in 2000 were found to be significantly more aware of
international ethics codes or standards, though 60% of this
group were not familiar with any of the international ethics codes
or standards asked.
44 Eubios Journal of Asian and International Bioethics 14 (March 2004)

Table 1: Characteristics of physicians in 11 medical school hospitals / medical centers (MSH/MCs) in Taiwan
Characteristic n %
N 2,425
Specialty
Primary care or internal medicine 1,036 42.7
Surgery 528 21.8
Psychiatry 56 2.3
Others 663 27.3
Dental 142 5.9
Gender
Female 339 14.0
Male 2,086 86.0
Education Degree
Bachelor’s 2,022 83.6
Masters Degree 216 8.9
Ph.D. 181 7.5
Current position
Resident physician 769 31.7
Chief resident physician 406 16.7
Attending physician 880 36.3
Vice superintendent or superintendent 28 1.1
Head of the department 292 12.0
Other 50 2.1
Experience in research abroad 596 24.9
Medical ethics courses taken (mandatory or compulsory) 1,833 75.6
IRB member (previous and inactive) 108 4.5

Table 2: Internal consistencies of physicians’ attitudes, intentions and subjective norms

No. of items Cronbach Alpha

Variables
Behavioral intention 2 0.73a 0.77b 0.82c 0.80d
Awareness 6 0.82o - - -
a
Behavioral attitude 8 0.74 0.76 b 0.79 c 0.78 d
Subjective norm 4 0.71 b 0.75 c 0.58 d -
a: Intervention Study - Regulated by Medical Care Act
b: Intervention Study - Not regulated by Medical Care Act
c: Interaction Study - Observation
d: Interaction Study- Survey
o: Overall
-:Indicates not applicable

Table 3: Physicians’ awareness of Human Research Participant Protection (HRPP) information

All Physicians IRB Member

*
Never Yes p-value
Awareness of HRPP Heard of it and familiar n (%)
Joint Institutional Review Boards 239 (9.9) 175 (7.6) 64 (61.0) <0.01
IRB 144 (6.0) 105 (4.6) 39 (37.1) <0.01
Nuremberg Code 43 (1.8) 32 (1.4) 11 (10.5) <0.01
Belmont Report 21 (0.9) 14 (0.6) 7 (6.7) <0.01
Declaration of Helsinki 151 (6.3) 113 (4.9) 37 (35.2) <0.01
Uniform Requirement for 213 (8.8) 171 (7.4) 42 (40.0) <0.01
Manuscripts Submitted to
Biomedical Journals
*:Chi-square test
 Eubios Journal of Asian and International Bioethics 14 (March 2004) 45

Table 4: Physicians’ attitudes, subjective norms and intentions regarding human subject protections
(Percentage of physicians who think the statements on the left are important, agree or serious) n (% of those who answered)

Items
Behavioral Attitudes Intervention Interaction
Behavioral beliefs A B C D
When conducting studies of the types listed on the right, we should 2,322 (97.4) 2,147 (90.3) 1,475 (62.1) 1,394 (58.6)
fully inform the patients or subjects (including interviewees) of the
study’s purposes and methods, the possible benefits of participating
in the study, and the potential risks and side effects induced by the
study.
When conducting studies of the types listed on the right, we should 2,335 (98.0) 2,170 (91.2) 1,506 (63.3) 1,500 (63.1)
obtain the informed consent of the patient or subject (including
interviewees) or his (her) guardian in advance.
When conducting studies of the types listed on the right, the 2,055 (87.0) 1,995 (84.6) 1,812 (76.9) 1,772 (75.2)
subjects shouldn’t be involved in research solely for administration
convenience, or because they are easy to manipulate as a result of
their illness or socioeconomic condition.
The draft plans of studies of the types listed on the right must be 2,205 (93.1) 1,855 (78.5) 1,005 (42.6) 851 (36.1)
reviewed and approved by the (Joint) Institutional Review Board or
Ethical Review Committee in advance.
Evaluation of behavioral outcome
When conducting studies involving human subjects of the types 2,255 (94.7) 2,221 (93.3) 1,965 (82.7) 1,896 (79.8)
listed on the right, do you think it very important that researchers
should end a study immediately if it is found that the study has
adverse effects (e.g., infringement of privacy or side effects) on the
patients or human subjects (including interviewees)?
When conducting studies involving human subjects of the types 2,271 (95.3) 2,120 (89.0) 1,344 (56.6) 1,226 (51.6)
listed on the right, do you think that not obtaining informed consent
from subjects (including interviewees) will have serious
consequences?
Do you think it very important to assess carefully the risk and the 2,077 (88.1) 2,048 (87.0) 1,783 (75.7) 1,705 (72.5)
expected benefits before selecting subjects (including interviewees)
such as children, indigenous people, patients without behavioral
self-consciousness and those with mental retardation?
Making informed consent of the patients or subjects (including 988 (41.6) 1,009 (42.6) 1,119 (47.2) 1,115 (47.1)
interviewees) a prerequisite will complicate the administration
process and deter the study.
The procedure of review by the (Joint) Institutional Review Board or 511 (21.7) 572 (24.3) 749 (31.8) 767 (32.6)
Ethical Review Committee in advance of studies of the types listed
on the right will deter a study’s smooth progress!
Subjective norms
Normative belief
Do your colleagues or friends think it important to have the (Joint) - 362 (74.9) 162 (33.0) 93 (23.2)
Institutional Review Board or Ethical Review Committee review
studies?
Motivation to comply
If your colleagues or friends think it important to have the (Joint) - 279 (84.3) 117 (80.1) 69 (77.5)
Institutional Review Board or Ethical Review Committee review
studies, do you agree with them?
According to your estimate, will they inform the patients before - 364 (69.6) 289 (52.2) 290 (65.2)
conducting studies?
According to your estimate, will they inform the hospital before - 280 (51.6) 254 (46.5) 192 (44.3)
conducting studies?
Behavioral Intention
Before conducting a study in the future, how likely would it be for 2,198 (93.3) 1,972 (83.8) 1,190 (50.7) 1,080 (46.0)
you to have the research project reviewed by the (Joint) Institutional
Review Board (IRB) or the Ethics Review Committee (ERC)?
Before conducting a study in the future, how likely would you obtain 2,286 (96.4) 2,135 (90.2) 1,438 (60.7) 1,355 (57.3)
the informed consent of the patients or subjects in advance?
a: Intervention Study - Regulated by Medical Care Act
b: Intervention Study - Not regulated by Medical Care Act
c: Interaction Study - Observation
d: Interaction Study- Survey
-: Indicates not applicable
46 Eubios Journal of Asian and International Bioethics 14 (March 2004)

Table 5: Physicians’ intention, attitude and subjective norms toward HRPP

Intervention Interaction
a b c d a: Intervention Study - Regulated by Medical Care Act
b: Intervention Study - Not regulated by Medical Care Act
(Mean ± S.D.)
c: Interaction Study - Observation
Specified by research type
d: Interaction Study- Survey
Behavioral Intention (Range from 1 to 7)
-: Indicates not applicable
IRB 6.5 ± 1.0 6.0 ± 1.3 4.7 ± 1.8 4.5 ± 1.9
Informed consent 6.6 ± 0.8 6.2 ± 1.2 5.1 ± 1.8 5.0 ± 1.8
(n) (2,385) (2,382) (2,380) (2,382)

Behavioral Attitude (Range from 1 to 49)

At-score 40.2 ± 7.3 36.4 ± 8.9 27.0 ± 10.6 26.1 ± 10.7
(n) (2,385) (2,382) (2,380) (2,382)

Subjective Norm (Range from –2.3 to 7.6)

Sn-score - 4.5 ± 1.9 3.2 ± 2.1 3.1 ± 2.0
(n) (568) (569) (459)

Non-specified by research type

Awareness of HRPP (Range from 1 to 3)
Aw-score 1.5 ± 0.4
(n) (2,416)

Table 6: Predicting physicians’ behavioral intention by awareness, attitude, subjective norm.

Intervention study Interaction study
Regulated by MCA NOT regulated by MCA Observation Survey
β S.E. β S.E. β S.E. β S.E.
Intent to submit proposals to IRB
Gender 0.033 0.048 0.165 0.145 0.134 0.174 0.093 0.204
Experience in abroad 0.127** 0.042 0.037 0.102 -0.089 0.127 -0.045 0.154
Behavioral Attitude 0.069** 0.002 0.077** 0.005 0.101** 0.006 0.100** 0.007
Awareness 0.206** 0.045 0.103 0.107 0.121 0.139 0.167 0.164
Subjective norm - - 0.086** 0.026 0.172** 0.030 0.122** 0.038
R2 0.30 0.38 0.48 0.40
Intent to obtain informed consent
Gender 0.081 0.042 0.085 0.128 0.164 0.163 0.133 0.192
Experience in abroad 0.012 0.037 -0.104 0.090 -0.178 0.119 0.039 0.145
Behavioral Attitude 0.059** 0.002 0.079** 0.005 0.114** 0.006 0.108** 0.007
Awareness 0.039 0.039 0.005 0.095 0.015 0.130 -0.089 0.155
Subjective norm - - 0.047* 0.023 0.128** 0.028 0.097** 0.036
2
R 0.28 0.41 0.54 0.45
MCA denotes Medical Care Act * : p<0.05 **: p<0.0 -: Indicates not applicable
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
Attitude and Subjective Norms
Attitude
Survey responses to the main descriptive results for
attitude, subjective norms, and intention of physicians toward
HRPP in the four kinds of research are summarized in Table 4.
Our findings show that over 78.5% of physicians had strong
belief in the importance of HRPP in intervention studies in all
four items of behavioral belief. However, over 20% of physicians
saw no importance in IRB reviews for intervention studies
unregulated by the MCA. Physicians’ beliefs about HRPP
review for interaction studies showed that almost 60% agreed
with requirements to inform research participants, obtain
informed consent, and fairly select research participants.
However, just over 40% regarded IRB review as important for
interaction studies. In addition, physicians tended to consider
the careful selection of patients to be more important than the
fully informing research participants, obtaining their informed
consent or submitting a proposal for IRB review.
Results from evaluating behavioral outcome of intervention
studies, showed that more than 93% of physicians considered it
important to end an intervention study immediately when
adverse effects occurred. For those intervention studies
regulated by the MCA, over 95% of physicians considered that
the consequence would be serious if they did not obtain
research participants’ consent. A smaller percentage, about
89% of physicians, considered this also to be true for
intervention studies not regulated by the MCA. More than 72%
considered it very important to assess both expected risks and
benefits before selecting subjects. Some negative reaction was
shown toward the need for IRB review and informed consent of
the patients as a prerequisite to gaining permission. Physicians’
attitudes toward HRPP also varied between intervention and
interaction studies, and these variations were larger with regard
to interaction studies than to intervention studies.
Subjective Norms
Physicians were asked about their subjective norms
regarding HRPP for the 3 studies other than intervention studies
regulated by the MCA. Results of analysis of subjective norms
are given (Table 4).
About 75% of physicians reported that their colleagues or
peers who were currently conducting intervention research not
regulated by the MCA had submitted their proposal for IRB
review before beginning the studies. Furthermore, 84% of
physicians reported that they agreed with this behaviors in
others. Only a very small percentage reported that their
colleagues or peers submitted observational research
proposals. A much smaller percentage reported that their
associates submitted survey research proposals. Almost 70%
of the physicians reported that their colleagues or peers would
inform the participants before conducting intervention studies
not regulated by MCA, 52% would do so before conducting
observational studies, and 65% would do so before conducting
survey studies.
In addition, about 52% of physicians reported that their
colleagues or peers would inform their hospitals when
conducting intervention studies not regulated by MCA, less than
47% would do so when conducting observational studies, and
44% would do so when conducting survey studies.
Regression Results
Means and standard deviations are given for each measure
(Table 5). According to the regression results (Table 6),
physicians’ attitudes were highly associated with their intention
to submit proposals for IRB review and obtain informed consent
from research participants, while their awareness was not
statistically correlated to intention except for regulated
interventional studies.
For research regulated by the MCA, experience in
conducting research abroad was significantly associated with
the intention to submit a proposal for IRB review. For other
47
research not regulated by the MCA, subjective norms were
significantly associated with physicians’ intention.
Discussion and Conclusion
Our study reveals that physicians in Taiwan are largely
unaware of research ethics and HRPP. Although current or
previous IRB members showed the highest level of awareness,
the low scores (Table 5) suggest a strong need for improved
education, particularly HRPP, either in medical school itself or
as continuing education.
In addition, physicians’ behavioral attitudes toward HRPP
varied among the 4 kinds of studies. A greater number of
physicians showed positive attitudes toward the need for HRPP
in intervention studies than they did toward interaction studies.
This difference could be attributed to the nature of research
physicians who were experienced with or currently involved in
such studies. The possible harm caused by social and
behavioral research was generally underestimated, and very
little importance was given to privacy or confidentiality issues.
Our study also showed that a larger variation existed in opinions
about the need for HRPP in interaction studies than opinions on
intervention studies. These results support a needs analysis
done by the National Bioethics Advisory Commission in 2001.
They recommended that research participant protection should
be flexible enough to be applied to widely different research
settings ( National Bioethics Advisory Commission, 2001).
Regression analysis results indicate that for MCA-regulated
research, other factors such as experience abroad, awareness
and attitudes affected physicians’ intention to submit their
research proposal for an IRB review. Despite legislation
governing human research, few physicians appear to
understand how the laws apply (Chief Medical Officer of
Department of Health and Department for Education and
Employment Home Office, 2001). This may explain compliance
problems, which still exist even in regulated research
environments such as the United States. Therefore, regulations
may not be sufficient in and of themselves to improve the HRPP
system in Taiwan.
Our study also showed that a small proportion of physicians
reported that the IRB system would deter research
development. Most respondents had positive attitudes toward
questions regarding analysis of risk benefit ratio, the informed
consent requirement, and fairness in selecting of research
participants, while some physicians seemed to have negative
reaction to the need for IRB review. These findings may have
been due to the lack of understanding or knowledge of the main
functions of the IRB by physicians. In addition, some physicians
might have encountered previous difficulty in dealing with IRB
submission, or have thought that the IRB system might
complicate the process of research and development. These
explanations suggest that excessive oversight may encourage
disdain among researchers, as well as create an impossible or
pointless workload for the ethics review committee. However, in
order to determine the validity of these speculations it will be
necessary to carry out research to address these new
questions. Some question whether requiring informed consent
would deter research because of the increased administrative
load. There is still no evidence on specific difficulties the
researcher may face, nor on additional costs for the research.
Since the concepts of informed consent and IRB originated
in western countries, their applicability to Taiwan or other Asian
countries continues to be highly-debated. In Taiwan, there is a
traditional reluctance to sign documents. In itself this should not
be sufficient justification to avoid informing participants.
Although written documents can in some circumstances be
extremely important, the process of mutual communication may
in fact be more important. Taiwan needs more education and
information dissemination not only for researchers and IRB
members but also for laypersons so that they can gain better
understanding of the meaning of participating in human
research and will not be afraid to communicate with researchers
or sign papers when necessary.
48 Eubios Journal of Asian and International Bioethics 14 (March 2004)
Our regression model demonstrated that physicians’
attitude was a major determinant influencing their intentions
toward HRPP. Currently, except for research covered in the
MCA, all research is unregulated. In this environment physicians
may be most influenced by their colleagues and peers.
Therefore, it is essential to promote HRPP in other types of
research not regulated by the MCA. Due to lack of evidence of
the effectiveness of regulatory HRPP policies and the long
process of establishing such a regulation, other strategies such
as creating a supportive environment and strengthening
institutions’ action in order to influence physicians’ attitudes in
general, might serve as adjuncts to HRPP reform in Taiwan.
Some limitations were inherent in our study. First, not all
physicians who met our inclusion criteria were included in our
study sample. Second, most of the measures of awareness in
our study were based on international ethics codes or standards
because Taiwan has based its development of related concepts
on western literature. This may have resulted in some bias in
measures of physicians’ awareness, but we expect that these
biases are very small. This also elicits the question of whether
western guidelines are suitable for Taiwan or other Asian
countries.
Acknowledgement
The research on which this paper is based was supported
by a National Health Research Institutes intramural grant (Grant
Number: 89A1MP). We acknowledge the support from the
CEOs of 11 medical centers or medical school hospitals as well
as their nurses or staffs for performing an excellent job of
administering the questionnaires.
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Artificial Insemination and
happiness
- Yali Cong, Ph.D.
Associate professor of medical ethics,
Department of Medical Ethics, Peking University Health Science
Center, 38 Xueyuan Rd. Bejing, 100083, China
Email: ethics@bjmu.edu.cn
Abstract
Based on a case that happened in 2001 in China, the
author wants to show the ethical and legal issues arising from a
woman’s wish, which should be her basic right to have a child
by assisted reproduction technology. This paper attempts to
analyse if there is some relationship between bioethics and
happiness, and to find if there is some reason that bioethics
should provide help for those whoever need it. The case is
about a woman whose husband was sentenced to death, she
applied to court to allow her to have a child for her husband by
artificial insemination of her husband. The conclusion of paper is
that there is no direct relationship between bioethics and
happiness, virtue and vice of bioethics not only depends on its
moral background, but also the legal system, social psychology
and other social circumstances.
In May 2001, Mrs. Zheng’s husband was put into prison for
murder. In August 2001, her husband was sentenced with the
death penalty. Mrs. Zheng wanted to have a child for her
husband and let the child to live with her parents-in-law, so she
applied to Zhoushan Middle Court, but her request was rejected.
Then she applied to the High Court of Zhejiang Province. Many
people paid attention to the case, but unfortunately, the court
took a passive tone, didn’t answer directly and Mrs. Zheng’s
wish came to nothing with the execution of her husband in
January, 2002. Before the execution, the question of whether
Zheng’s wish should be met was a hot discussion topic around
China.
The common idea of the society
It is no doubt that many people who considered the case
support Mrs. Zheng, even though there is no detailed data from
a large scale questionnaire. In a class of medical students,
among the 20 students, 3 were against Mrs. Zheng’s request,
including one who held sympathy in morality; while 17 students
supported Mrs. Zheng. In another 47 student class, 26 were for
and 21 against.
The main reason for support is that it is Mrs. Zheng and her
husband’s right. The main reason against is from the viewpoint
of the child’s growth, which they think it is not good to the child.
And there is another reason, misunderstanding maybe: now that
her husband’s right of life is deprived, let alone other rights. I
found that with the raising of grade of the students, the number
of persons against also rose.
The emerging of the issue related with the development of
biomedical technology
The issue of “whether the death row criminal ” has a right to
have a child is related to the development of biomedical
technology. Before, people couldn’t raise such a question or had
such request because there is no possibility for a death row
criminal to have a child due to the punishment of depriving of
freedom, and many rights, such as having a child, are mainly
based on the freedom. But now, artificial insemination provides
the possibility to have a child without violating the jail regulation,
even if the criminal does not has freedom.
Now the issue is: now that we have the technology, should
we use it? Just like the dream we want to fly before, but now we
have plane, and can use it to make our dream come true.
However, we also discuss human cloning, which we shouldn’t
do even if we have the technology and can do it. So this maybe
a similar situation.
The current legal views of China
Issue 1: Whether the death row criminal has the right to have a
child?
Some people said it is a blank field, because there is no
direct and clear declaration in current law. But more people
 Eubios Journal of Asian and International Bioethics 14 (March 2004) 49

opposed it, and they said: only if there is no clause in current

law to show objection, that means it is allowed. In the current
Criminal Law of China, there is no clause to mention the right to
have a child is deprived, so it means Mrs. Zheng’s husband has
the right. But people can easily raise a question that if the
criminal is a woman, such a request will violate the other law
(e.g. if the woman is pregnant, she will not be executed. But she
would be given the death penalty if not pregnant), so this raises
another question, and not the same issue.
The problem is that the request of artificial insemination
was made by Mrs. Zheng, and there is no doubt Mrs. Zheng’s
request is reasonable, and moreover the behavior of taking the
sperm of her husband will not violate the current regulation for
the jail management.
Issue 2: Now that the criminal has such a right, can this right be
realized?
This means the right and its realization are not the same
thing, moreover, respecting the right and supporting the right to
realization are also different. The latter relates to the individual’s
happiness to much extent.
In the discussion, some experts said the realization of such
right is difficult, because the doctor is not allowed to go into the
jail, let alone to take the sperm. Also, the judge will not support
Mrs. Zheng’s request so easily because the worrying about the
possible effects to society that more family members raise such
request and it will produce a bad effect to the children. In fact, it
is true in the field of law, many judges will take a passive way to
avoid any answer and let such request “die” naturally.
But many people argue that the judge should support Mrs.
Zheng’s request and which will show society the progress of law
in China, and they mentioned that not so many wives would like
to have a child for her criminal husband like Mrs. Zheng, so the
worrying is not necessary.
So, the situation is subtle: if the judge does not support
Mrs. Zheng’s request , it does not mean it is illegal; but if the
judge does support Mrs. Zheng’s request, it is perfect and it is
also legal.
The real psychology----the reflection of two different
traditions
Psychology argument 1: To have a child and continue the
generation for the big family is a strong tradition.
We have a words in China: among the three unfilial pieties,
having no child is the worst. The original aim of Mrs. Zheng’s
request was just such an idea, she hoped the child could be a
comfort to grandparents.
Biomedical technology and happiness
Happiness is pursed by everyone, it is not only a subjective
feeling, but connected closely with culture and its values in each
special region. In China, the whole and harmonious family, the
health and progress of child, and individual development are all
necessary factors in the formulation of happiness.
Whose happiness is also a question. Some people think that
if their own rights are realized it is happiness, some people think
if they give up their rights and can obtain other people (including
children, parents, other family members, and so on)’s interest in
return, that is happiness.
Due to the fact of under development of the legal system, the
judges are facing and will face many problems which will not be
clear in current laws or regulations. Under such circumstances,
the moral sense and level of judges will play an important role in
decision making, which will relate to the client’s happiness. In
China, many court cases show a special phenomenon, that is
the color of “personal rule” behind the rule by law. It also shows
a connection between law and politics, and the idea of some
important governors will produce fundamental effect to the
outcome of judge. The situation of an undeveloped legal
system, the psychology to avoid potential problems and
relatively lower professional morality level, all these can explain
the result of the balance of two tradition and the fate of this
case.
In fact, many people know this result at an advanced stage,
that is Mrs. Zheng’s request comes to nothing. To many
people, they can just understand the result, but they also think
it is imperfect, because it is not active to protect the reasonable
right of clients, and the most important is that such protection
does not harm social interest at all and does not violate the
current regulation.
The conclusion of paper is that there is no direct relationship
between biomedical technology and happiness, virtues and
vices of bioethics not only depend on its moral background, but
also legal system, social psychology and other social
circumstances. Usually, people have to not only think whether
we should support the client’s request, but also should balance
the possible outcomes of providing support.
P.S. Some kind people once gave a suggestion: to ask Mrs.
Zheng’s husband to donate sperm to sperm bank.

Psychology argument 2: Relationship, not the individual’s right,

is the most important in current China.
The child holds very important status in the family and
society. For example, if something is good to parents but not
good to child, the common value in China is to work for the
interest of child and give up the parents’ interest. The most
important reason for those people who don’t agree to support
Mrs. Zheng’s request, not because she and her husband don’t
have right, but because this is not good for her child’s growth.
For example this child will be brought up in a single-parent-
family, the child maybe has to bear the discrimination from
others, and there is financial difficulty for family, all these will
produce bad affects to the child’s psychology. Till now, China
has not developed a common value to think about the unclear
interest of potential child or fetus, and will easily justify his
behavior of supporting the interests of persons who already
exists here, but not concern much the interest of a person who
has not existed.
Of course some people argued that this is not an absolute
factor, which will be avoided by better education and shouldn’t
be regarded as a factor for legal judgment. On the contrary, the
right of parents is clear, and should be supported.
Even the two traditions co-exist now, which one can win
depends on the values of the field of law and the judgers.
50 Eubios Journal of Asian and International Bioethics 14 (March 2004)
Ethics in Domestic Violence
Research
- Omur Elcioglu PhD,
Osmangazi University, Faculty of Medicine, Department of
Medical Ethics and History of Medicine, Eskisehir, TURKEY
- Oztan Oncel PhD,
Istanbul University, Faculty of Medicine, Department of Medical
Ethics and History of Medicine, Istanbul, TURKEY
- Ilhami Unluoglu MD.,
Osmangazi University, Faculty of Medicine, Department of
Family Physician, Eskisehir, TURKEY
Corresponding Author: Omur ELCIOGLU
Email: elcioglu@ogu.edu.tr
Abstract
Domestic violence is a multi-faceted problem and its victims
are women from all social classes and positions. Studies
involving domestic violence have been carried out by
investigators in various disciplines, including medicine,
psychology and social science. In this paper we discuss the
ethical responsibilities of investigators who are concerned with
the health aspects of domestic violence.
The physical safety of respondents and interviewer from
potential retaliatory violence by the abuser is of prime
importance. At the same time the women, as the subject and
beneficiary of the research, need to give full informed consent
and ensure that the interview process is affirming and does not
cause distress. It is important that research findings are fed into
ongoing advocacy policy making and intervention activities.
Physicians have a crucial role in health care system’s
response to domestic violence. It is not the physicians’
responsibility to solve the problem of domestic violence. It is all
of our responsibility. Whatever the form of a study there are
certain basic ethical principles (respect for people, non-
maleficence, beneficence and justice) that investigators should
follow.
Key words: Domestic Violence, Investigators, Ethical
responsibility
Introduction
Domestic violence is a complex problem. Studies involving
domestic violence have been carried out by investigators in
various disciplines, including medicine, psychology and social
sciences. Some studies are concerned with records of prior
events and their assessment in retrospect. Some studies
involve face-to-face interviews with actual victims, using a
prepared set of questions. Whatever the form of study, there are
certain basic ethical principles that investigators should follow.
In 1991, the Council for International Organizations of Medical
Sciences (CIOMS)developed a set of International Guidelines
for the ethical review of Epidemiological studies. These
guidelines out line the basic ethical principles of epidemiological
research involving people: Respect for individuals, non-
maleficence (minimising harm), beneficence (maximising
benefit) and justice (Ellsberg &Heise, 2002:1599-1604).
Family violence has a ripple effect. Those who experience it
and those who wittness it suffer physical and emotional injuries.
Those who perpetrate it also wound themselves. Violence
damages family and other relationship, often permanently.
Clinicians often struggle when trying to address domestic
violence. They may not know what to say or do. They may nor
find it traumatic to listen to a patient reports. Some have trouble
empathizing with the victim’s helplessness (Lamberg, 2000:554-
556).
It is noteworthy that there have been many works on direct
violence, pointing out the seriousness of the situation many
women find themselves in around the world (Katherine &
Little,2000:135-141; Minow, 1999:1927-1929; Eyler & Cohen,
1999:2569-2576). In this paper we discuss ethical
responsibilities of investigators who are concerned with the
health aspects of domestic violence.
Ethical Concerns in Research on Violence Against Women
WHO have published guidelines for addressing Ethical and
Safety Recommendations for Research on Domestic Violence
Against Women (WHO,1999). Research on violence against
women, however, raises important ethical and methodological
challenges. Researching abuse is not like other areas of
investigation –The nature of the topic means that issues of
safety, confidentiality and interviewer skills and training are even
more important than in many other forms of research. It is not
an exaggeration to say that the physical safety and mental
wellbeing of both the respondents and the research team can
be put in jeopardy if adequate precautions are not taken.
In order to guide future research in this area, WHO has
developed the following recommendations regarding the ethical
conduct of domestic violence research that build on the
collective experience of the International Researchers Network
on Violence Against Women (IRNAW).
Potential to inadvertently cause distress
The main ethical concern related to researching violence
against women is the potential to inadvertently cause distress
(Ellsberg & Heise, 2002:1599-1604). New and rapid
developments in science and technology create new ethical
problems. When scientific studies are carried out on human
beings, scientific ethics may clash with medical ethics. The
attitude and the conduct of a scientist towards fellow scientists
and towards individuals involved in his/her study constitute the
subject of the scientific ethics (Özgür,1995:53-58). Scientific
ethics are clearly of wider scope than medical ethics, since in
addition to diagnostic and therapeutic trials, some scientific
studies attempt to perform experiments on human beings.
These experiments are valuable for discovering the causes of
domestic violence and for developing public policy to prevent it.
During an experiment, extremely confidential information may
be collected about participants. The use and dissemination of
this information requires special sensitivity to the circumstances
of the victims.
Minimising risk to respondents
The WHO guidelines provide recommendation for minimising
risk to respondents. It is well-known that female victims may feel
deeply ashamed, experience extreme generalized fear, and be
filled with anxiety that they will be victimized again. Some
victims sufficiently overcome their fears to volunteer for medical
and scientific investigations. Even when they are paid for their
participation, their coming forward is basically an altruistic act to
help others. The first ethical responsibility of investigators
(Aydın;2001) is therefore the protection of these volunteers.
Location and Time of Investigations
A medical or scientific study generally has a specific goal to
attain. The choice of a goal is normally determined by the
resources available to investigators. The study may target an
institution or a particular geographic area. These targets may be
chosen because of the prevalence of the problem in the
institution or among inhabitants of the area, or the target may be
chosen simply because of the expectation that the execution of
the study will be easy. In any case, in planning the study,
investigators must devote a portion of their resources to taking
care of the special needs of participants of the study
(Tezcan,1992;Aksakogu,2001).
In domestic violence studies, investigators should be
particularly sensitive to the freedom of movement of women.
The location of the study should be chosen so that there exists
an extensive and accessible public transportation system for
participants of the study to come to interviews with investigators.
Women must be free to choose interview times, and this fact
must be impressed upon them at the very outset. Transportation
costs may put an unnecessary burden on women and therefore
should be paid from the funds available for the study. If travel
times are long and interviews come close to meal times, women
should also be paid for meals. These compensations should be
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
offered and methods of payment clearly explained during the
initial contact with participants of the study.
Voluntary Participation
The principle of respect for individuals incorporates two
fundamental ethical principles: respect for autonomy and
protection of vulnerable people. Because of the special nature
of domestic violence, investigators must avoid causing feelings
of inferiority, shame, or coercion in participants. Information
provided by the participant must be voluntary. The questions of
an investigator must be well-prepared. As much as possible the
investigator should avoid open-ended questions that may push
the participant into awkward silence. In the preparation of
questions, the investigator can use for guidance many published
reports of domestic violence studies.
Participants' Understanding Of The Study
Kant's second categorical imperative (Singer,1994;Oguz,1998)
states "So treat humanity whether in their own person or that of
another always as an end, never means only." This is the
foundational principle of medical ethics. When a victim of a
domestic violence comes to a medical facility, she expects that
the doctor and his/her staff will use all the skills and tools they
have to treat her wounds, to reduce her pain, and to restore her
health. She is an "end" for the doctor and his/her staff. When
the same victim volunteers for a scientific/medical study, her
situation changes. The study aims at goals that are independent
of her person. She becomes a "means." This may have
unintended consequences, both psychologically and physically.
Her health and well-being may become endangered. This is
morally unacceptable whatever the benefits of the study
(Jonsen,1989:205-208; WHO,1999). Indeed, the ethical rule
has been clearly stated in the Helsinki Declaration of the
Association of World Physicians: health and well-being of
patients must have priority over any scientific result or benefit.
One way to avoid or reduce such unintended consequences is
to promote the subject's understanding of the study. This
amounts to removing the psychological screen that one
normally erects between a professional and a layman. She
should be informed about the goal and the methods of the study
in detail. The investigator should discuss the nature of
questionnaires she will be expected to fill out and explain to her
how they relate to the scientific/ medical aim of the study. This
(Gerbert et al, 2000: 329-331) should not be done in an
authoritarian or intellectually overwhelming fashion but in a
manner that puts her psychologically on par with the
investigator. She must feel free to discuss with the investigator
any concerns she might have. She must also feel free to
withdraw from the study at any time if she thinks her interest is
not being well-served. It is the ethical responsibility of the
investigator to be attentive to the mood of the volunteer and
solicitous of reasons behind the mood (WHO,1999).
Tools
The basic tools in domestic violence studies are registration
forms, questionnaires, and polling forms. These tools must be
thoroughly tested during their preparation on control groups to
make sure that they do not negatively provoke the moral
sensibilities of participants. Investigators should not forget that
they are seeking and collecting information about events that
are unpleasant, about acts that are legally and socially
unacceptable, and about situations that are humiliating to the
participants of the studies. Questions intended to elicit
confessions are not the best method to gather accurate
information. In an interrogative atmosphere, a participant may
refuse to answer questions or give less than truthful answers.
This would defeat the purpose of a scientific study. A better
strategy is to prepare multiple scenarios and ask questions
about these scenarios. A participant is then put into the position
of an impartial observer offering honest opinions about
hypothetical situations. If it is needed, the participant's own
personal history can be constructed from these comments
WHO,1999).
It can happen that a participant volunteers sensitive
information. It is then best that investigators confine themselves
51
to factual questions, such as when the event took place, how it
started, etc. Elicited facts should be carefully recorded in as
much detail as is offered by the participant. This factual
orientation should generally be adopted in investigators' use of
language. Investigators (Malterud,1998:195-198) should avoid
using emotionally charged words or phrases, in particular the
word "violence", in the presence of the participant.
Because of the special nature of domestic violence, security
arrangements must be considered among the tools of a
scientific study. In individual domestic violence cases, the
potential exists for explosive events, which can endanger not
only participants but also investigators themselves. Sufficient
precautions and continuous security measures must be taken to
prevent such events. Experience indicates that, as a security
precaution, it is best to interview a female victim alone without
any other member of her household, if she lives in the
household in which the violence occurred (Collier, 1994:485;
WHO,1999).
Personnel and Training
For a scientific study, one generally gathers personnel
according to their technical abilities and trains them thoroughly
in goals and procedures. Investigators are then expected to
observe whatever they are supposed to observe in an alert but
intellectually and emotionally detached manner. This is not
sufficient in domestic violence studies. An investigator for such
a study cannot be as detached and non-interfering as, for
example, a biologist is when the latter observes the daily
struggle for survival among animal species. First, there are legal
requirements and moral obligations when one witnesses or
learns about actual crimes. The personnel of a study are
citizens of a country and members of a community. They cannot
abdicate their legal duties or tarnish their personal dignity and
reputation for the sake of a study. Second, domestic violence
events can be dramatic and sensational and are, therefore, daily
bread and butter for newspapers and television programs. A
negligent and callous misstep can result in publicity that could
greatly damage the reputation of the scientific community. Third,
no matter how neutral and abstract the scientific aims of a
domestic violence study are, the study's ultimate goal is to
modify certain social and cultural practices. Those who have a
stake in the perpetration of these practices will view the study as
a political attack on themselves and will counter-attack. Their
targets are likely to be the characters and reputations of the
investigators.
Clearly, the personnel in a domestic violence study ought to be
dedicated men and women who, either naturally or by training,
have special sensitivity to human beings. The personnel must
include people trained and available to offer first aid if a
participant of the study needs emergency medical treatment.
The personnel must include people trained to handle extreme
agitation so that they can provide comfort to a participant going
through an emotional tempest. Investigators must be informed
about the local health care system and have pre-arrangements
with professionals in it who will take care of the medical and
emotional emergency needs of a victim. They must also be
trained about police and court procedures and have pre-
arranged access to legal professionals so that they can guide a
participant through various bureaucracies. Finally, the personnel
must be thoroughly informed about governmental and non-
governmental organizations that provide aid, shelter, and child-
care to victims of domestic violence (WHO,1999; Ferris et
al.,1997:851-857).
Use and Confidentiality Of Data
The information collected during a study belongs to both
investigators and participants. How it will be used must
therefore be settled at the beginning of the study by mutual
consent. A consent form for the use of data, photographs, and
other images must be prepared and signed by a participant at
the initial interview. This consent form must be sufficiently
detailed so that future disputes may be avoided if a particular
participant withdraws from the study and requests the
suppression of the relevant data.
52 Eubios Journal of Asian and International Bioethics 14 (March 2004)
It is the ethical responsibility of investigators to preserve the
confidentiality of the data collected during a study.
Confidentiality is required both because of patients' rights and
for scientific reasons. At the outset of the study, a small group of
investigators must be designated as the principals who will have
access to the raw data. Computer files that contain raw data,
and rooms and cabinets that contain documents must be
secured (Thurstan et al..,1999:127-131). Participants' actual
names should never be used on questionnaires, polling forms,
or on various reports. Instead, codes must be developed to
identify individuals and events. Only coded and processed
information should be made available to investigators outside
the small designated group.
Concluding Remarks
As the discussed in this paper, the challenges facing domestic
violence researchers and advocates can be viewed in the
context of 3 important trends. First, the extraordinary rate of
change in social, political, and scientific understanding of
domestic violence during the past decade means that the
definition of the problem-and definition of success- is continually
changing. Second, each component of an interdisciplinary
approach- domestic violence as a health problem, a legal
problem, and a social change problem-contributes relatively
unique definitions and measures of what it means to be
successful. Third, in each arena-health, justice, and social
change- researchers and practitioners are separated by wide
gaps in experience, professional authority and goals.
Interdisciplinary methods can narrow these gaps, reminding us
that outcome measures in domestic violence need to address
the status of health, justice and human rights in our
communities (Flitcraft,1997:1400-1401).
We must remember that women living with violence are
already at risk. Researchers cannot eliminate this reality, just as
they cannot fully eliminate the possibility that further harm will
be caused by their study. They do, however, have an obligation
to carefully weigh the risk and benefits of any study, and to take
every precaution possible to restrict possible harm and
maximise possible benefits (Ellsberg &Heis,2002:1599-1604).
Universal screening, identifying risk factors,validating patients,
and documenting abuse will help prevent further abuse. We are
all responsible for solving the problem of domestic violence .
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Yöntemleri.(Research Techniques and Analysis Methods). Dokuz
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Aydın,E (2001), Tıp Etiğine Giriş (Introduction to medical ethics)Pegem
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Collier,J(1994), Patient rights,The Lancet 343: 485.
Ellsberg, M and Haise,L(2000), Bearing Witness:Ethics in domestic
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Ferris,E.l.,Norton,P.G.;et al(1997),Guidelines for managing domestic
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Flitcraft,A(1997), Learning from paradoxes of domestic violenceJAMA
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Gerbert,B.,Moe,J.,Carpers,N,et al. (2000), Simplifying physicians’
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Lamberg L(2000), Domestic violence : What to ask,What to do JAMA
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suggested by Umea researchers:Qualitative research and feminist
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Minow,M.(1999),Violence against women – A challenge to supreme
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recommendations for research on domestic violence against
women.WHO/ EIP/GPE/99.2.
Clinical Ethics Discussion 4:
Urgent “lifesaving” clinical
research
- Atsushi Asai, MD, MBioeth., PhD.,
Associate Professor, Department of Biomedical Ethics, School
of Public Health, Kyoto University Graduate School of Medicine,
Konoe-cho, Yoshida, Sakyo-ku, Kyoto 606-8501, Japan
- Koichiro Itai, MA,
Assistant Professor, Department of Philosophy and Ethics,
School of Medicine, Miyazaki Medical College, Miyazaki, Japan
Correspondence address: Atsushi Asai, MD,
Email: aasai@pbh.med.kyoto-u.ac.jp
Abstract
No matter how far medicine advances, incurable disease
will inevitably exist; and the dying patient’s last resort will
likewise look to medical research. In this report, we examine a
case concerning the use of experimental medical therapy on a
critically ill child. We discuss the ethical argument pertaining to
the recommending of experimental medical therapy to the family
of a dying patient.
Under the circumstances of having to face the impending
death of one’s own child, parents of a terminally ill child are
extremely vulnerable to suggestion and often loose the ability to
make a composed decision. Moreover, there exists the
possibility of not only patients, but also medical staff and
researchers, to fall into therapeutic misconception. Likewise, for
the terminal patient and his/her family though, experimental
medical therapy is often the only hope, which is, however,
always accompanied by a factor of uncertainty and is
considered to be merely an unapproximated gamble. The
proposing of experimental medical therapy can result in being
cruel by shattering the parent’s expectations of saving their
child.
We examine the issues involved in proposing an
experimental medical therapy to patients who are in dire need of
a last hope; and conclude that, in times of emergency, we must
take great consideration in recommending an experimental
medical therapy as an “innovative treatment.” In extreme
circumstances where an individual’s life is on the line, doing
nothing can be quite trying; yet, what is right is not necessarily
doing something, but rather making the right decision.
Key words: vulnerability, experimental medical therapy,
critically ill, cruelty, double uncertainty, and pediatric patient.
1. Introduction
No matter how far medicine advances, incurable disease
will inevitably exist; and the despair that lingers in the hearts of
those to whom have lost a child or spouse unfortunately does
not fade away. Likewise, the medical staff whom stand before a
suffering patient and his/her family are faced with a feeling of
utter powerlessness. This runs deep for the many who are
affectionate and see their work as a mission. While death that
 Eubios Journal of Asian and International Bioethics 14 (March 2004) 53

lies in the wake of longevity is rather easy to accept, death of an
infant or of one’s own child is seen to be subversive and absurd.
Unfortunately, this absurdity is dealt with all too often for those
whom are in pediatrics. Here, medical research exists as the
last hope for the many patients and their families.
In this paper, we examine a case concerning the use of
experimental medical therapy (EMT) on a critically ill child. We
discuss the ethical argument pertaining to the recommending of
EMT to a family of a dying patient. We explore: 1) how the
parent’s initiative of consent is influenced by the critical
situation; 2) the commission/omission of treatment; 3) the
psychology of therapeutic misconception; 4) lastly, we examine
if it is permissible for the medical provider to propose an
unproven EMT as innovative treatment to the family of a
critically ill minor.
On the one hand, the argument for allowing the use of
EMT considers the following three points: 1) the patient’s
approaching death; 2) the family and patient’s right to receive
EMT; and 3) how such lies in accord with the fundamental goal
of medicine. On the other hand, the argument against the use of
experimental therapy considers the respecting of a patient’s
dignity, the factor of double uncertainty, the issue of cruelty, the
limits to providing access to information, the dangers of a
slippery slope effect, possible therapeutic misconception by
medical staff, and the impartial allocation of medical resources.
Following a review of the various discussions and
arguments, we conclude by investigating the following points: 1)
the patient’s proxy’s loss of decision making capacity; 2) the risk
of therapeutic misconception by the medical provider; 3) the fact
that EMT, while seen as a last hope, is a gamble with an
unclear outcome and carries an inevitable uncertainty; and 4)
the cruelty of shattered expectation as associated with this
gamble. Here, we consider the distress involved in proposing
EMT to those who are in dire need of a last hope; and conclude
that, in times of emergency, we should not recommend EMT.
Lastly, we investigate the role of an Institutional Review
Board and Research Ethical Committee (hereafter referred to as
IRB). We conclude that, in circumstances similar to the case of
discussion, it is necessary for such committees to stop EMT
upon an objective examination concerning the possible merits
and demerits of the EMT, the shading of therapeutic
misconception and the possible alterative motives of the
medical staff and so on. In extreme circumstances where an
individual’s life is on the line, doing nothing can be quite trying;
yet, what is right is not necessarily doing something, but rather
making the right choice.
The case we present is based on our hands on
experience; however, all peoples, diseases and treatments are
products of our imagination. Any similarities between the
presented case and real life occurrences are merely
coincidental and shall not be seen as in any way related.
D’s physician, Dr. I, is a specialist in autoimmune
diseases and is head of the department of collagen diseases.
He has been treating D since the very onset. Not only does he
feel professionally responsible, but also has come to feel
emotionally responsible for D.
Throughout the two years of treating D, he and D’s
parents have become quite close. While D has become
attached to Dr. I, Dr. I has gained a reciprocal trust from D’s
parents. Dr. I has consulted physicians located both
domestically and abroad; he has reviewed the most recent
literature in the field. All of his efforts, however, have come up
with nothing.
A few days ago, Dr. I discovered a report in a medical
journal for collagen diseases. This report looked at a series of
cases whereby large doses of immune suppressants where
prescribed to adults with final stage disease A. The results
showed that while three of the 20 patients who participated in
the study passed away, three also improved (1 life year
increased). The remaining 14 participants showed neither signs
of improvement nor deterioration; yet, with continual therapy, a
decrease in lymphocyte count and the onset of a fever were
observed. Ten of the patients had complications including
vomiting, fatigue, and reversible liver/kidney damage. Bacterial
infection was observed in five of the patients. (Note: The
medicine used in this study can be covered by the national
health insurance as a conventional therapy for autoimmune
disorder.)
Dr. I believes that this EMT is D’s last and final hope. The
treatment, however, has never been used on a child or infant
with disease A. Regardless of whether or not it could rescue D
from the wraths of death, treatment of D could be used as an
observational case for a further report.
Due to this treatment being nonstandard, it is necessary
for Dr. I to submit a protocol to the IRB for approval. The IRB
review process, which usually takes approximately two months,
is too long for D to wait. D has only a number of days left. After
staying up all night devising a protocol, Dr. I submits it to the
IRB with a request for urgent review.
At this stage, we need to consider the following questions:
Is it ethical to recommend this EMT to patient D and to D’s
family? Should the IRB prioritize the review of Dr. I’s protocol?
And what decision should the IRB make in this situation?

2. The Case
Patient D, a five-year-old boy with a rare autoimmune
disease A has been in and out of a university hospital since the
onset of disease A. Currently, there exists no proven effective
therapy for disease A. Treatment has been limited to attending
to any and all complications.
Patient D is gradually slipping into a state of
unconsciousness; his chart shows that his blood pressure is
highly instable caused by pericarditis and myocardosis, which
eventually lead to pulmonary edema and heart failure. His level
of nutrients, his liver and kidney function continue to deteriorate
leaving little or no room for possible treatment.
Patient D’s parents have tried every possible means of
treatment, each a disappointment. Now, as they burden in
sorrow, they are having to face the arriving death of their son.
Upon hospitalization, D has undergone medical therapy
including the use of vasopressors; after undergoing a
tracheotomy, he is hooked to a respirator. Due to the use of
tranquilizers and being in a state of unconsciousness, however,
D seems to be in a painless state.
54 Eubios Journal of Asian and International Bioethics 14 (March 2004)
3. Looking Inside The Mind Of A Dying Child’s Parents
Sentimentality and Reason
We are creatures of reason. Yet, at the same time, we
exist within an emotional web of human relationships between
child and parent, wife and husband, man and man. Our mind
breathes in this dichotomy between emotion and reason.
Likewise, at times our emotions drive our actions. As in the case
of patient D, everyone involved is emotionally invested. In cases
where a parent’s adored child is on his/her deathbed, a
“reasonable” ethical decision is often difficult to reach.
In the case of discussion, patient D is dying; his
physician, to whom D’s parents trust, proposes an EMT with a
15% mortality rate, 15% success rate, and 50% probability of
side effects. In light of D’s condition, the occurrence of side
effects could be lethal; the possibility of death needs to be taken
into consideration. Likewise, due to this high risk associated
with the occurrence of side effects and the lack of evidence
concerning this EMT on minors, it is fair to estimate a mortality
rate of 30%.
If we were in the shoes of D’s parents, how would we
feel? We do not even have concrete data from descriptive
research. What we do have, however, is the fact that we love
our son and would sacrifice anything in order to save him. We
can see here that in times of desperation, we become
“drowners” in a sea of hope. Well aware that their son will soon
pass away, the parents of D are desperate in finding a means of
saving him.
Here, we need to ask whether or not persons, under
the circumstances similar to our discussion at hand, are capable
of making a composed and reasonable decision. In the case of
D’s parents, their consenting to the recommended EMT is most
likely a paternal instinctual response and not a product of
reasonable thought.
Next, we need to consider the following question: if a
composed reasonable decision cannot be made, should
consent be acquired from a suitable proxy and not from the
parents? D’s parents have experienced the many bitter stages
of D’s illness with him; they see their child as first priority and
they will, ultimately, have to bear the death of D more than
anyone else. In rare cases, however, parents are not always
suitable to represent the welfare of the child. For instance, when
a parent is incapable of feeling the same kind of compassion
and love towards their child.
In the case of D, his parents would sacrifice anything,
including their own lives. Even though they may be approaching
things from an emotional standpoint and not one reason, this is
natural. Accordingly, this cannot be seen as sufficient grounds
for the use of a proxy.
D’s parents are most suitable to represent D not because
they are capable of making a rational decision based on reason,
but rather because they have an unconditional love for D as his
parents. On the other hand, however, this is the precise reason
for their increased vulnerability to both good and evil measures
of hope. Although they very well may be unaware of their
vulnerability, their intention and will to save D is as strong as
rock. In short, the fact they are willing to do anything in order to
save D invites an abyss of vulnerability and an abundance of
desperate hope.
Commission versus omission
In the following section, we discuss the issue of
commission versus omission. In our case of discussion, D is
critical and there is nothing else medicine can do. We can only
wait. Our last resort is using high dosages of immune
suppressors. However, while this EMT could save him, it could
also turn out to kill him. Nobody knows to which will result.
We are faced with the decision of whether we choose to
attempt to treat him with an EMT or let him pass away in peace.
Certainly enough, we neither are causing him to suffer nor are
we hastening his death. But then again, we are dealing with a
double bladed sword; that is, while we could be saving him with
this EMT, we could also be killing him. In short, we are
incapable of knowing to which will result; we are incapable of
calculating which will be best for him. Omission will inevitably
result in letting him pass away.
In these circumstances, the act of trying to save one’s
child and patient is psychologically easier. For D’s parents, the
act of trying is essential. “By doing what we can do now, we
won’t feel regret later,” is the greatest psychological gain
possible. Accordingly, by saying “we may be able to doing
something” to D’s patients, we are not increasing the
possibilities, but rather, we are decisively revealing a path
where the possibility of merely waiting disappears.
Therapeutic Misconception
Will D’s parents be willing to agree to the proposed
innovative treatment knowing that it is experimental? Are they
really able to comprehend that this EMT: 1) is considered an
initial step towards understanding whether or not it is an
effective treatment, 2) can not be considered certain to be able
to save D, and 3) is clinical research that will benefit patients in
the future by adding to the expanding knowledge concerning
clinical medicine. In fact, will they be able to realize that by
agreeing to treatment, they are placing their son on the
“experimental stone.” This decision is extremely complicated. As
stated supra, in light of D’s parents both emotionally and
psychologically being desperate, they see this EMT as an
indisputable treatment and as the last resort to saving their
child. This inevitably points to a high possibility of therapeutic
misconception.
The experimental use of high dosages of immune
suppressors may be comparable to an emergent life saving
surgery with a high probability of death. For instance, suppose a
patient is brought to the emergency room from a lethal car
accident where her organs have been severally damaged. If
nothing is done, the patient will die. If we open her up and
attempt to stabilize her, we may save her; however, the risk of
death during operation is also extremely high. What would the
parents do under these circumstances? This decision involves a
psychology of “we have to do something…,” a natural reaction
to wanting to save one’s child.
To a certain extent, this example resembles our case of
discussion. However, because our case is dealing not with a
proven and accepted treatment, there is a great tendency to fall
into therapeutic misconception. We are dealing with the
experimental use of high dosages of immune suppressors on
patient D and there is no supporting evidence for it being an
effective or it being a beneficial treatment. On the one hand, the
emergent surgery has a high risk but a proven effectiveness; on
the other hand, we know neither the degree of risk nor the value
of our EMT.
The parent’s state of mind and its significance
In our case, the circumstances are decisive. We can
overlook the fact that the imminent death in our case has a
great impact on the person who has to decide. If D were in a
stable condition and his death were not pressing, would D’s
parents really agree with the experimental use of high dosages
of immune suppressors? For instance, if D’s condition was not
as pressing as in our case and if D still had an estimated six
months to live, would D’s parents agree to an experiment with a
15% mortality rate? The problem we need to consider is
whether or not it is appropriate to propose this EMT to D’s
parents when D is on his deathbed. If this treatment were not
proposed to D’s parents, they would not hope its success; they
would not need to struggle with the decisions of doing this or
doing that.
If our psychological analysis in not mistaken, once the
slight possibility of saving D is suggested by his physician to D’s
parents, his parents will cling onto the hope of saving him until
the end. Accordingly, the imperative problem is of whether or
not it is suitable to recommend this kind of EMT to desperate
parents, and whether or not it is appropriate for physicians and
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
medical researchers to throw a lost hope to a person in
desperation.
4. Arguments For Disclosing Information Concerning EMT
Up until now, we have described the decisive importance
of recommending an EMT to D’s parents and the associative
psychological replications. In the following section, we review
the possible benefits of using an EMT on a critical patient.
These arguments for the use of EMT pertain to the patient’s
imminent death, the patient’s right to know, the disclosure and
right to access to information, and lastly, the fact that the
purpose of medical therapy is to save lives.
Argument #1: The patient’s imminent death.
Comparing the benefits and risks in the case of EMT is
meaningless if set on premise that “if we do nothing, the patient
will unmistakably die,” the fact is that even with the best
standardize therapy, D can not be saved. By prescribing D
immunosupressors, there lies the possibility of bringing about
his death sooner; however, we could not consider this risk
without holding it contrast to the null probability of saving D with
the best standardized therapy. Without question, we would not
recommend this experimental treatment with a mortality rate of
100% and a survival rate of 0%.
However, with a success rate of 15% and a mortality rate
of 15%, one could justify proposing this EMT. As mentioned
infra, omission of EMT would result in the patient dying for no
standard therapy is effective. In the case of a chronic illness
where there is no risk of dying, a 15% success rate and a 15%
mortality rate would not be sufficient in justifying the use of this
type of EMT. Nevertheless, the patient presently lying on his
deathbed and the ever-pressing need to do something has a
great impact on the situation.
What are we to do with a 15% success rate and to an
85% mortality rate? On the premise that “if we were to do
nothing, he will inevitably die,” any possibility of saving the child
could be considered as a high probability. Physicians would
certainly recommend a treatment with a 50% success rate and
10% mortality rate in the case where omission of medical
treatment lead to an imminent death.
It is possible to consider the lowering of a patient’s
quality of life (QOL) subsequent to EMT. In the case of D,
however, the lowering of QOL is irrelevant for he is neither
conscious nor in a state of pain. Accordingly, there is no evident
reason for not recommending this EMT to D’s parents. A 15%
chance of saving D from dying is seen as relatively hopeful. Yet
on the other hand, the low rate of success and apparent
uncertainty indicate that this therapy is no lifeline. Thus, the
proposed experimental therapy is seen to lie somewhere in-
between being hopeless and acting as a lifeline.
Argument #2: The right to access to information.
If D and D’s parents are looking for anything with even
slight efficacy, they have the right to know about an EMT and
the right to undergo treatment. The covering up options by the
medical staff in the name of nonmaleficence is nothing more
than paternalism. Trying to protect D from EMT in the name of
nonmaleficence will only lead to his death. One could say,
rather, that the EMT is an attempt to save D from dying.
Accordingly, when acquiring informed consent, it is permissible
to provide the parents information regarding EMT.
In today’s age of the Internet, there is a high possibility
that D’s parents could look up information regarding the
experimental use of high dosages of immunosupressors and,
subsequently, request “innovative therapy.” In the case where
D’s parents request treatment, despite realizing that 15%
success rate is based on data collected with a small number of
adult patients and that D’s dying is ever-impending, the
physician should sit down and talk with D’s parents about the
specifics of using this EMT. Regardless of whether or not the
therapy is experimental, or whether or not the probability of
actually saving D is outlandish, D’s parents and physicians
55
should sit down and discuss the various options. The disclosure
of information concerning this type of EMT does not provide D’s
parents more options, but rather, even if it is seen as a last
resort, it could provide D’s parents a means to continue to
believe.
The use of EMT in our case of discussion may need not to
be approved by an IRB. We are not dealing with standard
clinical research. We are dealing with a preliminary innovative
therapy that could save D from dying. Accordingly, if the team of
physicians and D’s parents both consent to it’s use, EMT could
be suitable in treating D.
Argument #3: The objective of medical therapy
The most vital objective of medicine is to save the dying
patient. In our case of discussion, “omission,” defined here as
the continuing of conventional therapy, would inevitably lead to
D dying. Experimental intervention, however, provides two
paths: one of living and one of dying. As a medical professional,
one has the duty to propose all the options that have even a
slight hope of saving the patient; there also exists the issue that
unless D is treated with the EMT, other pediatric patients under
similar circumstances cannot benefit from possible future use of
the therapy. If the treatment is effective with D, it could be used
as the starting point for further evidence. A random control trial
could then prove this EMT to be clinically effective against
disease A and safe.
5. Arguments For The Nondisclosure Of Information
Regarding EMT
Several arguments suggest that, when conventional
treatment is ineffective, it may be permissible to propose an
EMT as an option to the patient’s family on the condition that
there exists a slight possibility of saving the child and that the
EMT would neither harm nor lower the patient’s QOL. However,
there exists a few highly justified arguments against this
standpoint. In the following section, we discuss those reasons
against disclosing information regarding an EMT to the family of
a dying pediatric patient.
The respect for D as an independent individual
The argument that one should respect D’s human dignity
is valid. Despite he being only 5 years of age and
unconsciousness, D’s dignity must be observed. He has the
right to be protected from being treated inhumanely. Although
the possibility of D’s parents voluntarily consenting to the EMT
is quite low, it can be considered unethical to conduct clinical
research without final consent from the subject.
In the case where D could realize his physiological
condition and make a decision, he may accept to undergo
treatment knowing that this was, although uncertain, the only
possibility of being saved. He is to decide whether to undergo or
to refuse treatment based on it being a harmful approach. It is
the patient’s right to choose and to feel comfortable with his
reasonable decision.
The patient also has the right to know and the right to
disclosure. D, however, is five years old and, moreover,
unconscious; he is neither capable of communicating nor of
making a decision. Proxies, representing a patient with a loss of
decision-making capacity, are allowed to make decisions
regarding conventional therapies. In the case of clinical
research, however, the use of a proxy is recognized only when
the experimental therapy has a high probability of directly
benefiting the patient.
Double Uncertainty
In the following section, we examine the aspect of double
uncertainty inherent to cases where the EMT has only a certain
probability of saving the patient’s life. There is a vital difference
in quality between conventional therapy and this type of EMT.
The probabilities of success versus risk of a conventional
therapy are statistically known. For instance, let us suppose that
a treatment X is effective on 70 patients out of 100. Here,
56 Eubios Journal of Asian and International Bioethics 14 (March 2004)
uncertainty rests on whether a patient falls in the remaining 30
or the successful 70. With the use of an EMT, however, the
supposed 15% efficacy is itself uncertain. In order to prove the
rate of efficacy, a clinical trial needs to be conducted.
Additionally, even if this 15% were proven, whether or not D
would fall into this 15% is again uncertain. Our case exemplifies
this kind of double uncertainty.
Even if the success rate of using high dosages of
immunosuppressors on adult patients with disease A was 50%
or 100% instead of only 15%, one could still find validity in the
argument against recommending this treatment to D’s parents
based on the principle of double certainty. The mere probability
of 50% or 100% is all too uncertain when it comes to saving a
patient from dying. Conducting EMT in the name of saving a life,
accordingly, is impermissible in times of emergence.
There exists an increased level of uncertainty inherent to
the nature of EMT. For instance, the data concerning side
effects of the EMT on adult patients is inapplicable. The level of
uncertainty ascribed to possibly harming subjects is significantly
high. One can only deny those side effects that have been seen
in previous studies on adult subjects. It is possible that D may
suffer and experience pain unforeseen by I or D’s parents.
While a patient’s needs increase while being in critical condition,
the same often is true regarding risk. Despite D’s needs
increasing, the expected benefits of EMT do not necessarily
increase.
Cruelty
Providing false hope to persons having to face and slowly
accept the tragic fate of soon loosing their child is far from being
an act of beneficence. Even if that hope is founded on concrete
data, there is merely a 15% chance of success. Although the
patient may die with an omission of therapy, EMT carries a
mortality rate of 85%. Giving hope to parents who will later have
to face, once again, the unbearable fact that their son will soon
die can be considered to be cruel.
As explained infra, proposing the experimental use of high
doses of immunosupressors revokes any other options. That is,
there is always the option of allowing D’s parents to resign their
hopes of saving their son. They would then be able to spend his
remaining days quietly by his bedside. The irresponsible act of
throwing a lost hope to D’s parents consequently rids them of
the limited and precious time left with their child; it is far from
being a beneficiary act.
Treatment has the objective of benefiting the patient.
Conventional therapy with a success rate of over 50% benefits
the patient. A treatment with a 15% success rate and a 15%
mortality rate can also be considered beneficial. However, in the
case where the probabilities of harm versus effectiveness are
not yet substantiated as evident, the decision of whether or not
such a therapy is beneficial is impossible. To even slightly
suggest the possibility of saving a dying child’s life without
providing any substantial means of making a decision regarding
the treatment itself is, needless to say, cruel.
Therapeutic misconception held by the medical staff
Therapeutic misconception is considered to be one of the
factors behind proposing and accepting EMT. While the parents
of D inevitably are influenced by this therapeutic misconception,
what about Dr. I in this case? The possibility of Dr. I having
become emotionally involved with patient D’s circumstances is
high. In this sense, Dr. I is just as vulnerable to therapeutic
misconception as D’s parents. EMT is conducted not on the
premise of expecting effectiveness, but rather, in order to prove
a therapy’s effectiveness. To justify the use of an EMT as a
reason to save a life is nothing more than therapeutic
misconception.
Justice
In our case of discussion, the issue of justice is pressing.
Firstly, asking D and D’s parents, in all their vulnerability, to
participate in research that one is conducting could be seen as
“using” them. It would be difficult for D’s parents to refuse EMT
based on: 1) the recommended therapy is D’s last and only
hope, 2) it is would be quite difficult to refuse the suggested
EMT in the context of having relied upon Dr. I throughout D’s
treatment, 3) the relationship of fidelity between physician and
family would fall into strain subsequent to refusing the
suggested therapy, and 4) compared to other circumstances,
D’s parents are very likely to be therapeutically misconceived.
Secondly, this type of EMT should not be carried out
under conditions where a patient is on the verge of death. One
should recruit patients with the same disease yet not in a critical
state. Unlike research concerning cardiac pulmonary
resuscitation, this type of EMT does not require subjects to be in
critical condition. Accordingly, one should not conduct this type
of EMT under critical circumstances.
Thirdly, regardless of how much Dr. I wishes to save
patient D, the fact is that he has invested interests in conducting
the first trial internationally on pediatric patients with disease A.
Accordingly, when Dr. I explains the EMT to D’s parents,
consciously or subconsciously, he may phrase it in an all too
convincing way. The mere fact that the medical staff may hold
the subconscious desire to carry out this research points to a
significant frame effect. We need not only to consider the
psychological state of the patient’s parents, but also of the
medical staff.
Fourthly, according to the principle of justice, the IRB
should not review Dr. I’s protocol with priority over others. In the
case of the IRB reviewing this case as urgent indicates an unfair
prioritizing based on the rule of rescue. The average two
months common for the IRB to review a case is a result of the
numerous research protocols that are proposed. Even in the
case where the circumstances are not urgent, there are
hundreds of patients dying of an incurable disease. It is unjust to
prioritize D’s research due to our incidentally knowing D’s
situation personally and not knowing the many other hundreds
dying. For instance, suppose that the approval of another
proposal is postponed a week due to the prioritizing of D’s
experimental treatment. The subjects who may have
participated in the postponed clinical research may pass away
within that week subsequent to not being able to undergo
therapy. The limited time of the IRB needs to be justly
proportioned and not determined by a proposal’s degree of
urgency or necessity. One needs to take into consideration the
effect of the research, the order of proposal and the waiting
time. We need to treat equally those patients dying who lay not
before us with those patients dying before our eyes.
Slippery slope effect
There is a slippery slope effect inherent to our case of
discussion. If D’s experimental therapy were prioritized as an
urgent review and approved, there would exist the concern of a
slippery slope effect on the process of reviewing research. A
priority-based review conducted with D’s case may lead to a
similar process regarding other critically ill patients, other
patients under urgent circumstances, and other families with a
dying child. This prioritizing of urgency, likewise, may lead to
proposals becoming increasingly risky with lower probabilities of
success and greater side effects. Additionally, the number of
urgent proposals from ambitious researchers would, more than
likely, proliferate. Concurrent to this slippery slope would be the
increased number of non-urgent proposed being overlooked or
postponed. Moreover, critical patients like D would more and
more become subjects of clinical research. Here, we need to
consider whether or not Dr. I’s behavior can be universalized,
that is, would it remain ethical on a universal level.
The limits of information disclosure
A patient’s right to access to information concerning
treatment should be respected. In the case of EMT, one has the
right to access to information concerning the protocols reviewed
by the IRB and used to recruit subjects. The medical staff,
however, should have the right of discretion regarding EMT.
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
Even if the subject him or herself expresses the desire to
undergo a certain EMT, there is no ethical obligation to go
against one’s conscience by carrying out this EMT. In the case
where the physician feels an obligation to disclose information
concerning the EMT, does he or she have this same obligation
to those subjects recruited from other countries with a similar
critical condition? What about research that is not published? It
would be impossible to disclose all information regarding the
research protocol to subjects in studies conducted
internationally.
6. Conclusıon
This paper has discussed whether or not it is permissible
to recommend an EMT under urgent circumstances to the
parents of a dying pediatric patient. The imperative problem is
deciding whether or not it is appropriate to recommend EMT to
desperate parents and whether or not it is suitable for
physicians and medical researchers to throw a lost hope to
people in desperation. On the one hand, we have examined
arguments of it being permissible based on the fact that the
patient faces an imminent death, that the patient’s parents have
the right to choose and the right to access to information, and
lastly, that the objective of medicine is to try to save patients’
lives. On the other hand, we have found it impermissible based
on the following arguments: it can be seen as undignified
treatment of D, the factor of double uncertainty, the cruelty of
proposing an EMT as a last resort, therapeutic misconception of
the medical staff, subconscious motives held by researchers
including self-benefit, various issues pertaining to research
justice, collapse of the review process subsequent to the
slippery slope effect, limitations of information disclosure, the
disparity between patient’s decision and his proxy’s decision,
and lastly, the unknowable likelihood of side effects. We see
that one cannot justify an overlooking of these factors based on
an intention of wanting to the save the life of a dying child. The
members of the IRB and the medical staff involved need to
remain objective even when feeling compassion towards the
patient. The position of justifying the use of an EMT based on
the principle of wanting to save a dying patient could be
understood emotionally; nonetheless, members of the IRB need
to reconfirm their decision beyond the multiple number of
possible misapprehensions.
The role of an IRB is to act as a brake regarding the self-
interest of medical researchers, the use of therapeutic
misconception by medical staff, and the probability of risks over
benefits. Dr. I requested his proposal be reviewed urgently in
order to save D’s life. The subject of Dr. I’s proposed EMT is a
dying patient being treated under Dr. I. Even the members of
the IRB could fall into therapeutic misconception emotionally.
However, what is needed is for the IRB to make a decision from
an objective standpoint. For the medical staff and proxies, final
decisions regarding treatment of dying patients are ever
pressing. While “doing nothing” is heart rendering, the right thing
to do is not a matter of what to do, but rather of making the best
decision.
Experimental Medical
Treatment for a Terminal
Pediatric Patient:
Commentary on Asai and Itai
- Frank J. Leavitt, Ph.D.
Chairman, The Centre for International Bioethics
Faculty of Health Sciences, Ben Gurion University of the Negev,
Beer Sheva, Israel
Email: yeruham@bgumail.bgu.ac.il
57
I always learn a great deal from Asai and Itai’s case
studies. They are based on their personal, hands-on experience
with patients. In reading, one feels their personal concern. I
have to admit, however, that with respect to this particular case I
cannot agree with them. Please forgive my simplistic approach,
but I think the matter is summed up in their statement that while:
“…we are incapable of calculating which will be best for him.
Omission will inevitably result in letting him pass away.” If the
inevitable result of omission is death, then why not try
something even if the presumed success rate is only 15%? Asai
and Itai talk about the cruelty of giving the parents “false hope”.
This is a serious matter. But why need the proposal of an EMT
be phrased in such a way as to give false hope? The physicians
have to find a way to explain to the parents that they would like
to try this therapy as a last resort, while aware that the chances
of success are almost non-existent.
Asai and Itai discuss at length the complications of the
approach to the institutional review board (IRB). But I doubt that
ethics require turning to an IRB in such a case. The World
Medical Association Declaration of Helsinki
[http://www.wma.net/e/policy/b3.htm] is God’s Revealed Word
about ethics. It can certainly be wrong. But their guidelines for
medical experimentation on human subjects are extremely
useful and often show a good deal of wisdom. Paragraph 32 of
the most recent version says:
"In the treatment of a patient, where proven prophylactic,
diagnostic and therapeutic methods do not exist or have been
ineffective, the physician, with informed consent from the
patient, must be free to use unproven or new prophylactic,
diagnostic and therapeutic measures, if in the physician's
judgement it offers hope of saving life, re-establishing health or
alleviating suffering. Where possible, these measures should be
made the object of research, designed to evaluate their safety
and efficacy. In all cases, new information should be recorded
and, where appropriate, published. The other relevant
guidelines of this Declaration should be followed. "
I think that whoever wrote this guideline showed a great
deal of wisdom in recognizing that when the alternative is
certain failure, ethical restrictions should be liberalized.
58 Eubios Journal of Asian and International Bioethics 14 (March 2004)
The Development of Health
Insurance in Turkey and its
Importance from the Point of
View of Medical Ethics
- Ibrahim Basagaoglu, Ph.D.
Department of Medical Ethics, Faculty of Medicine, Istanbul
University, Istanbul./TURKEY
Email:ibasagaoglu@tnn.net
- Aysegul Demirhan Erdemir, M.D., Ph.D.
Department of Medical Ethics, Faculty of Medicine, Uludag
University, Bursa/TURKEY
Email: ademirer@yahoo.com
Abstract
Health Insurance shows some periods in Turkey. After the
foundation of the Turkish Republic, health insurance developed
and had modern characteristics. Some problems are present in
the relations between patient and physician in the health
insurance today. In the period of Ottoman Empire, both religious
social foundations and professional guilds helped poor patients.
Some foreign insurance companies opened some bureaus in
Turkey after 1850. The Law of Ottoman Insurance Company
had come into force in 1892 (1). Afterwards, modern insurance
laws were seen in the period of Turkish Republic.
Today, two kinds of health insurances are present in
Turkey. One of them is the health insurance belonging to the
Official Foundations. Another kind is the special health
insurance (2). The persons who sign insurance policy with
insurance companies should know some points. These are very
important from the point of view of the ethical principles and the
relations of patient-physician. In this paper, these subjects are
stressed and some results are obtained.
In the Ottoman period, both religious social foundations
and professional guilds helped to the poor patients. The needs
of the poor patients were provided in some foundations such as
guesthouses and hospitals (3). Hospitals were called
"darüsshifa" (healing house in English) (4). Poor patients were
treated in the hospitals. These were "wakf" (charitable
foundations). These were present in a complex city. But, poor
patients didn’t have official social security. Modern social
insurance began to develop in Turkey in the nineteenth century.
The religious beliefs were contrary to the concept of modern
insurance. According to The Agreement About Branches of
Foreign Anonym Insurance Companies with the date of 1889, all
the companies should get permission. So, many insurance
companies began to get permission. The Agreement of Ottoman
Insurance Company had come into force in 1892 and an
Ottoman Insurance Company was founded. In this agreement,
we see some articles about the management and aims of the
insurance company. Some banks founded the General Ottoman
Insurance Company. Turkish National Insurance Company was
also founded in 1916. We see many Turkish Insurance
Companies and some social security foundation-ship up to
1923. Some of them are Military Retired Cooperation, Civilian
Personnel Retired Cooperation. These supported the social life
of the personnel. Dilaver Pasha Agreement with the date of
1865 has some articles about the therapies and the
compensations of miners.
In the Period of Turkish Republic, some modern laws
were seen in the field of health insurance. The Law of the Trade
with the date of 1926 regulated the relations between the
insured person and insurance company and has some articles
belonging to the control of insurance. The Law of Control of
Insurance Companies contains articles about the rights of the
insured persons. Some articles about the aids of health to the
workers are present in the Law of Protection of Health with the
date of 1930. The laws about some insurances such as Disease
Insurance, Death Insurance, Old Age Insurance etc. were
passed between 1930 and 1960. The Law of the Control of
Insurance Companies had come into force in 1959 (5).
The Turkish Insurance System developed with some laws
such as the Retired Cooperation (1950), The Law of the Control
of the Insurance Companies (1959), The Law of the Social
Insurances (1965) and so, the health of people was insured.
Moreover, the Law of the Socialization of Health Services had
come into force in 1961. This law provides that health services
reach to everybody. According to another law with the date of
1992, poor patients who provide a green card from the official
foundations are treated without fee. The persons who haven’t
any guarantee from the point of view of the social security, and
can not provide the expenses of health services can get a green
card. These persons shouldn’t give a false knowledge about
their economic conditions. Moreover, the persons who want to
obtain a green card should know their legal applications. If they
change their dwellings, they should inform about their new
addresses. The health Ministry should pay their expenses (6).
We can see some ethical problems between patient,
insurance company and hospital. Some difficulties may exist in
the patients’ therapies because of these problems. Because the
social insurance hospitals are very crowded in Turkey, the
physicians cannot have the time for the therapies of the
patients. Sometimes physicians cannot behave emphatically
because of their economic, social and professional problems.
Patients’ number is very much and the physicians should treat
about 100-200 patients in a day. Some persons work in some
foundations without insurance because their foundations don’t
want to pay their premiums. So, they cannot be treated when
they are ill. As a result, their health hasn’t social security.
Moreover, they cannot apply for the special insurance company
because they are not rich. Moreover, today, many special
insurance companies are present in Turkey. The Insurance
Premium of the Patient should be in the equal ratio to his(her)
treatments’ expenses. If the expenses are more than the
insurance premium, the payments belonging to the therapies of
the patients cannot be made and this condition is against the
beneficence principle of the medical ethics. Today, the number
of specially insured persons increase in Turkey. But, the person
who signs the insurance policy with the insurance companies
should know some points. These are very important from the
point of view of the ethical principles and the relations of the
patient-physician. The names of the diseases of the persons
and their therapies’ ways should be written on the insurance
policy (7). The physician should write a true report about the
diagnosis of the insured person’s disease. Moreover, two rules
are very important (8) :
1) The disease of the patient who makes an agreement
with insurance company should be in the list of the diseases of
this insurance company (8).
2) If the insured person has a different disease, it should
be determined with a report and this disease should be added
to the company’s disease list. Generally, rich persons apply for
the special insurance companies (9).
Conclusion
As a result, health insurance has ethical problems in
Turkey. These can be seen both in the fields of special
insurance and state insurance. Ethical dilemmas can be seen
in the relations of patient-physician and in the foundations of
health insurance (10). All of these problems have been stressed
in this paper. Moreover, the importance of some laws about the
health insurance has been pointed out in Turkey.
References
1) Ersan G.. Türkiye’de Sosyal Güvenlik(Social Security in Turkey).
Istanbul:Türk Dünyası Araytırmaları Vakfı;1987.p.34-78.
2) Alper Y. Türkiye’de Sosyal Güvenlik ve Sosyal Sigortalar (Social
Security in Turkey and Social Insurances). Istanbul: Alfa Yayınları;
1999.p.1-230.
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
3) Demirhan EA. Sosyal Sigortalar Kurumunun Türk Tıp Tarihindeki Yeri
ve Sosyal Sigortalar Kurumu(Social Insurances in the Turkish
Medical History) Bursa Bölge Hastanesi. Dirim Dergisi 1997; 73
:306-14.
4)Yıldırım N. The History of the Foundation of Poor Persons in Istanbul.
Istanbul Darülaceze Müessesesi Tarihi. Istanbul: Numune
Matbaacılık; 1996.p.23-230.
5) Aydınlar AU. Sosyal Sigortalar Kanunu (Law of Social Insurances).
Istanbul:Nobel Tıp Kitabevleri ; 1976.p.55-7.
6) Elcioglu O,Unluoglu I,Demirhan EA. Green card and ethical
problems. J Medical Ethics Law and History 2003 ; 11 :8-11.
7) Demirhan EA. Lectures on Medical History and Medical Ethics. Nobel
Tıp Kitabevleri; Istanbul: 1995.p.78-123.
8) Tomes JP. The Health insurance portability and accountability act of
1996, understanding the untikicback laws. J Health Care Finance
1998; 25:55-62.
9) Campbell A,Gillett G,Jones,G. Medical Ethics. Oxford University
Press; New York :2002.
10) Horstman K. Technology and the management of trust in insurance
medicine.Theoretical Medicine and Bioethics 2000 ; I :39-61.
Biological Views of the
Inexistence of Human Races
1 2
- Silviene F. Oliveira & Luzitano B. Ferreira
1
Department of Genetics and Morphology, University of Brasília,
Brazil.
2
Post Graduation Program, University of São Paulo, Brazil.
lbferr@rge.fmrp.usp.br
Abstract
In biology, race can be defined as a geographically
bounded population showing accentuated genetic
differentiation. It is believed that the division of human species
into “races” presents solid biological base. However, there are
problems over using this term. The present work aims to point
out some of the difficulties of using the concept of races for the
human species, using a biological approach. The race concept
is typological, imprecise, based on subjective concepts, and can
suffer different interpretations according to the criteria used,
who is using it, and even the time and place of the
determination. The chosen characteristics for the conception of
races are usually in accordance to the convenience of the user,
based on external and extremely complex morphologic criteria,
with little support of genetic knowledge. This concept is also
static, and does not represent the modifications and evolution of
human populations, with the same evolutionary origin. Most
populations are not circumscribed, so that there is genetic flux
among them, leading to genetic differences not big enough to
support the sub-division of the human species into races. The
genetic differences among human groups are smaller then
between individuals of the same population. From this biological
point of view, the existing inconsistency for the classification of
the human species in different races, make the morphological
criteria used nowadays nonsense.
Introduction
The human being feels the need of classifying everything
around us. Even though the first classifications of the species
are from immemorial times, it is known that the philosophers
separated the beings in aerial, terrestrial and aquatic domains
or whether they are useful or hazardous to humans. In the
biological classification proposed by Linneaus, still used today,
the species are separated in categories, going from the most
broad (rein) until the most specific (species). The subdivision of
different populations of a species is denominated subspecies,
correct designation of what we call “race”. This concept was first
introduced to human populations by the French biologist Buffon,
as an arbitrary classification that was used simply like a label
and not like a scientific entity (1).
59
The term “race” has several concepts in biology. In
agreement to Mayr (2), race is a sympatric population, not
interrelating, that differs in its biologic characteristics, but is
does not differ in morphologic characteristics. Futuyma (3)
states that race is a vague and meaningless term, for a set of
populations occupying a particular region that differ in one or
more characteristics from populations elsewhere, frequently
equivalent to subspecies. Race is also defined as a
circumscribed population with accentuated genetic
differentiation.
Historically, the division of the human beings in races was
used not only to classify and try to better comprehend the
different populations, but most of all to justify the exploration
and oppression of people considered “biologically inferior”. For
example, the Amerindians were considered not civilized during
all the American colonization (4). For at least 50 years, between
1850 and 1900, the American census contributed directly to the
generation of scientific ideas of race that were the base of the
racial speech that justified and supported the slavery and
segregation (5).
Although the race concept can, in some few cases, be
used to reveal inequities between human groups, the utilization
of this concept in medical sciences can contribute to ideas of
biologic determinism (6) and complicate diseases diagnosis (7).
Moreover, stereotypes associated to certain ethical groups can
produce distinct behavior among health professionals, resulting
in less access to health services (8), diagnosis exams of high
technology (9) and treatment (10).
Because of its concept, there is a belief that the distinction
of human being has a solid base in biologic evidences.
Nevertheless, there are several problems for the utilization of
this concept by the biologic point of view. Because of this, the
purpose of the present investigation was to verify the difficulties
of the utilization of the race concept for human populations.
The first problem in the conception of human races, in
agreement with Futuyma (11), is the need of having populations
circumscribed geographically. The human specie migrates by
nature and expanded through all the continents since its origin.
A brief partial isolation permitted the beginning of the
differentiation of the species. Nevertheless, mainly after the
beginning of the Great European Navigations, any type of
isolation was capable to be broken. With the innovation and
increase of the transports this possibility reached unimaginable
levels in few decades ago. Besides, trying to apply only
geographic criteria for the designation of human races is not
adequate because, as stated Cartmill (12), if “black”, “white”,
“asiatic” and amerindians individuals that are born in the same
place are different by the racial point of view, so the races are
not distinct geographically. On the other hand, if these
individuals constitute a race, the races are not distinct
phenotypically.
The definition of race is imprecise, extremely broad and
submitted to several interpretations in agreement to the criteria
to be utilized. There is not a specific criteria that can guarantee
to populations the designation of race, which is taking lots of
systems to propose the abandon of the term (13). Applied to the
human beings, this term corresponds to an arbitrary system of
visual classification that does not demarcate distinct populations
(14).
Race is a characteristic of convenience, which is used
when there is the need to distinguish populations, which makes
different criteria to be used by different classifying agents.
Several characteristics and genetic polymorphisms show
different geographic patterns with the possibility of several
combinations to distinguish one population from another (15).
The recent number of human races identified can vary from 3 to
200 (16).
The classification of human beings depends on who and
where the evaluation is made. Anthropologists that lecture in
institutions that are not from the elite and that had a social origin
less privileged tend to be more receptive to the position of non
existence of races than their colleagues from elite institutions
60 Eubios Journal of Asian and International Bioethics 14 (March 2004)
(17). In England, “Asiatics” correspond to people that come from
India, Pakistan and Bangladesh, whereas in the United States, it
describes people from Pacific Islands, China and Japan (18). A
person with European ancestry born in Mexico could be
classified as “white” in all the countries of Latin America,
whereas in the United States would probably receive the
classification of “latino” or “hispanic”.
The definition of some races can change with the time. In
the Unites States, in the beginning of immigration, Irish and
Italians were considered “not-white” being afterwards classified
as “caucasians” (19). Mexicans were considered “white” in
decades of 1940 and 1950 (20), being nowadays designated as
“hispanics”.
Classification is not elucidative and can obscure the
human diversity. Frequently there are utilized broad and vague
terms for the definition of races, which can include several
populational groups by the point of view of origin, culture and
ancestrallity under the same designation. The American census
of 1990 set ten subcategories for Asiatics and natives from the
Pacific Islands, but none for “whites”, which answered for 80%
of the population (21). The term “asiatic” utilized in the United
States can underestimate several populational groups, making
the great part of the world population o be seen as one (22).
Frequently the criteria utilized for the racial classification is
not adequate. Generally there are used extern morphologic
characteristics not very representative genetically. In one study
with a “white” brazilian population, it was verified the
contribution of 28% of afro-descendents and 28% of amerindian
in the total pool of mitochondrial DNA, which is inherited from
the mother (23). In one study of a “black” population of
Pittsburgh, in the United States, it was verified the presence of
25% of genes considered as “caucasians” (24). In other
American cities, the mixture of “European genes” in afro-
descendents ranged from 11.6% to 22.5% (25). In one afro-
descendent brazilian population, considered “black”, in the
Amazonic region, morphologic parameters verified the presence
of 14% of mixture individuals, whereas in the study of 12 genetic
markers of blood groups the mixture reached 24% (26). In the
same population, studies with markers of chromosome Y, of
paternal origin, verified the presence of 43% of mixture and with
mitochondrial DNA, of maternal origin, a mixture of 47% (27).
The color of the skin, as well as the color and the shape of
the hair and eyes, used in the races classification, are polygenic
and multifactorial characteristics not yet understood by the
biologic point of view (28). It is a characteristic of continuous
variation that does not allow the categorization in classes. The
levels of just one pigment known as melanin are responsible for
the production of several shades in the humanity. The
environment and age are factors extremely important in the
definition of the color of a person which turns very difficult to
associate a certain phenotype to a genotype (29). The
interaction with the environment is individual, that is, depends
on the history of life of each person, despite being similar to
individuals inhabiting the same geographic region.
Race is a typological concept and is based upon ideal,
nonexistent types in the nature. Being a static concept, based
upon fixed types, race cannot explain the complex changes of
structures in the biologic human variation (30). Besides, the
classical vision of race implies in a homogeneous group of
individuals where the members are similar biologically among
them and differ from members of other groups, which does not
occur, because members of certain group possess great genetic
variations (31).
It is important to remember that the concept of race
emerged in a time when it was believed that the World was
constant and unchangeable since the moment of its creation.
The beings did not modify or evolve. The classification were
only to better adequate the beings in the Scala Naturae, or
Great Scale of the Beings. This scale was considered
permanent, unchangeable and did not present defects or
lacuane (32). Thus, the different human population, considered
unchangeable, not only was adequate but also should be
differentiated in this Scala Naturae. This static concept is not
consistent with the continuous process of biological evolution.
The biological human variation, as well as of the other species
is continuous, complex and changeable.
Comparing the human populations with other species, it is
observed that the human specie is the one that presents one of
the smallest values of genetic diversity. This fact is a direct
consequence of the high rate of dispersion, migration, as well as
the short time of evolutive history of our specie. Comparing the
human being with species of mammals with power of
dispersion, we see that the human differences are not high,
even with the great distribution of the human population. The
human beings show a modest level of genetic differentiation and
this level of differentiation is below from what is conventionally
written of what separate races (33).
Only recently we can test the existence of races in more
precise biological terms, with the advance of genetics and
molecular biology. Data show that the differences between
human populations are not enough to classify them as races.
The results of extensive genetic studies of several human
populations from different continents show the fragility of the
concept of race, because it was verified that the human diversity
was higher inside the “racial” or geographic groups than among
them. Lewontin, analyzing populations from distinct continents,
concluded that 85% of the human genetic diversity occurred
inside the populations or races (34). In 1980, studying the
populations of Europe, Africa, Middle Orient, Asia, America and
Oceania, Latter (35) verified that the diversity inside the
populations was nearly 84%, among populations of one group
6% and only 10% among the geographic groups. Others studies
with several populations and different markers had the same
conclusion (36,37).
No one can deny that Homo sapiens is a specie markedly
differentiated; few argue the observation that the differences in
the color of the skin is the most obvious sign of this variability.
But the variability does not request the designation of race, in
the case of our specie, it does not occur in levels that allow this
designation. This point of view does not imply that there is not a
variation among populations that compose our species, but this
variety is not characterized as race (38).
Race is a social and not a biological concept, with serious
ethical implications. As mentioned by Varma (39), the history of
Eugenia presents scientific questions related to race and
ethnicity, despite the benevolent intentions, can take to the
legitimacy of discriminatory stereotypes.
The classification of human beings in different races is not
based upon biological differences, is imprecise, convenient for
those that do the classification, generally does not auxiliate a
better comprehension of human groups, does not inform with
precision our evolutionary history and is not based in genetic
differences among human population. This division, arbitrary
and artificial, emphasizes the small differences among
populations with their stereotypes and prejudices, and not
supplying a better comprehension of the human being.
References
1- Cooper, R & David, R. 1986. The biologic concept of race and its
application to public health and epidemiology. J Health Polit Policy
Law, 11:97-116
2- Mayr, E. Populações, espécies e evolução. Companhia Editora
Nacional, Editora da Universidade de São Paulo. São Paulo, Brazil.
3- Futuyma, D. J. 1998. Evolutionary Biology. Sinauer Associates,
Sunderland
4- Oppenheimer, G. M. 2001. Paradigm lost: Race, ethnicity, and the
search for a new population taxonomy. Am J Public Health, 91:1049-
1055
5- Nobles, M.. A 2000. Comparative Analysis of Racial/Color
Categorization in US and Brazilian Censuses. Am J Public Health,
90: 1738-1745
6- Jones, C. P. 2000. Racism, and the practice of epidemiology.
American Journal of Epidemiology, 154:299-304
7- Caldwell, S. H. & Popenoe, R.1995. Perceptions and misperceptions
of skin color. Ann Intern Méd, 122: 614-617.
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
8- Lieu, T. A., Newacheck, P. W. & McManus, M. A. 1993. Race,
ethnicity and access to ambulatory care among US adolescents. Am
J Public Health, 83:960-965.
9- Hannan, E. L., Kilburn, H., O’Donnell, J. F., Lukacik, G. & Shields, E.
P. 1999. Access to coronary artery bypass surgery by race/ethnicity
and gender among patients who are appropriate for surgery. Medical
Care, 37:68-77
10- Bach, P. B., Cramer, L. D., Warren, J. L. & Begg, C. B. 1999. Racial
differences in the treatment of early-stage lung cancer. N Engl J
Méd, 341:1198-1205.
11- Futuyma, D. J. op. cit. note 4
12- Cartmill, M. The Status of the Race Concept in Physical
Anthropology. Am Anthropologist 1999; 100:561-660
13- Futuyma, D. J. op. cit. note 4
14- Fullilove, M. T. 1998. Abandoning “Race” as a Variable in Public
Health Research – An Idea Whose Time Has Come. Am J Public
Health, 88:1297-1298
15- Templeton, A. R. 1998. Human Races: A Genetic and Evolutionary
Perspective. Am Antropologist, 100:3
16- Armelagos, G. J. 1994. Racism and physical anthropology: Breves’s
review of Barkan’s the retreat of scientific racism. Am J Phy Anthrop,
93:381-383
17- Littlefield, A. 1982. Redefining Race: The Potential Demise of a
Concept in Physical Anthropology. Current Antropology, 23:641-655
18- Pfeffer, N. 1998. Theories in health care and research: theories of
race, ethnicity and culture. British Medical Journal, 317:1381-1384
19- Thomas, S. B. 2001. The color line: Race matters in the elimination
of health disparities. Am J Public Health, 91:1046-1048
20- Hayes-Bautista, D. E. & Chapa, J. 1987. Latino Terminology:
conceptual Bases for Standardized Terminology. Am J Public
Health, 77:61-68
21- Bhopal, R. & Donaldson, L. 1998. White, European, Western,
Caucasian, or What ? Inappropriate Labeling in Research on Race,
Ethnicity and Health. Am JPublic Health, 88:1303-1307
22- Clayton, E. W. 2002. The complex relationship of genetics, groups,
and health: what it means for public health. J Law Med Ethics,
30:290-299
23- Alves-Silva, J., da Silva M., Guimaraes P. E., Ferreira, A. C.,
Bandelt, H. J., Pena, S. D., Prado, V. F.. 2000. The ancestry of
Brazilian mtDNA lineages. Am J Hum Genet, 67:444-461.
24- Chakraborty R., Kamboh, M. I., Nwankwo, M., Ferrell, R. E. 1992.
Caucasian genes in American blacks: new data. Am J Hum Genet,
50:145-155
25- Parra, E. J., Marcini, A., Akey, J., Martinson, J., Batzer, M. A.,
Cooper, R., Forrester, T., Allison, D. B., Deka, R., Ferrell, R. E.,
Shriver, M. D. 1998. Estimating African American admixture
proportions by use of population-specific alleles. Am J Hum Genet,
63:1839-1851
26- Guerreiro, J. F, Ribeiro-dos-Santos, A. K, dos Santos, E. J. M.,
Vallinoto, A. C. R., Cayres-Vallinoto, I. M. V., Aguiar, G. M. F and dos
Santos, S. E. B. 1999. Genetical-demographic data from two
Amazonian populations composed of descendeats of African slaves:
Pacoval and Curiau. Gen Mol Biol, 22:163-167
27- Ribeiro-dos-Santos, A. K., Pereira, J. M., Lobato, M. R., Carvalho,
B. M., Guerreiro, J. F., Batista-dos-Santos, S. E. 2002. Disimilarities
in the process of formation of Curiaú, a semi-isolated Afro-Brazilian
population of the Amazon Region. Am J Hum Biol, 14:440-447
28- Sturm, R. A., Teasdale, R. D., Box, N. F. 2001. Human
pigmentation genes: identification, structure and consequences of
polymorphic variation. Gene, 277:49-62
29- Sturm, R. A., Box, N. F., Ramsay, M. 1998. Sturm et al. Human
pigmentation genetics: the difference is only skin deep. Bioessays,
20:712-720.
30- Goodman, A. H. 2000. Why genes don’t count (for racial differences
in health). Am J Public Health, 90:1699-1702
31- Jones, J. S. 1981. How different are human races ? Nature,
293:188-190
32- Futuyma, D. J. op. cit. note 4
33- Templeton, A. R. op. cit. note 15
34- Lewontin, R. C. 1972. The apportionment of human diversity. Evol
Biol, 6:381-398
35- Latter, B. D. H., 1980. Genetic differences within and between
populations of the major human subgroups. Am Nat, 116:220-237
36- Deka, R., Shriver, M. D., Yu, L. M., Ferrel, R. E. & Chakraborty, R.
1995. Intra- and inter-population diversity at short tandem repeat loci
in diverse populations of the world. Electrophoresis, 16:1659-1664
37- Barbujani, G., Magagni, A., Minch, E., Cavalli-Sforza, L. L. 1997. An
apportionment of human DNA diversity. Proc Natl Acad Sci USA,
94:4516-4519
38- Livingstone, F. B. 1997. On the non-existence of human races. In:
Ridley, M. Evolution. Oxford University Press, Oxford
61
39- Varma, J. K. 1996. Eugenics and immigration restriction: Lessons
for tomorrow. JAMA, 275:734-737
Cyber-pharmacies and ethical
concerns over marketing
drugs online
- Vinod Scaria
Center for Cybermedicine and Internet Research
Perumcheril, 33/4711, Malaparamba, Calicut 673009,Kerala
India
E-Mail: vinodscaria@yahoo.co.in
Introduction
The last few years have witnessed the rapid proliferation
of websites offering online medical advice and selling
prescription drugs over the Internet. These new class of Online
Pharmacies originated as an innate part of the booming e-
economy, wherein all real world services were rendered online.
The inherent anarchic structure of Internet lets anybody
sell virtually anything over the Internet, without bothering to
obey the law of any single country. Moreover the cross-border
practice possible over the Internet lets it impractical to monitor
the activities of these websites. This poses a severe public–
health threat and an ethical catastrophe.
The concerns regarding Cyber-pharmacies have been
growing steadily probably with the report in early 2000 on some
cyber pharmacies [which advertised of facilities that were in
existent] settling US Federal trade commission charges [1], and
the publishing of the E Health Ethics Initiative code of conduct.
[2]
Interesting Research on Cyber-pharmacies
Eysenbach [3] studied Websites selling Viagra Online by
posing to be a patient for whom the drug was clearly
contraindicated, and found that 3 of the 22 websites delivered
the drug in spite of being contraindicated. He also found that
only on two websites a physician reviewed the order. He also
found that in a majority of cases, even a proper history was not
taken.
Bonakdar [4] studied websites offering cancer cure and
concluded that a number of websites offered cancer cure
through herbal medication with little regard for current
regulations.
Scaria [5] studied websites offering sale of Viagra and
analysed the information regarding contraindications provided to
potential consumers and found that though most of the websites
provided information on contraindications, majority was
incomplete
Ethical Concerns
Information and the right to reliable Information
Consumers have the right to reliable and trustworthy
information about something he is going to buy. Studies [5]
show that most of such information is incomplete. Often the
Information is fraudulent or inconclusive [see Fig1]. Inconclusive
or fraudulent information bound in a cloak of professional design
and presentation is an important concern.
62 Eubios Journal of Asian and International Bioethics 14 (March 2004)
Figure [1] A Screenshot from a website that claims to enlarge
male genital organs in 30 days. The website claims it to be
Medically proven, but does not provide any evidence/details
regarding research.
Honesty, Disclosure and Candor
The consumer has the right to know who is behind a
website, and what his/her affiliations are- since they are of direct
importance to his health. It would also enable the consumer to
make informed decisions, and to think of probable avenues of
malpractice. The fact is that most of the websites selling drugs
are really gateway websites, which redirect/link to bigger firms
by virtue of some affiliate program. These websites [serving as
middlemen] are little concerned about the quality of information
they provide or responsibility to consumers. In other words,
these websites are interested in nothing but profit.
Consumers also have the right to honest analysis of
research findings. Many websites advertise of ‘Medically
Proven’ products, but hardly provide any information regarding
the setting in which the study [if any] was conducted, and when
and where [a scholarly journal] it was published. Stephen
Barrett [7] says Herbal medications, could not possibly be sold
profitably on the Internet without deception, which includes (a)
lack of full disclosure of relevant facts, (b) promotion or sale of
products that lack a rational use, and/or (c) failure to provide
advice indicating who should not use the products. Given the
number of websites selling such ‘Herbal” medications, anyone
could just imagine how ethical the marketing practices on the
Internet are.
Informed Consent and Responsibility
Informed consent is a key pillar of trust and relationship in
real world. Over the Internet, consumers are potentially under-
informed or worst un-informed. This raises the integrity of the
consent provided by potential consumers. Most of the websites
offer a disclaimer notice, according to which all liability is
restricted to refund of money.
Trust and Relationships:
Physician-patient or Customer relationships virtually never
exist in the online world. The maximum liability in any case is
minimized to refund of money. Thus lack of relationship in the
virtual world, with the potential of Internet to maintain anonymity
of concerned individuals leads to the deterioration of ethical
conduct and quality of services.
Anonymity
Internet has created a situation wherein anybody could
operate in total anonymity. This is perhaps the prime source for
concern. Over the Internet, anybody could express anything,
sell anything and mislead anyone, under the cloak of a
professional website and a flashy Domain name and E-Mail ID.
Anonymity means the concerned individuals are potentially free
of any responsibilities to the customers and thus not obliged to
perform according to ethical norms.
Quality Assurance, Accountability and Consumer Protection
One could easily see that anybody could promote virtually
anything over the Internet. Only a good web host and a flashy
website is all what is needed. Since most of these websites
operate in anonymity, and potentially out of the reach of law of
any single country, patients who have been deceived are less
likely to get protection/compensation from consumer reprisal
forums.
Privacy and Confidentiality
Privacy and Confidentiality are part of ethical conduct in a
real world physician-patient relationship. Over the Internet, there
is hardly anything private/confidential. Anybody from a
Webmaster to a hacker could have access to your personal
information. Most of the websites do not have a privacy policy or
reliable framework to prevent people from peeking into their
consumers’ personal information. Though regulatory
frameworks [6] are emerging, there is hardly any compulsory
system to oversee the implementation of such frameworks over
a time-bound period.
Cross Border Activity and Legal implications.
Legal frameworks are highly variable. What might amount
to an unlawful conduct in one country/region may not be the
same elsewhere. Similarly one drug that may be available with
prescription in one country/region may be available elsewhere
without one. Moreover different countries have different
standards for production and marketing of drugs. This would
also serve as potential areas of conflict between two parties.
Moreover, due to the lack of a Universal code of conduct, the
consumers hardly have any avenues to have their complaints
redressed.
Experiences with the E-Health Adversities Research Database
[E-HARD]
The E-HARD [8] was set up in January 2003 to collect
evidence related to E-Health adversities. To date three cases of
fraud involving cyber pharmacies have been submitted, and
currently under evaluation. These websites were involved in
marketing so-called ‘herbal preparations’ for diseases as varied
as Cancer and AIDS. One website even claimed to cure AIDS
with their six week therapy.
It is also amazing to note that these websites also
significantly contribute to the menace of Unsolicited Commercial
E-Mail [UCMs] or SPAM. Some of our unpublished research
shows Health related spam contribute to something around 10-
12% of all Unsolicited commercial E-Mails.
Conclusions
Internet is slowly evolving into a new ‘Virtual World’ or the
‘Second World’ and is leaving its impact in our lives too. The
emerging E-Economy is also making its presence felt in all
domains. The virtualization of Healthcare is also underway- with
the Emergence of CyberMedicine and Telemedicine as
emerging technologies. Cyber-Pharmacies- a virtual extension
of real world pharmacies also forms a significant part of the new
economy. The ethical concerns regarding marketing of
medications online are myriad- most of them emerging from the
anonymity and anarchy offered by the Internet. A regulatory
approach to this problem is not possible due to the uncontrolled
and anarchic structure of Internet.
The possible way out is perhaps trustmarks/seals like the
HON code of conduct seal [9] and consumer Education.
Coaxing more websites to join such accreditation programs
would significantly improve the state of E-Health. Moreover
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
setting up of websites that systematically collect evidence on
misconduct over the Internet is necessary. A host of such
websites, with interconnectivity would enable planning and
implementation of strategies aimed at improving the state of
affairs.
References
1] Online Pharmacies Settle FTC Charges
http://www.ftc.gov/opa/2000/07/iog.htm
2] eHealth Ethics Initiative. eHealth code of ethics. Internet Healthcare
Coalition, May 2000. www.ihealthcoalition.org/ethics/ehcode.html
3] Eysenbach G.Online Prescribing of Sildanefil (Viagra®) on the World
Wide Web. Journal of Medical Internet Research 1999;1(2):e10
http://www.jmir.org/1999/2/e10/
4]Bonakdar RA. Herbal cancer cures on the Web: noncompliance with
The Dietary Supplement Health and Education Act. Fam Med 2002 Jul-
Aug;34(7):522-7
5] Scaria.V. Buying Sildenafil Citrate Online: are prospective buyers
informed of contraindications [in process of publication] [Preliminary
Draft]
6] Crigger B. Foundations of the eHealth Code of Ethics
http://www.ihealthcoalition.org/ethics/code-foundations.html
7] Barett S.How to Spot a "Quacky" Web Site
http://www.quackwatch.com/01QuackeryRelatedTopics/quackweb.html
8] E-Health Adversities Research Database
http://www.virtualmed.netfirms.com/ehard.html and
http://www.cybermedicine.netfirms.com/ehard.html
9] HON Code of Conduct http://www.hon.ch/Honcode
Competing Interests: The author maintains the E-Health
Adversities Research Database [E-HARD]. He is also the author
of the research paper [4] on cyber pharmacies cited in this
paper.
Actualisation of the
'Philosophical Functionalism'
in Bioethics
- Konstantin S. Khroutski, Ph.D.
Institute of Medical Education, Novgorod State University after
Yaroslav-the-Wise, Novgorod Velikiy (Russia)
IME NovSU, A/B 123, PO-25, Novgorod Velikiy, 173025 Russia;
E-mail: hrucki@mail.ru
Abstract
Developing the original philosophical system, exhibited in
my previous publications in the Eubios Journal of Asian and
International Bioethics (2002, 2003), I attempt to outline in this
paper, on the basis of the original 'philosophical functionalism',
the conception of the universal Cosmist anthropology and the
deduced notion of the bioethics of individual’s health. The
proposed approach in bioethics is characterised as person-
centric, health-centric and cosmist functional. Significantly, my
demonstrating and actualising of the Cosmist theses relies on
the first philosophical fundamentals: cosmological, ontological,
epistemological. Substantially, Cosmist anthropology and
bioethics treat a man as the bio-social-cosmist creature, but not
merely a bio-social one. The core notion of the original
approach is a person's Basic (Cosmist) Functionality, the
realisation of which leads a man to the entire ontogenetic well-
being.
Key words: philosophy of Process, Cosmist universal
anthropology, basic functionality, bioethics of individual’s health
"Philosophy is a science and therefore, like every other
science, it seeks to establish truths that have been strictly
proved and are therefore binding for every thinking being and
not only for a particular people or nation."
Nicolei O. Lossky.
(This sentence opens the chapter "Characteristic Features
of Russian Philosophy" in N.Lossky's book "History of Russian
Philosophy").
63
Introduction
From the very origin the question remains of whether
bioethical knowledge actually exists. Bioethics is a
multidisciplinary field of knowledge. But may be it is more "para"
than "multi"? Is it really possible to conduct the bioethical
expertise in medicine, especially in family medicine? Basically,
the term "bioethics" itself carries a deep contradiction in its
meaning, insofar it covers both the scientific substance (based
on "bios" - life sciences achievements) and the ethical
substance (based on "ethike" - philosophical reasoning). To all
appearances current bioethics will preserve (and even worsen)
this ambiguity and controversial character in its future
developments. Hence, are we capable to achieve the foundation
for clear practical activities in bioethics?
To my firm belief, the given situation is a direct challenge
to the creation of a new basis for bioethics, as well as
philosophy and science on the whole. The judgment of Nicolei
Lossky, which serves to me as an epigraph, clearly shows the
way to reaching this basis - through the synthesis of an a priory
(intuitive, phenomenological) knowledge with an a posteriory
knowledge (of objective, empirical, and descriptive essence),
although this kind of synthesis is the greatest philosophical sin.
Significantly, Lossky had endowed with particular powers the
philosophical branch 'cosmology'. To prove this it might be
sufficient to demonstrate his understanding of the task of
philosophy:
..."having studied the basic elements and aspects of the
world, philosophy must detect the interconnection between them
which forms the world-whole. Moreover, the world-whole,
studied by the branch of metaphysics called cosmology,
contains concrete individual elements of such significance as for
instance, the biological evolution, the history of humanity – and
philosophy must answer the question as to their meaning and
their place in the world-whole." (Lossky 1951, p. 402)
We do need cosmological thinking. Life on Earth is a
universal phenomenon in its substance. The latter is the
undeniable fact of natural sciences. Hence, we are substantially
inadequate in comprehension the cosmological (in Lossky's
meaning) foundations for universal philosophy and science. In
my context, for instance, I claim that either we will reach the
creation of the rational basis for universal bioethics or the
professional status, institutionalisation and future developments
of bioethics remain beyond the area of their lucid objective
understanding. In this, I fully support the claim of Prof. Jozef
Glasa, who puts forward the need for a new underlying
anthropological paradigm:
"The anthropological paradigm seems to be the decisive
point of reference. It represents a particular conception of what
the human being is; an image which implicit or explicit grounds
for everyday choices, thus determining models of behaviour,
criteria for evaluation and motivation for action. The term
"human nature," a guiding principle for ancient and medieval
cultures, has become a question for the modern and post-
modern culture of contemporary mankind. On the other hand,
human nature can be observed as an object of a great
anthropological project that should help to understand what and
who human beings really are, their proper place in the
biosphere and in the universe... Within the global project of
human nature, it has to have a say in the case for the future of
humankind." (Glasa, 2001)
Cosmist Basic Notions and Terms
The substantial characteristic of my original philosophical
system was given in my previous publications in the EJAIB
(2002, 2003), as well as in the other publications (Khroutski
2000, 2001, 2002, 2003). Here, I want to develop in depth some
core notions and terms, which might be crucial for
understanding the whole concept. I am content to exhibit my
points now taking into account the critical comments of the
colleagues that were caused by my presentation of the material
64 Eubios Journal of Asian and International Bioethics 14 (March 2004)
on the XVIIth European conference on philosophy of medicine
and health care in Vilnius, 2003.
Primarily, my cornerstone cosmological notion is CEPLE:
Cosmic Evolutionary Process of Life on Earth (my abbreviation
for it is simply Process). Process is an objective phenomenon
verified by numerous scientific disciplines, including
comparative anatomy, biochemistry, etc., related to evolutionary
history and, chiefly, to molecular biology. Therefore, Process is
an a posteriory notion precisely of objective and empirical
essence. Simultaneously, Process is an a priori notion, for it is
solely revealed through rational (intuitive) cognition. Hence, the
notion of Process integrates a posterior and a priori thinking,
disclosing the approach for universal comprehension of the
phenomenon of the life on Earth.
The other substantial notion, which stresses the
universality of the life on Earth, is 'subject'. In Cosmist
philosophy 'subject' means the integrated functional subject,
which forever integrates autonomously and hierarchically other
subjects (to be the functional whole) and, simultaneously,
always being functionally integrated by the higher organised
subject (organism). In other words, from the cosmist point of
view subject means every living organism on Earth: molecule,
cell, biological organism, biosphere, human being, family,
community, social body, society, mankind, and, ultimately,
Process itself (CEPLE) - the one common whole cosmic
evolutionary process of the life on Earth.
Another cornerstone notion is 'emergent future', which
means the successive appearing of the integrated macro-level
of the ontogenesis of a subject's (man's) wellbeing (the
university for a schoolboy; the vocational body for a graduate,
etc.). In this, the term "emergence" substantially has the
accepted meaning: the rise of a system that cannot be predicted
or explained from antecedent conditions.
Further, I would like to stress the cosmist meaning of the
term 'society'. This has not the prevailing political meaning, but
it relates to any community, structure, organization, or any other
socially functioning body of people having common purposes of
their organization.
It is also important to distinguish the meaning of the terms
'cosmist' and 'cosmic': the former stresses two points: a) the
intrinsic subjective origination of the primary perceptions of
man's creative activity; b) the deliberate character of a person's
creative activity, aimed at the achievement of the most desirable
possible state of adaptation and development on the current
level of her or his existence and, simultaneously, the gratifying
ascent on the successively higher level of man's entire
ontogenesis. In other words, a person performs cosmist
creative activity basically on his or her own. In turn, the term
'cosmic' puts a particular emphasis that a subject is ultimately
the function of Process. Finally, writing the word 'Cosmist' with a
capital letter or in Italics accentuates its reference to the original
philosophical system I have proposed.
Finally, the term 'creativity' has no correlation with
supernatural factors, but designates precisely a person's
inherent natural ability and energy to create: to originate, to
design, to invent, to bring into existence, etc. new products, or
results, or effects, etc. of one’s creative activity.
Original cosmological principles lay the foundation for the
advancement of a framework of ontological assumptions - the
so-called ACW system: of Absolute (in regard to the all-
embracing evolutionary Process), Cosmist (universal,
functionally intentional realisation of the ascending ontogenesis
of any subject - living organism: biological, personal or societal,
including man), Wholism (with reference to universal functional
integration of any subject into one whole - self-unfolding and
evolutionary ascending - Process). The definition of the ACW
system is exhibited in my previous publications.
Cosmist Anthropology: Reconciling Scientific and
Humanistic Paradigms
The cornerstone conception of the Cosmist anthropology
is the establishment of the three distinct functional macro-orders
of man's existence (functioning):
Homo Sapiens animalis (HSA) - the direct function of the
Biosphere.
Homo Sapiens sapiens (HSS) - the direct function of Society.
Homo Sapiens cosmicus (HSC) - the direct function of Process.
Both HSA and HSS are always Bio-Social creatures, and
not Bio-Social-Cosmist creatures. In other words, man in this
perspective is a bio-organism, social actor, and unique person
in his adaptation to the society, but he or she is not a Cosmist
agent carrying out his personal (functional, specific) contribution
to the one common Process. Cosmist philosophy replaces
"being" (a basic concept that serves as a starting-point for any
serious metaphysician) by "functioning," as a more basic
Cosmist concept, which points to the necessity of active
evolution for every living subject.
A crucial point is: In recognising the notion of Process we
obtain the substance to which all Earth's living subjects can be
functionally reduced. Every living subject on Earth is ultimately a
function of Process - of the ultimate self-evolving organism of
life. Reasonably, then, every living subject on Earth has
its/his/her basic (ultimate, cosmist) functionality. The notion of
man's basic functionality means that any subject is intrinsically
and basically dedicated for the realisation and execution
ultimately of the special function.
In light of the Cosmist concept, basic cosmist
functionality (BCF) governs human ontogenesis. In other
words, basic functionality hierarchically organises man's entire
repertory of biological and social needs in one integral order.
This order, in principle, repeats the hierarchy of the main stages
of biological and social evolution on Earth. Hence, biological
and social needs may be considered tools for BCF to implement
its self-unfolding and ultimate self-actualisation. In other words,
all biological and social needs of human beings conform to the
ultimate end of his or her specific functional contribution to
wellbeing in the shared Earth life Process. The latter is mainly
possible at the high creative level of mature social stability, the
culminating point of man's ontogenesis.
In course of this reasoning the fundamental principle of
CosmoBiotypology has emerged. CosmoBiotypology may serve
as a concrete cosmist law, which states: Every living subject on
Earth is a natural (more accurately, cosmic) function of the
higher-level congenerous subject and ultimately of Process
itself. Thus, every living subject on Earth naturally bears the
biotypological traits of this intrinsic basic functionality and
naturally relates to the appropriate ecological-social
environment. In other words, the principle of
CosmoBiotypology establishes the functional identity and thus
the universal meaning of the three macro-orders of man's entire
wellbeing: satisfying subjective feelings and perceptions;
adequate position in the social-ecological environment; and
biological constitution or biotype. The latter serves precisely to
fulfil the person's cosmist functional assignment. Thereby, the
CosmoBiotypological principle aspires to universalise
biomedical, social, and human knowledge – to unite rationally
man's subjective knowledge with objective knowledge of man
and, thus, to reconcile previously incompatible scientific and
humanistic paradigms.
Conclusion
Prof. Darryl Macer, director of the Eubios Ethics Institute,
distinguishes at least three ways to view bioethics:
1. Descriptive bioethics is the way people view life, their moral
interactions and responsibilities with living organisms in their
life.
2. Prescriptive bioethics is to tell others what is ethically good
or bad, or what principles are most important in making such
decisions.
3. Interactive bioethics is discussion and debate between
people, groups within society, and communities about 1 and 2
above. (Macer 1998)
 Eubios Journal of Asian and International Bioethics 14 (March 2004) 65

In this course I claim the existence of the fourth way - - K. K. Verma, Ph.D.
bioethics of individual's health, the essence of which is a Retd. Professor of Zoology
person's self-realising his or her inherent route of wellbeing HIG 1/327 Housing Board Colony
(healthy, safe, satisfactory, happy) ontogenesis. Fundamentally, Borsi, DURG ñ 491001, India.
the proposed universal bioethics of individual's health is truly Email: kkverma@kkverma.com
personcentric, health-centric and of true wholistic subject-
subject essence. The subject-subject pattern means that an
explorer (a subject: scientist, doctor, specialist in bioethics, etc.)
treats any phenomenon of the one common evolutionary
process of the life on Earth (Process) not simply as an object of
scientific observation or analytical reasoning, but likewise as the
equally (in relation to him) integrated - in relation to Process -
subject, which (who) has its/his/her own functional assignment
and, thus, its/his/her own as past and present as emergent
future being and wellbeing. Moreover, relying on Cosmist
philosophical fundamentals, I logically claim that: A) exclusively
the personalist (subjective) level of consideration is
appropriate for the universal comprehension of phenomena of
the life on Earth, including the individual health of a man; and B)
that exclusively the cosmist functional approach can reach the
universal comprehension of the entire living world on Earth:
biological, personal, and societal.

References
Glasa J. 2001. Bioethics: 'A Case for the Future of Man',
(http://business.hol.gr/~bio/HTML/PUBS/VOL6/HTML/glasa.htm)
Khroutski, K.S., and Veber V.R.: 2000. 'Health – a central ontological
problem ESPMH Conference, Krakow 2000 – Abstracts', Medicine,
Healthcare & Philosophy 3 (3): p. 381.
Khroutski, K.S.: 2000. 'Individual Health: New Definition and Ontological
Background', Medical Ethics & Bioethics (Bratislava) 7(1-2): pp. 14-
17.
Khroutski, K.S.: 2001. 'Introducing Philosophical Cosmology', World
Futures 57(3): 201-212.
Khroutski, K.S.: 2001. 'The Doctor of Tomorrow – Physician,
Psychologist, Philosopher: Towards the Cosmist-Hippocratic Ethics
in Biomedicine', Appraisal 3(4): 135-146.
Khroutski, K.S.: 2002. 'Towards the Bioethics of Individual's Health:
Introduction of the Cosmist Philosophical Fundamentals', Eubios
Journal of Asian and International Bioethics 12(1): 2-9.
Khroutski, K.S.: 2002. 'Epistemology of civilised man’s diseases', E-
Logos (http://nb.vse.cz/kfil/elogos/epistemology/khrout1-02.htm)
Khroutski, K.S. and Peicius, E.: 2003. 'Introducing the Emergence-
Discourse Method to Philosophy of Medicine and Bioethics: In
Search for Rational Comprehension of Individual Health', Eubios
Journal of Asian and International Bioethics 13(1): 15-20.
Khroutski, K.S.: 2003. 'Integrative Mental Mapping Project Under the
'EDM' Processing: The Thesis', Eubios Journal of Asian and
International Bioethics 13(3), pp. 93-98.
Khroutski, K.S.: 2003. 'Introducing the notion of "Civilised Man's
Diseases": Philosophical substantiation. ESPMH Conference, Vilnius
2003 – Abstracts', Medicine, Healthcare & Philosophy 6: p. 193.
Khroutski, K.S. 2003. 'The Cosmist Future of Personalism', Appraisal
4(4), pp. 183-193.
Khroutski, K.S.: 2003. 'Bringing Forward the Philosophy of Universal
Science: A Cosmist Concept', E-Logos
(http://nb.vse.cz/kfil/elogos/science/khrout1-03.pdf)
Khroutski, K.S.: 2003. 'The Universalist Future of Contemporary Bio-
Science', World Futures (in print);
Khroutski, K.S.: 2003. 'Universal Anthropology: A Cosmist Approach',
Anthropology & Philosophy (in print).
Lossky, N.O. 1951. History of Russian Philosophy. New York:
International. Universities Press, Inc.
Macer, D. R. J. 1998. Bioethics is Love of Life: An Alternative Textbook
Christchurch, N.Z.: Eubios Ethics Institute.

CORRECTION - Social Darwinism – a

misinterpretation of a scientific theory
On p. 13 under the point (d) it was said, “In the modern human
species biological evolution (in the meaning of speciation) has
stopped taking place 1.5 million years ago…”. Here it should be
“0.15 million years ago…” Apologies. 1.5 million years ago it
was H. erectus stage in human evolution!
66 Eubios Journal of Asian and International Bioethics 14 (March 2004)
News in Bioethics & Biotechnology
Comments are written in text form together with recent
references. This list continues from the last issue of EJAIB and
will continue. This list is available on-line topic-by-topic (and
the on-line topical files have been updated), at:
http://www.biol.tsukuba.ac.jp/~macer/NBB.html
Genetic Engineering of Plants
Resistance for potato late blight has been engineered that is
race nonspecific, Trends in Plant Science 9 (2004), 5-6. A
conditional marker allowing both positive and negative
selection in plants has been made, NatBio 22 (2004), 455-8.
Genetic variation in plants is discussed in Nature Reviews
Genetics 5 (2004), 248. Sequencing of a rice centromere has
uncovered active genes, NatGen 36 (2004), 138-45.
California is planning to plant drug-producing GM rice,
Nature 428 (2004), 591. Indian scientists have made a salt-
resistant rice by GM, Science 303 (2004), 308. A company in
New Zealand, trees and Technology, is preparing about 3
million cloned Monterey pine trees for planting next year,
NatBio 22 (2004), 261. A review of genetic enhancement of
soybean oil for industrial uses is AgBioForum 6 (No.1, 2003),
11-3. The future of biotechnology in soybeans is reviewed in
AgBioForum 6 (No.1, 2003), 8-10. The development of GM
wheat is expected soon, Ram's Horn 218 (Feb 2004), 5.
Genetic Engineering of Animals
Mice have been cloned from olfactory sensory organs,
Nature 428 (2004), 44-9. Fish sperm can be made to order,
Nature Reviews Genetics 5 (2004), 167; PNAS 101 (2004),
1263-7.
The genome sequence of rat has been published making
further studies of genetics and disease possible, Science 303
(2004), 455-9; Nature 428 (2004), 464-6, 475-6. On rodent
models of hypertension, J. Physiology 554 (2004), 56-63. In
general on genetics of complex traits in animals, Nature
Reviews Genetics 5 (2004), 202-12. Artificial insemination in
beef cattle and fertility is discussed in J. Animal Science 82
(2004), 987-93. Animal models of hypertension are discussed
in TIG 20 (2004), 136-45.
Fluorescent enhancement of signaling in mantis shrimp is
reported in Science 303 (2004), 51. A description of the
Drosophila genome and a stock center for genetic variant flies
is in NatGen 36 (2004), 205, 207, 209, 211-2, 283-7, 288-92. A
cooperative mouse house is being made in New York, NatMed.
10 (2004), 214. Changes in lifespan of Drosophila are possible
by inbreeding, Heredity 92 (2004), 275-81. Regulation of bone
mass in mice is by lipoxygenase gene Alox15, Science 303
(2004), 229-32; cholesterol free mice have been made that are
viable, Science 302 (2003), 2087. Mice models of arthritis are
in Nature 426 (2003), 454-6; macular degeneration, NatMed. 9
(2003), 1390-7; Huntington disease may be treated by
trehalose, NatMed. 10 (2004), 123-4, 148-54.
Designer Molecules
A backwards-moving myosin motor has been engineered,
Nature 427 (2004), 558-61. A review of therapeutic peptides is
TIBTECH 21 (2003), 556-62. An engineered pathway for
formation of disulfide bonds has been made, Science 303
(2004), 1185+. Protein engineering is discussed in SA (Jan.
2004), 22-3. Protein surgery is discussed in Nature 427 (2004),
203-4. On RNAi, Nature Reviews Focus 5 (Dec. 2003), 4;
Nature Reviews Genetics 5 (2004), 81. Use of a ribozyme to
control gene expression is reviewed in Nature 428 (2004), 281-
6. Proteins can be made without DNA, SA (April 2004), 20-1.
Making ultra long DNA is discussed in NS (22 Nov. 2003), 8.
Making microbes by design is reviewed in Science 303
(2004), 158-61. Communication between bacteria is discussed
in SA (Feb. 2004), 22-3. Xylose fermentation by GM yeast is
reported in Bioresource Technology 92 (2004), 163-71. A
review of industrial enzymes is GEN 24 (15 March 2004), 1,
15-6, 59.
Biotechnology & the Public
A study of terror risk communication is in Biosecurity and
Bioterrorism 1 (2003), 255-8; and on risk communication in
general, BMJ 327 (2003), 1162-5, 1368, 1403-4; Public
Understanding of Science 12 (2003), 203-9; Science 303
(2004), 630-2. The ethics of crossing species boundaries is
discussed in Amer. J. Bioethics 3 (Summer 2003), 1-13, 20-1.
Monsanto is spending much money to promote the image of
biotech in Brazil, Ram's Horn 217 (Jan. 2004), 3-4. There is a
trend in Australia for increased risk perception but not an
increase in concern about biotechnology according to a new
survey (Media release 11 Feb. 2004, contact Craig Cormick,
Biotechnology Australia, 0418-963914).
Medical research sometimes raises media circuses, HCR 34
(Jan. 2004), 3; Morreim, EH. "High-profile research and the
media", HCR 34 (Jan. 2004), 11-24. Media ethics is also
discussed in Scientist (1 Dec. 2003), 53-4; Sociology of Health
& Illness 25 (Sept. 2003), 513-640; Public Understanding of
Science 12 (2003), 123-45; Nature 426 (2003), 222-3; BMJ 327
(2003), 1174; 328 (2004), 294; Lancet 363 (2004), 491. The
high profile of Japanese Nobel Prize winners is discussed in
Nature 427 (2004), 282-3. The Japanese Science Council is
being changed, Nature 428 (2004), 357.
The ethics of public consultation is discussed in Health
Care Analysis 11 (2003), 15-25. An interesting series of public
meetings is being held in New Zealand to seek public opinion
over whether human genes should be placed in other organisms
by the Bioethics Council, www.bioethics.org.nz. Participatory
research ethics in public housing is discussed in Science and
Engineering Ethics 9 (2003), 485-502. On biotechnology and
bioethics, CQHE 13 (2004), 185-92; NatBio 21 (2003), 1282;
22 (2004), 269-70; Science 303 (2004), 1142; NS (28 Feb.
2004), 44-7. On the ethics of technology, a book review of
Kass, LR., Life, Liberty and the Defense of Dignity is HCR 34
(Jan. 2004), 44-5. Technological mastery is discussed in
Science 303 (2004), 629-30; Nature 426 (2003),385-6.
Discussion of useful biotechnology for the global society is in
NatBio 21 (2003), 1434-6. On the age of DNA, Nature 426
(2003), 229-30; NatMed. 10 (2004), 15; Genome 46 (2003),
925-973. Phobias of nature are discussed in Sociology of Health
& Illness 25 (2003), 644-61.
Fears of nanotechnology are debated in Nature 426 (2003),
750; Economist (20 March 2004), 87-8. Methods to integrate
ethics in the engineering curriculum are discussed in Science
and Engineering Ethics 9 (2003), 543-68. Religion and science
with the teaching of creationism are discussed in BioScience 54
(2004), 3, 6-7; Science 303 (2004), 1268; Nature 428 (2004),
595.
The abuse of genetics in sport is discussed in Guardian (17
Feb. 2004). New steroids are difficult to detect, SA (Feb. 2004),
12-3; NS (1 Nov. 2003), 3, 8-9; Lancet 362 (2003), 1466. There
are also genetic tests for athletic performance, see
www.gtg.com.au. Memory enhancing drugs are discussed in
Science 304 (2004), 36-8. Cosmetic surgery is discussed in
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
BMJ 328 (2004), 590; Lancet 362 (2003), 1560; 363 (2004),
958. On breast implants, Lancet 363 (2004), 218, 379, 664.
Regulation & Field Trials of GMOs
A summary of accidents in GM containment is in
GeneWatch 17 (Jan. 2004), 8-9; see
www.genewatch.org/bubiodefense. On GMO regulation
internationally, GeneWatch 17 (Jan. 2004), 12-4. The UK
government approved use of commercial GM crops on 9 March
2004, Science 303 (2004), 1590. They claimed that GM crops
are beneficial for the environment, NS (6 Dec. 2003), 17. They
have approved the commercial growth of Bayer LL-Chardon
variety of fodder forage maize, NatBio 22 (2004), 371; Current
Biology 14 (2004), R213-4. The UK debate on GMOs is
discussed in GeneWatch 16 (Nov. 2003), 10-12; Current
Biology 14 (2004), R889-90; Nature 428 (2004), 107; NS (13
March 2004), 3. Mendicino county in California, USA has
banned growth of GMOs, Science 303 (2004), 1608; Nature
426 (2003), 488. Meanwhile, Europe has approved commercial
GM crops, Science 303 (2004), 448; Nature 427 (2004), 474.
The present state of use of GM crops in the EU is in Acta
Agric. Scand. Section B Suppl.1 (Dec. 2003), 14-18. The EU
has adopted regulation for the Cartegena Protocol, Agrafood
Biotech. 118 (25 Nov. 2003), 10; and approval of GM crops,
Science 303 (2004), 448. A review of the EU GM pipeline is
Agrafood Biotech. 118 (25 Nov. 2003), 6-7. The agency
responsible for GM trials in Germany is shifting from Ministry
for the Environment to the Federal Agency for Natural
Conservation, which is more negative towards GM trials,
Nature 427 (2004), 279.
A discussion of sustainable agriculture for developing
countries is Biology International 45 (2003), 34-8. Debates
over intensification of rice are in Nature 428 (2004), 360-1. A
paper on ethics in FAO is Macer, DRJ., et al. "Ethical
opportunities in global agriculture, fisheries, and forestry: The
role for FAO", J. Agric. & Env. Ethics 16, 479-504.
Brazil has approved provisional measure No. 131
authorizing the planting of transgenic soyabean in 2003/2003
and the sale and harvest of soybeans until 31 January 2005,
Agrafood Biotech. 118 (25 Nov. 2003), 12. Criticism of
Monsanto policy in selling GM soybean and corn seeds to
Argentina and Brazil is in Ram's Horn 218 (Feb 2004), 1-4.
Papers on the GMO debate in Africa are African J. Biotech 2
(2003), 394-516; Nature 426 (2003), 224-6; NS (20 Dec. 2003),
21. A list of GM crops in Africa is in NatBio 22 (2004), 260.
Monsanto is planning to export GM wheat to South Africa,
Nature 427 (2004), 386-7. Bt cotton may be useful for small-
scale producers in South Africa, NatBio 22 (2004), 379-80.
Australia and New Zealand would face serious economic
consequences if they boycotted GM technology according to
economic estimates, APBN 7 (No., 24, 2003), 75,77; Nature
428 (2004), 594. The number of chronically hungry people is
increasing about 5 million a year, BMJ 327 (2003), 1303.
The planting of GM crops containing drugs is expected
soon, NatBio 22 (2004), 133. The transgenic GloFish is being
sold in California, though there is debate over its safety, Nature
426 (2003), 372, 596; NatBio 22 (2004), 379; NS (20 Dec
2003), 24. The mixing of cultivated plants and wild relatives is
discussed in Nature 427 (2004), 395-6. There are still debates
over defining GM, Science 303 (2004), 1765-71; Nature 426
(2003), 495. On academic freedom and GM views, Nature 426
(2003), 591.
A report on the ways to confine GMOs is US National
Research Council, Biological Confinement of Genetically
67
Engineered Organisms, 2004
(http://books.nap.edu/openbook/0309090857/html/),
BioScience 54 (2004), 179. A report on the regulation of GM
insects has encouraged the development of systems to regulate
GM insects, Pew Initiative on Food and Biotechnology, Bugs in
the System, 2004. (http://pewagbiotech.org/research/bugs/) For
a review see Science 303 (2004), 449; JAMA 291 (2004), 1055;
NatBio 22 (2004), 141. A report from the Keystone meeting
held on GM insect vectors is in NatMed 10 (2004), 216. A
review of how mobile elements drive evolution is Science 303
(2004), 1626-32. On horizontal gene transfer, Nature 427
(2004), 72-5. Lethal effects of biological insecticide Bt types
on nontarget lepidoteransis claimed in Community and
Ecosystem Ecology (Dec 2003). On the genetics of insecticide
resistance, Trends in Genetics 20 (2004), 163-70.
A commentary on the Kay report to US Congress on the
survey for bioweapons in Iraq is in Biosecurity and
Bioterrorism 1 (2003), 239-46. Biosecurity peer review in the
USA has been set up, Science 303 (2004), 1595. The question
of coding behaviour for bioweapons is discussed in Science and
Engineering Ethics 9 (2003), 453-70. The possibility of
reemergence of smallpox if released by terrorists is discussed in
Bulletin WHO 81 (2003), 917-8. Much money is being spent in
research in the USA on biodefense, Nature 426 (2003), 598-
601; NatBio 22 (2004), 375-8; Nature Reviews Genetics 5
(2004), 23-33. The US crackdown on scientists that research
infectious diseases is causing many to dispose of their
collections and stop research, NS (8 Nov. 2003), 3, 6-8; Science
303 (2004), 1743-4; Nature 426 (2003), 593; 428 (2004), 6. At
the same time approved researchers are making superbugs in
the lab., NS (1 Nov. 2003), 6-7; (28 Feb. 2004), 6-7. It is unsure
how rapidly smallpox spreads, SA (Jan. 2004), 13-4. A book
review on Japanese Germ Warfare is in Nature 427 (2004),
396. Also on bioweapons fears, Nature 427 (2004), 767; 428
(2004), 109, 454; NatBio 22 (2004), 369. On anthrax
vaccination in soldiers, NatMed 10 (2004), 112.
Vaccines & Diseases
A paper looking at leprosy is Burns, SL. "Making illness
into identity: Writing "leprosy literature" in modern Japan",
Nichibunken Japan Review 16 (2004), 191-212. There are still
stigmas in society in Japan for those with leprosy, Lancet 363
(2004), 544. On leprosy genetics, Nature Reviews Genetics 5
(2004), 161. A review of the prevention of smallpox in India in
the 19th century is NISTAD News 5 (Oct 2003), 34-6. A 19th
century French physician's dilemma in smallpox is discussed in
JAMA 290 (2003), 2329-30. Also on smallpox, JAMA 290
(2003), 2610. Ebola vaccine has been tested in humans, JAMA
291 (2004), 549-50; Lancet 362 (2003), 1815. There may have
been multiple sources of Ebola outbreaks since 1995, Science
303 (2004), 298-9. Ebola may be linked to decline of some
wildlife also, Science 303 (2004), 387-90.
There has been renewed debate on dangers of MMR
vaccine in the UK, BME 192 (2004), 1; 195 (2004), 1, 3-4;
GreenhealthWatch 7 (2003), 1-2; NEJM 350 (2004), 1380-2;
Nature 427 (2004), 765; 428 (2004), 1; BMJ 327 (2003), 1069;
328 (2004), 773; Lancet 363 (2004), 567-9. The authors of a
paper suggesting a link have withdrawn their paper, Lancet
363 (2004), 750; Nature 428 (2004), 112; NS (13 March 2004),
4. There were concerns about links of the researcher who
claimed a link being also involved in a court case on the risks,
BMJ 328 (2004), 483. Italy and UK have low MMR vaccine
uptake rates, BMJ 327 (2003), 1124. The question of whether
measles can be globally eradicated is discussed in Bulletin
68 Eubios Journal of Asian and International Bioethics 14 (March 2004)
WHO 82 (2004), 134-8. Japan is funding efforts to make a new
recombinant vaccine to provide protection against 4 diseases,
NatMed. 9 (2003), 1337. A study has found no link between
HiB type 1 vaccination and type 1 diabetes, NEJM 350 (2004),
1398-404. A vaccine that used to used, has health affects,
inactivated intranasal influenza vaccine increases risk of Bell's
palsy, NEJM 350 (2004), 896-903.
The additives to vaccines do not appear to pose any risks to
children, Lancet 362 (2003), 1987; SA (March 2004), 8-9. On
the safety of whole virus for influenza vaccine, Lancet 362
(2003), 1959-66; and vaccination against flu, JAMA 290
(2003), 2656-7; Science 303 (2004), 1280-2. The 1918 killer
flu virus has been identified, Science 303 (2004), 1787-8, 1866-
70; NEJM 350 (2004), 522-4; BMJ 328 (2004), 353, 368; see
also Science 302 (2003), 1519-22. Studies have found that flu
infections may actually enhance the development of asthma and
allergic responses, contrary to the hygiene hypothesis, NatMed.
10 (2004), 232-4. Influenza vaccine coverage in Japan is
reported in Lancet 362 (2003), 1767. Methods for delivering
vaccines are discussed in TIBTECH 21 (2003), 465-7.
The prospects for eradication of polio are discussed in
Science 303 (2004), 1960-8; Lancet 363 (2004), 93, 215;
Bulletin WHO 82 (2004), 1-70; NatMed. 9 (2003), 1454. There
have been problems in polio vaccination in Nigeria, NEJM 350
(2004), 645-6; BMJ 328 (2004), 485; Lancet 363 (2004), 709.
Atherosclerosis may have infection-induced involvement of
mitochondrial chaperonins, Lancet 362 (2003), 1949. The use
of meningococcal vaccine is discussed in NEJM 349 (2003),
2353-6.
Asian bird flu epidemic has had ,major economic
consequences and led to the sacrifice of many chickens across
infected countries, Science 303 (2004), 447; BMJ 328 (2004),
243; Nature 427 (2004), 573; NS (31 Jan. 2004), 10-1; (27
March 2004), 6-7. There were also threats to humans in some
cases, Hien, TT. Et al., "Avian influenza A (H5N1) in 10
patients in Vietnam", NEJM 350 (2004), 1179-88; BMJ 328
(2004), 238-9, 243, 308; JAMA 291 (2004), 1429-30. There is a
large market for animal biotechnology products, NatBio 22
(2004), 251. However patent concerns led to delays over
Vietnam's use of the vaccine, NS (25 Jan. 2004), 8. In general
on diseases like avian flu and SARS which cross species
boundaries, NEJM 350 (2004), 1171-2; Science 303 (2004),
292, 447, 609; NS (7 Dec. 2003), 13; (28 Feb. 2004), 36-9;
CMAJ 169 (2003), 698; Nature 427 (2004), 274, 472-3; Lancet
363 (2004), 134, 234-6, 373, 582, 587-93, 1006; BMJ 328
(2004), 308; NatMed. 10 (2004), 211. Livestock brucellosis has
saved human lives also, Bulletin WHO 81 (2003), 867-75.
The first case of a BSE-infected cow in USA led to bans on
beef imports from USA for sometime in some countries, NEJM
350 (2004), 539-41; SA (April 2004), 12-3; NS (21 Feb. 2004),
11; Current Biology 14 (2004), R93-4; JAMA 291 (2004), 553-
5; Nature 427 (2004), 5, 766; NatMed. 10 (2004), 113. There is
little risk to the public, JAMA 291 (2004), 543-9. In general on
disease risks from food and testing, Science 303 (2004), 156-7;
Lancet 363 (2004), 1084-5; NS (6 Dec. 2003), 20; (10 Jan.
2004), 5; (27 March 2004), 4. There are also risks that vCJD is
being transmitted by transfusion of blood, Lancet 363 (2004),
411-2, 417-21, 422; BMJ 328 (2004), 118-9; Science 303
(2004), 291, 1285. There is some association of CJD with use
of Lyodera, MJA 180 (2004), 177-81. A possibility of a drug to
fight CJD has been raised, Nature 426 (2003), 487; BMJ 328
(2004), 603. Korea has cloned cows resistant to BSE
(hopefully), Nature 426 (2003), 743. Prions may have a role in
long-term memory, Science 303 (2004), 28-9. Prion disease
may spread in the body, NatMed. 9 (2003), 1463-4; Lancet 363
(2004), 411, 422-8. Wildgame feasts may also be linked to
CJD, CMAJ 169 (2003), 443. Japan has now 11 cases of BSE-
infected cows, and may have found a new strain, NatMed. 9
(2003), 1442.
A paper on ethics and SARS is Singer, PA. Et al. "Ethics
and SARS: lessons from Toronto", BMJ 327 (2003), 1342-4;
and on public health control, Pang, X. et al. "Evaluation of
control measures implemented in the Severe Acute Respiratory
Syndrome outbreak in Beijing, 2003", JAMA 290 (2003), 3215-
21; 3222, 3229, 3251. On the Singapore cases, BMJ 328
(2004), 195-8. Tracking of SARS virus using DNA arrays is
reported in Genome Research 14 (2004), 398-405; NEJM 349
(2003), 2468-70; see also, JAMA 290 (2003), 2533-4. During
the SARS epidemic the virus evolved, Science 303 (2004),
1666-9; NEJM 349 (2003), 1875-6; Lancet 362 (2003), 1807-8;
363 (2004), 99-104. The duty to treat and SARS is discussed in
HCR 34 (Jan. 2004), 4; CMAJ 169 (2003), 141. A paper on
SARS and comparisons to lepers is in Croatian Medical J. 44
(2003), 674-80. The role of WHO in responding to disease
outbreaks is discussed in Science 303 (2004), 1605-6.
Information on SARS in Japan is reported in Lancet 363
(2004), 571-2.
There were only a few 2004 cases of SARS, Bulletin WHO
82 (2004), 152-3; Nature 427 (2004), 6-7; BMJ 328 (2004), 65;
NS (10 Jan. 2004), 6. This was despite many measures to
prepare for another outbreak, Lancet 362 (2003), 1632-3; 363
(2004), 409; Nature 426 (2003), 609-10, 752-3; 427 (2004),
87, 89; NEJM 349 (2003), 2381-2; Current Biology 14 (2004),
R91-3; CMAJ 169 (2003), 285-92, 299-200; JAMA 290 (2003),
2934; 291 (2004), 1313; NS (20 Dec 2003), 15. There have
been two reported lab accidents with SARSs, Science 303
(2004), 26. A genetic susceptibility to SARS has been
suggested, NatMed. 9 (2003), 1335. SARS vaccines are
discussed in Science 303 (2004), 944-6; Nature 427 (2004),
185; 428 (2004), 561-4; Lancet 362 (2003), 1895-6. The
presence of antibodies in patients suggests repeated SARS
infections, Nature 427 (2004), 185; NS (24 Jan. 2004), 15.
Border screening for SARS is still in effect in several countries,
MJA 180 (2004), 220-3; NatMed. 9 (2003), 1441. It is possible
SARS transmission may occur on aircraft, NEJM 349 (2003),
2416-22.
On public health in China, AJPH 93 (2003), 1991-3. The
ethics of evaluating a new treatment for melioidosis is
discussed in BMJ 327 (2003), 1280-2. On ecology of infectious
diseases, PLoS Biology 1 (Nov. 2003), 148-9. Emerging vectors
in the Culex pipiens complex are reviewed in Science 303
(2004), 1535-8. African labs are include din the tsetse-fly
genome project, Nature 427 (2004), 384. On emerging
diseases, Nature 428 (2004), 19; NS (10 Jan. 2004), 19.
Monkeypox has been detected in the Western hemisphere,
NEJM 350 (2004), 342-50.
Badgers are being killed to attempt to restrict TB in UK
cattle, however it appears it may increase local incidence of
TB, Nature 426 (2003), 834-7. Also on TB, Nature 427 (2004),
295; Lancet 363 (2004), 537, 814-9, 951.
Cities may have led to the recent outbreaks of dengue in
Southeast Asia, NatMed. 10 (2004), 129-30, 344+. At least 450
persons died from dengue in Indonesia in 2004, a doubling
since last year, Lancet 363 (2004), 956. Sustainable
schistosomiasis control is discussed in Lancet 362 (2003),
1932-4. Viral encephalitis is discussed in NEJM 350 (2004),
1266; BMJ 327 (2003), 1366. A review of Lassa fever is BMJ
327 (2003), 1271-5. Pacific countries have been fighting
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
lymphatic filariasis, as have other countries in the world where
120 million persons are infected, Lancet 362 (2003), 1906.
There are efforts to try to make this the first disease eradicated
through the use of drugs. The American Red Cross has decided
to screen blood for Chagas disease, Lancet 362 (2003), 1988.
Stable SNPs have been reported in malaria genes in
isolated populations, Science 303 (2004), 493. A review of the
14 grand challenge topics chosen by the Gates Foundation for
global disease research is in Bulletin WHO 81 (2003), 915-6.
The use of the Global Fund, WHO and medical malpractice in
malaria are discussed in Lancet 363 (2004), 237-40; BMJ 327
(2003), 1188. In general on malaria, BMJ 328 (2004), 534-5.
On genetic control of malaria, Science 303 (2004), 1984-5,
2030-32; PLoS Biology 1 (Nov. 2003), 142-4. The human
genome also changes as we interact with parasites, NS (22 Nov.
2003), 44-7. APOE genotype also alters risk of malaria, JMG
41 (2004), 145-6. The drug sulfadoxine-pyrimethamine
continues to fight against falciparum malaria in Malawi after 10
years use, BMJ 328 (2004), 545-8. Mosquito Anopheles has a
receptor for human sweat odorant, Nature 427 (2004), 212-3.
The implications of changing climate for malaria is discussed
in Nature 427 (2004), 690-1. Ethiopia may face 15 million
persons infected with malaria, Lancet 362 (2003), 2071. There
are still hurdles to make a vaccine against malaria, Bulletin
WHO 81 (2003), 902-7; Lancet 363 (2004), 150-6.
Giving insecticide-treated bednets to pregnant women is
discussed in Lancet 362 (2003), 1515-6, 1549-50; 363 (2004),
132-3. DEET-based insect repellents appear to be safe for
children, CMAJ 169 (2003), 209-12. A study of children over 6
years found that insecticide-treated curtains reduced child
mortality in Burkina Faso, Bulletin WHO 82 (2004), 84, 85-91.
A paper on fear of mosquitoes in USA is Herrington, JE., "Pre-
West Nile Virus Outbreak: Perceptions and practices to prevent
mosquito bites and viral encephalitis in the United States",
Vector-Borne and Zoonotic Disease 3 (2003), 157-74. A record
of US cases of West Nile infections is Lancet 362 (2003), 1870.
A book review of For Love of Insects is Nature 428 (2004),
368. Hybrid mosquitoes are suspected in West Nile virus
spread, Science 303 (2004), 1451.
Delayed prescriptions can reduce antibiotic use in
respiratory infections, BMJ 327 (2003), 1361-2, 1324-7. The
problems of antibiotic resistance in bacteria are discussed in
BMJ 327 (2003), 1177-8; Lancet 362 (2003), 1554-5; Science
302 (2003), 1488; JAMA 290 (2003), 2976-84; NatMed. 10
(2004), 6. Antibiotic resistance in food is a problem also,
BIOforum Europe 5 (Sept. 2003), 266-7. Links between
antibiotics and breast cancer are debated in JAMA 291 (2004),
827, 880-1. There are few new antibiotics, Lancet 362 (2003),
1726-7. The possibility of using predatory bacteria for
antimicrobial strategies is discussed in JAMA 291 (2004), 1188-
9.
AIDS & Sexually Transmitted Diseases
The question of compulsory screening of immigrants for
HIV and TB is raised in BMJ 328 (2004), 298-300. Attitudes
towards premarital HIV testing in Malawi is reported in
Croatian Medical J. 45 (2004), 84-7. A report from prenatal
HIV testing in Georgia is in JAMA 291 (2004), 1061-2. In
general on HIV testing, Economist (28 Feb. 2004), 84.
Papers on HIV, AIDS, sexual and reproductive health from
different countries are in Reproductive Health Matters 11 (Nov
2003), 6-198. Papers on HIV and use of ARTs are in JME 29
(2003), 313-29. WHO has been accused of backing campaigns
with dirty needles, NS (6 Dec. 2003), 5, 8-9. WHO policy is
69
discussed in Lancet 362 (2003), 1900-1. On Chinese policy,
Lancet 362 (2003), 1983; NatMed. 10 (2004), 4. Japan is
seeking safer blood tests after HIV mistakes, NatMed. 10
(2004), 217.
The involvement of caregivers in the informed consent
process for AIDS clinical trials is described in Nursing Ethics
11 (2004), 42-52. Also debates over vaccine clinical trials is in
Science 303 (2004), 316, 954-5, 961; Lancet 362 (2003), 1728.
A review on the use of attenuated live HIV vaccines is
Current Opinion in Infectious Diseases 17 (Feb. 2004), 17-26;
Science 303 (2004), 294-7. In general on HIV and AIDS crisis,
BMJ 327 (2004), 1101-3. Therapy for HIV is discussed in
NEJM 349 (2003), 2351-2, 2460-1; Lancet 362 (2003), 1597-8.
The World Bank has concluded that potential resistance to
antiretroviral therapy should not stop distribution to poor
countries, NatMed. 9 (2003), 1343-4. HIV drug resistance is
reviewed in NEJM 350 (2004), 1023-35. Access to therapy in
Africa is discussed in BMJ 328 (2004), 280-2; Lancet 362
(2003), 1811. The question of risk of myocardial infarction
from use of antiretroviral therapy is suggested in NEJM 349
(2003), 1993-2003; BMJ 327 (2003), 1186.
Screening of women with high risk types of papillomavirus
and later notification for tests is discussed in Lancet 362
(2003), 1866, 1871-6. Once a day valacyclovir reduces risk of
transmission of genital herpes, NEJM 350 (2004), 11-20.
Microbicides are safer for STD prevention, Lancet 363 (2004),
1002-3.
Microbes & Pollution Remedies
The engineering of plants for phytoremediation has been
progressed through the concept of vacuolar
compartmentalization, Trends in Plant Science 9 (2004), 7-9.
Molecular markers for plant bioremediation are available in
Germany, Industrial Processing 26 (Jan. 2004), 7. A review of
the long-term ecosystem response to the Exxon Valdez oil spill
is Science 302 (2003), 2082-6. Planning for removal of oil from
a sunken tanker is discussed in SA (Jan. 2004), 18. Restoration
of an open-cast coal mine by planting exotic tree species is
reported in Ecological Engineering 21 (2003), 143-51. A report
from remediation at US Dept. of Energy sites is Science 303
(2004), 1615-6.
Environmental Issues
On the ozone hole, Nature 427 (2004), 289-91. Genetic
differences in glutathione S- transferase enzymes alter the
sensitivity to sunburn, Amer. J. Pharmacogenomics 2 (2002),
147-54. Tanning is dangerous, FDA Consumer (Nov. 2003),
16-7. On air pollution and allergies, Lancet 363 (2004), 95-6.
Also on health impact of air pollution, NEJM 350 (2004), 834-
5. A summary of illnesses in USA from chemical agents is
JAMA 290 (2003), 2247-8; American Scientist 92 (Jan. 2004),
38-45. Chemicals alter reproductive health also, BMJ 328
(2004), 447-51. Estrogen may disrupt nitrogen fixation, Science
303 (2004), 950; EST 37 (2003), 5471-8.
A paper on ethics is Leopold, AC., "Living with the land
ethic", BioScience 54 (2004), 149-54. The need for clean water
is growing, BMJ 327 (2003), 1416-8; MJA 180 (2004), 260-1.
The environmental effects of NAFTA are discussed in
Environment 46 (March 2004), 26-41. Noise pollution is
discussed in NS (22 Nov. 2003), 26-7; (21 Feb. 2004), 26-9;
Pepper, CS. Et al. "A review of the effects of aircraft noise on
wildlife and humans, current control mechanisms, and the need
for further study", Environmental Management 32 (2003), 418-
32.
70 Eubios Journal of Asian and International Bioethics 14 (March 2004)
The impact of climate change on ecosystems is discussed in
Science 303 (2004), 176-7, 1600-2; SA (March 2004), 40-7.
Russia is still to decide whether to ratify the Kyoto Protocol,
Science 303 (2004), 1461-2. On the impacts of climate change,
MJA 179 (2003), 571-2. Volcanic eruptions are linked to El
Nino, Nature 426 (2003), 239-41. Wind power is discussed in
NS (6 Dec. 2003), 30-33.
Global warming and nuclear power are discussed in
Science 303 (2004), 433. On the development and politics of
nuclear weapons in North Korea, Science 303 (2004), 452-4;
and in general, Science 303 (2004), 161-4, 1772-3; Nature 426
(2003), 213; 428 (2004), 451; NS (7 Feb. 2004), 7.
Biodiversity
Genomic sequencing of sea water has found great diversity
of organisms, NS (13 March 2004), 12. Discussion of microbial
biodiversity is in Nature 428 (2004), 25-6; Current Biology 14
(2004), R65-6. There are many species not yet identified in the
oceans, NS (20 Dec. 2003), 20. in the USA, declining numbers
of species have been added in recent years to the list of
endangered species, Nature 426 (2003), 592; BioScience 54
(2004), 180-1. The burden of overcrowding upon the
environment is discussed in NS (22 Nov. 2003), 6-7. Decline in
birds is discussed in NS (13 March 2004), 14-5; and butterflies
in Science 303 (2004), 1747; 304 (2004), 27. On conservation
genetics, NatGen 35 (2003), 297. Conservation policy in coffee
growing areas is discussed in Science 303 (2004), 625-6.
Tropical soils and food security is discussed in Science 302
(2003), 1356-9; and fisheries in Science 302 (2003), 1359-62;
Nature 326 (2003), 378-9.
The dangers of ecotourists are discussed in NS (6 March
2004), 6-7. The conservation of dangerous animals like pumas
and wolves is feared by some, but most avoid humans, Nature
427 (2004), 385; NS (15 Nov. 2003), 50. India and Bangladesh
are carrying out a joint tiger survey, Science 303 (30 Jan.
2004). Hunters have led to decreased horn size in bighorn sheep
because of selective shooting, Nature 426 (2003), 595. Trophy
hunting in African male lions causes much damage as older
males are shot, NS (28 Feb. 2004), 16. Ivory sales have
increased fears of illegal trade in elephant tusks, NS (20 March
2004), 10. The exotic pet trade not only hurts biodiversity but
also has human health concerns, Nature 427 (2004), 277.
Overall however human health depends upon biodiversity,
Environmental Health Perspectives 112 (2004), A12-3.
Prospects for making money from bioprospecting are not clear,
SA (Dec. 2003), 17-8; Nature 427 (2004), 576, 769.
The impact of global warming is also to blame to smaller
numbers of North sea cod, NS (13 Dec. 2003), 8; Nature 428
(2004), 4. An overall calculation of extinction risk from climate
change is in Nature 427 (2004), 145-8. Reducing risks to
endangered ocean species is the goal of marine reserves that
are expected to be made in the USA soon, NS (15 Nov. 2003),
49; (21 Feb. 2004), 8; BioScience 54 (2004), 27-39. Hatcheries
may help for some endangered salmon, Science 303 (2004),
1980. In Norway salmon stocks are under threat from a
parasite, NS (28 Feb. 2004), 14. Antarctic biodiversity is
discussed in Current Biology 14 (2004), R169-70. Pollution
from sewage is one factor leading to decline in corals, NS (10
Jan. 2004), 12-3; Science 303 (2004), 1293; 304 (2004), 31.
A call for tests of the presence of DNA on Mars are made in
NS (27 March 2004), 19. A paper looking at inhabitable stars in
our Galaxy is in Science 303 (2004), 59-64. The cal for more
space exploration is made in Science 303 (2004), 589.
Animal Rights
In many cases the costs will outweigh the benefits of
using animals in experiments, Research Europe (5 Feb. 2004),
7. Protestors in the UK have ended plans for a primate research
center at University of Cambridge, Nature 427 (2004), 471. A
UK legal decision may help stop harassment of employees of 7
Japanese companies who use animal testing at Huntingdon Life
Sciences in the UK, Scrip Magazine (Dec 2003), 22-3. The
monitoring of lab animals during experiments is described in
NS (28 Feb. 2004), 12-3. The negative effects of sonar on
cetaceans is discussed in NS (24 Jan. 2004), 45. A paper on
minimizing harm from experiments is Morris, MC & Weaver,
SA (2003), "Minimizing harm in agricultural animal
experiments in New Zealand", J. Agric. & Env. Ethics 16, 421-
37.
Chicken welfare is found to be influenced more by
housing conditions that stocking density, Nature 427 (2004),
342-4.
A series of papers on what makes humans human with
comparisons to chimpanzees is in NS (21 Feb. 2004), 36-43;
Current Biology 14 (2004), R148-9; Nature 427 (2004), 208-9;
428 (2004), 606; Science 302 (2003), 1960-3. Genetic studies
of chimp genome compared to human genome find about 1500
genes have some differences between the two species, Nature
426 (2003), 746, 750. Dating of languages is discussed in
Nature 426 (2003), 391-2, 435-9; Science 303 (2004), 1315-39;
SA (April 2004), 24-5. The ethics of intention and pain are
discussed in Philosophical Quarterly 53 (2003), 502+. Imaging
studies are being used to see how the brain thinks about pain,
Science 303 (2003), 1121, 1162+. Cannibalism and energy for
a species are reviewed in Ecological Monographs 74 (2004),
135-57.
Brain function
Drugs and ways to help people forget are discussed in
Science 304 (2004), 34-6. Neural pathways that suppress
unwanted memories are described in Science 303 (2004), 232-
5. The evolution of cooperation is discussed in Nature 428
(2004), 611-2; Science 303 (2004), 1128-30. In general on
neuroscience research, NS (1 Nov. 2003), 52-5. The difference
between madness and badness is discussed in NS (13 Dec.
2003), 36-9; (20 March 2004), 38-41. A study of how people
may see the world in different ways is Science 303 (2004),
1617-8, 1634-40. Intention is discussed in Science 303 (2004),
1144-6, 1208-11. Book reviews on consciousness include
Nature 426 (2003), 604; 427 (2004), 783; 428 (2004), 603-4,
606; SA (March 2004), 74-5. Development of the human frontal
cortex is related to mutations in GPR56, a G protein-coupled
receptor, Science 303 (2004), 2033-6. Object-specific responses
in the cortex are described in Science 304 (2003), 115-7.
Learning is discussed in Nature 428 (2004), 378. A 3-D atlas of
the brain is expected later in 2004, NS (10 Jan. 2004), 32-3.
A small number of genes creates complex thoughts, Nature
427 (2004), 681. Human variation in gene expression and brain
has been surveyed, Nature 428 (2004), 757; and as discussed in
the Animal Rights News section, comparisons with chimpanzee
genome are also being made. On artificial intelligence, Nature
427 (2004), 680.
Discussion of why people often socialize with people of the
same sex is in NS (24 Jan. 2004), 35-7. Studies of why male
gorillas have good relations may be because they are often
related to each other, Nature 428 (2004), 383. Also on animal
socialization, NS (20 Dec. 2003), 56-9. Studies of marmosets
has found they use their whole brain when thinking about sex
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
including regions associated with decision-making, like
humans, Science 303 (2004), 952. A book review of Why We
Love is Nature 427 (2004), 396-7. Also on love, NS (22 Nov.
2003), 18.
Safety of Recombinant DNA Products
Alpha-Interferon has showed promise against SARS in
monkeys, JAMA 290 (2003), 3222-8; Lancet 362 (2003), 293-4;
Science 303 (2003), 1273. Post-exposure treatment with a
recombinant inhibitor of factor VIIa/tissue factor may be useful
in treatment of Ebola, if monkey experiments can be applied to
humans, Lancet 362 (2003), 1953-8. Gamma-1b interferon
may not aid patients with idiopathic pulmonary fibrosis, NEJM
350 (2004), 125-33. The use of pharmacogenomics for
application of recombinant growth hormone is discussed in
Amer. J. Pharmacogenomics 2 (2002), 93-111. A paper on the
quality of life of persons living with achondroplasia is Prenatal
Diagnosis 23 (2003), 1003-8. The safety of recombinant
insulin is not clear for some persons, GeneWatch 16 (Nov.
2003), 3-5. Use of recombinant follicle stimulating hormone for
ovulation induction is reported in BMJ 328 (2004), 192-5. G-
CSF therapy with peripheral blood stem cells in myocardial
infarction is reported in Lancet 363 (2004), 751-6, 746.
A DNA vaccine that may protect allergy sufferers against
allergy has been developed in Japan, Biotechnology News 24 (4
March 2004), 3-4. Cancer vaccines may boost survival after
kidney tumours are removed, Lancet 363 (2004), 583, 594-9;
NS (28 Feb. 2004), 17. There is some success, GEN 24 (15
March 2004), 1, 10, 12-3; NatMed. 9 (2003), 1354-5; JAMA
291 (2004), 550-1. Another cancer vaccine trial was halted,
NatMed. 10 (2004), 3. Use of an anti-interleukin-5 antibody in
hypereosinophilic syndrome is reported in NEJM 349 (2003),
2334-9. Erythropoietin may impair, not improve, cancer
survival, NatMed. 9 (2003), 1439.
Food safety
Ways to combat against obesity are discussed in The Edge
(ESRC, UK) 15 (March 2004), 16-21; MJA 179 (2003), 577-9;
BMJ 327 (2003), 1125; 328 (2004), 363; Lancet 363 (2004),
182, 211-2, 339; NS (20 March 2004), 5; Nature 428 (2004),
239, 244; JAMA 291 (2004), 1186-8. Some persons have
surgery for obesity, NEJM 350 (2004), 1075-9. Links between
obesity and cancer are being tested, JAMA 290 (2003), 2790-1.
APOE and TGF-beta1 genes are associated with obesity
phenotypes, JMG 40 (2003), 918-24. Estimates of ideal body-
mass index among Asians are discussed in Lancet 363 (2004),
157-63. The US has banned the dietary supplement ephedra
because of safety concerns, Nature 427 (2004), 90. The sugar
industry has criticized a WHO report on healthy eating, Int. J.
Health Science 33 (2003), 831-3; Lancet 363 (2004), 1068-70.
The USA has also criticized the proposed new policy on diet,
BMJ 328 (2004), 245. On the diet industry, Nature 428 (2004),
252-4. Diabetes may be linked to obesity through adipocytes
and macrophages, NatMed. 10 (2004), 126-7. Preventing
diabetes in south Asians is discussed in BMJ 327 (2003), 1059-
60.
Coffee consumption has an inverse relationship with type 2
diabetes mellitus in Finnish men, JAMA 291 (2004), 1213-9.
Folic acid reduces the risk of ischemic stroke, BMJ 328 (2004),
211-4, 247. Omega-3 fatty acids have benefits for health, and
may be in both fish and plants, BMJ 328 (2004), 30-5, 406.
They are also suggested for animals, NS (7 Feb. 2004), 18. Junk
food is causing many problems however, Lancet 362 (2003),
1593; NS (29 Nov. 2003), 16. However, chocolate can have
71
benefits, Nature 426 (2003), 787. Food high in purines may
increase risk of gout, NEJM 350 (2004), 1093-103. Diets high
in meat also pose dangers, NS (13 March 2004), 19. There is
doubt over a study that claimed multivitamins would help
postpone Alzheimer disease, BMJ 328 (2004), 67. Functional
foods are discussed in Nature 427 (2004), 284-6; BMJ 328
(2004), 190-1.
UNICEF has issued another report warning on the dangers
of vitamin deficiencies, Lancet 363 (2004), 378; Bulletin WHO
82 (2004), 230-1. Studies have shown that there was long term
mortality after the severe starvation during the siege of
Leningrad, BMJ 328 (2004), 11-4. Childhood stunting from
inadequate water and sanitation is great today also, Lancet 363
(2004), 94-1, 112. Yeast life-span extension by calorie
restriction is analyzed in Science 302 (2003), 2124-6.
Preventing foodborne disease is important, NEJM 350 (2004),
437-40; JAMA 290 (2003), 2788-9.
The EU has defend the new traceability and labeling rules,
Food Chemical News (22 March 2004), 5-7; though they are
seen as barriers to trade by others, Food Chemical News (15
Dec. 2003), 8-9. In the USA, 77% of consumers said that they
would pay more for beef certified free of BSE, and one third of
persons were very concerned about the BSE finding, Food
Chemical News (2 Feb. 2004), 11-2. Concerns over salmon are
also being raised, Science 303 (2004), 154-5, 226-9; NS (17
Jan. 2004), 3, 8; JAMA 291 (2004), 929-30. Aquaculture should
be more sustainable, Nature 426 (2003), 378-9.
The FDA is reconsidering its position on open
commercialization of meat and milk from cloned animals,
NatMed. 9 (2003), 1444; NatBio 21 (2003), 1415-6. A UK
BMA report said more study should be done to prove GM food
is really beneficial compared to other food, BMJ 328 (2004),
602. (www.bma.org.uk/GMFoods). The first commercially sold
GM-labeled beer in the world is sold in Sweden, NS (7 Feb.
2004), 6; NatBio 22 (2004), 259. On EU GM food regulation,
NatBio 22 (2004), 149, 383-4. DNA chips are testing for
mixing of meat from different animal sources, NS (6 March
2004), 12-3. Angola has refused GM cereal, Int. Herald
Tribune (31 March 2004). A general discussion of GM food is
in FDA Consumer (Nov. 2003), 28-33. On the fate of
transgenes in the human gut, NatBio 22 (2004), 170-2
Disease Risks & Drugs
The regulation of drugs and clinical trial abuses in India are
discussed in Indian J. Medical Ethics 1 (2004), 2-5, 11-21.
Some local governments in the USA have been buying cheaper
drugs in Canada, BMJ 327 (2003), 1126; JAMA 290 (2003),
2921-5. European prices are also cheaper, Economist (31 Jan.
2004), 53-4. Counterfeit drugs are discussed in NEJM 350
(2004), 1384-6. On ethical issues, Miller, FG. Et al. "Ethical
issues concerning research in complementary and alternative
medicine", JAMA 291 (2004), 599-602. Trade in traditional
medicines is discussed in NatBio 22 (2004), 263-5; SA (Dec
2003), 26. The trade is causing degradation of biodiversity, NS
(10 Jan. 2004), 10-1. Ethics of public health surveillance is
discussed in Science 303 (2004), 631-2.
The drug Lipitor has been linked to amnesia, NS (6 Dec.
2003), 14. A website that links the way genes influence drugs is
www.pharmgkb.org, Science 303 (2004), 443. On monitoring
drug treatment, BMJ 327 (2003), 1179-81, 1222-5. Doctors
continue to use treatments that do not work, BMJ 328 (2004),
474-5. The health impact of the first Gulf War are discussed in
BMJ 327 (2003), 1357-8. Psychiatric drugs are discussed in
NEJM 349 (2003), 2369-71. On statins, JAMA 290 (2003),
72 Eubios Journal of Asian and International Bioethics 14 (March 2004)
2243-5; Lancet 362 (2003), 1498; BMJ 328 (2004), 400-2, 500-
1. A review of aspirin is NS (7 Feb. 2004), 36-9.
Lifestyle change to alter risk of diabetes is useful, BMJ 327
(2003), 1120-1. Ethics of recommending lifestyle change is
discussed in JAMA 290 (2003), 2660-1. Self-poisoning with
pesticides is reviewed in BMJ 328 (2004), 42-4. Tests on
pesticide safety on humans may be conducted in USA now,
Science 303 (2004), 1272; Nature 427 (2004), 770-1. On
occupational safety, Lancet 363 (2004), 673-4; JAMA 290
(2003), 3069-70. Pet ownership and health is discussed in MJA
179 (2003), 460-1. On the hygiene hypothesis, Nature 428
(2004), 354. Asthma rates are increasing, NS (27 March 2004),
36-9. On stress in cities, Science 303 (2004), 463.
A Netherlands Health Council report is addressing the
impact of passive smoking, Network 19 (March 2004), 8-12.
On the dangers of ionizing radiation in medicine, BMJ 327
(2003), 1166-7; 328 (2004), 19-21; Lancet 363 (2004), 340; NS
(6 March 2004), 10. A medical response to nuclear incidents is
prepared in BMJ 328 (2004), 568-72. On risks of cancer from
mobile phones, BMJ 328 (2004), 124, 292. A Swedish study of
extremely low frequency magnetic fields suggests dangers from
welding, Epidemiology 14 (2003), 420-6. There is little new
evidence that EMF fields are harmful, Network 19 (March
2004), 27-8.
Traffic safety is discussed in Bulletin WHO 81 (2003), 916-
7; NS (13 Dec. 2003), 23; BMJ 327 (2003), 1455-6. An
international study on depiction of old persons on traffic signs
is BMJ 327 (2003), 1456-7.
Patenting & Business
Benefit sharing from genomics is discussed in Health Law
Review 12 (2003), 36-8. Patenting of genes is debated in
Health Care Analysis 11 (2003), 119-30; Health Law J. 10
(2002), 123-46; Science 303 (2004), 1757-8; NatBio 22 (2004),
231-2. The question of expired patents on cell lines, SA (Dec.
2003), 25. Patent enforcement is discussed in SA (April 2004),
22. On IP and the US constitution, Colombia Law Review
(2004), 272-362. On profits from native medicines, NS (28 Feb.
2004), 15.
The issue of ghost writers for pharmaceutical companies is
discussed in BME 194 (2004), 4. The ethics of receiving gifts
from industry is discussed in Amer. J. Bioethics 3 (Summer
2003), 39-46; JAMA 290 (2003), 2404-7. A report on
academic-industry relationships in the life sciences is in NEJM
349 (2003), 2452-9; Nature Reviews Molecular Cell Biology 5
(2004), 243-7. Industry sponsored studies of drugs are twice as
likely to have positive conclusions, BMJ 327 (2003), 1006. The
roles of civil society in Thailand in public health as a counter to
commercial pressures is reviewed in Lancet 363 (2004), 560-
63. Also on ethics of business, NEJM 349 (2003), 1980-1;
Bulletin WHO 82 (2004), 74-5. New Zealand is planning to ban
direct drug advertising, BMJ 328 (2004), 68-9. On Canadian
policy on drug adverts, CMAJ 169 (2003), 405-12, 425-7.
On biotechnology in Australia, NS (22 Nov. 2003), 56-9;
China, GeneWatch 17 (Jan. 2004), 10-12; in Japan, NatBio 21
(2003), 1256-7; in Germany, NatBio 22 (2004), 257-8; in
ScanBelt NatBio 22 (2004), 355; in UK, NS (13 March 2004),
52-3; in Russia, The Scientist (15 Dec. 2003), 50. A book
review of Daniel Callahan, What Price Better Health? (Univ.
California Press 2003, 341pp.) is Science 303 (2004), 1613-4.
On biotechnology business centers, Nature 428 (2004), 121-2.
A discussion of generic and similar "me-too" products is NEJM
350 (2004), 211-2. On science reforms in Japan, Science 303
(2004), 1746; 304 (2004), 41. Biodefense research is attracting
some companies, NatBio 22 (2004), 387-91.
Birth Control
The problems of maternal mortality are discussed in
JOGNN (March 2004), 153; Lancet 363 (2004), 989-93. The
rising global population and limits for our planet are discussed
in NS (8 Nov. 2003), 19; BioScience 54 (2004), 195-204. Some
Catholic leaders have claimed that HIV passes through
condoms, NatMed. 9 (2003), 1443.
Contraceptive research is reviewed in NatMed. 10 (2004),
213; NEJM 350 (2004), 307-8. On emergency contraception,
NEJM 349 (2003), 1830-5. Research to make a male
contraceptive is discussed in NS (10 Jan. 2004), 38-41.
A discussion of Chinese family planning is in Conscience
24 (Winter 2003-4), 25-32. Delayed marriage age in women is
shown in SA (Jan.? 2004), 17. The use of IUDs is discussed in
CMAJ 169 (2003), 585. A review of sexuality in medieval
Croatian sources is Croatian Medical J. 45 (2004), 25-30.
Sexual orientation is discussed in BMJ 328 (2004), 469; NEJM
350 (2004), 333-41. A US inquiry has found NIH funded
sexuality studies can continue, Science 303 (2004), 741. A
book review of The Oxytoxin factor is NatMed. 10 (2004), 122.
A book review of Adam's Curse: a Future without Men is
Lancet 363 (2004), 578.
Discussion of HRT is in JAMA 291 (2004), 1434; NatMed.
10 (2004), 121; BMJ 328 (2004), 357-8, 371-5; NEJM 350
(2004), 991-1004.
Embryo Status
The ethics of embryo research and natural reproductive
lotteries are discussed in CQHE 13 (2004), 68-95, 110-2. The
US Congress Partial-Birth Abortion Ban Act 2003 is
reproduced in BME 194 (2004), 8-11. There has been much
discussion, Lancet 362 (2003), 1464, 1509; BMJ 327 (2003),
1009; NEJM 350 (2004), 184-6. Several US judges have issued
subpoenas for abortion records, Lancet 363 (2004), 626. A
historical review of US abortion policy 1951-1973 is in AJPH
93 (2003), 1810-9. A European Court of Human Rights is
considering an abortion case, BMJ 327 (2003), 1367. A UK
case of late abortion for a fetus with cleft palate is being
debated legally, BMJ 327 (2003), 1307. In the UK it is
necessary to give consent before embryos are used in research
(see ART for cloning discussion), BME 191 (2004), 5-6. A
book review of A Child is Born is Lancet 363 (2004), 497.
The early induced abortion of severely handicapped infants
is debated in Linacre Quarterly 70 (2003), 218-22. In the UK
mothers suspected of killing their babies might be dealt with
outside of the criminal system, BMJ 328 (2004), 425. Trends in
elective termination of pregnancy between 1989 and 2000 in
the French county of Isere is reported in Prenatal Diagnosis 23
(2003), 877-83. Pregnancies that end in spontaneous or induced
abortions do not increase breast cancer rate, Lancet 363 (2004),
1007-16.
Cloning and stem cells
The UN has left the debate on human cloning on hold,
ready to resume later in the year, HCR 34 (Jan. 2004), 5-6;
Current Biology 13 (2003), R937-9. Those who have comments
on this should send to the editor who is working on a report for
United Nations University on the issues for consideration when
the UN General Assembly revisits the issue. On ethics and
cloning stem cells, Monash Bioethics Review 22 (Jan. 2003), 8-
24; New Zealand Bioethics J. 5 (2004), 22-8, 29-30; JME 29
(2003), 207; Sociology of Health & Illness 25 (2003), 793-814;
Nature 426 (2003), 603; 428 (2004), 587; NS (21 Feb. 2004), 3.
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
A paper in Italian on cloning ethics is in Bioetica e Cultura 12
(No. 2, 2003), 283-8. Against reproductive cloning, NS (22
Nov. 2003), 23; (24 Jan. 2004), 4; BMJ 328 (2004), 185;
Lancet 363 (2004), 827-8. The use of pluripotent adult germ
cells in treatment is discussed in Ford, NM. "Using pluripotent
germ cells in regenerative medicine. An ethical alternative",
National Catholic Bioethics Quarterly 3 (2003), 697-706.
There was controversy over the departure of two members
of the US President's Bioethics Council who were positive
towards stem cell research, Science 303 (2004), 1447. Harvard
University is setting up a privately funded US$100 million
institute for stem cell research, Science 303 (2004), 1453;
Nature 428 (2004), 8. Stem cell research might be a ballot issue
in California, Science 303 (2004), 293; NS (20 March 2004), 7.
New Jersey also has backed use of stem cells, NatBio 22
(2004), 142.
European Parliament members approved the funding of
stem cell research using human embryos, in countries that do
not outlaw it, BMJ 327 (2003), 1248. On EU regulation of
stem cell research, JME 29 (2003), 203-8; NatBio 22 (2004),
157-8. Spain will support stem cell research, Nature 428
(2004), 247. On policy in China, Nature 427 (2004), 278.
Researchers in Korea have published results of making
human ES cells from a cloned human embryo, Woo Suk
Hwang et al., "Evidence of a pluripotent human embryonic
stem cell line derived from a cloned blastocyst", Science 303
(2004), 1669-74, 937-9, 1581; Nature 427 (2004), 664; NatBio
22 (2004), 361; JAMA 291 (2004), 1185-6. This type of
experiment could be legally performed in some countries but
not in others. More ES cell lines are needed, NEJM 350 (2004),
1275-6, 1351-2; NatBio 22 (2004), 159-63, 399-400. On the
potential for stem cell therapy, NatBio 22 (2004), 283-5; NS (21
Feb. 2004), 6-7, 16-7; BMJ 328 (2004), 484; Lancet 363
(2004), 581. Making stem cells is discussed in Nature 426
(2003), 490-1. Embryonic germ cells and male gametes can be
made from ES cell lines in mice, Nature 427 (2004), 106-7,
148-54.
Assisted Reproductive Technology (ART)
A discussion of the concept of civil disobedience in the
context of ARTs is Turkish J. Medical Ethics 4 (2003), 215-20.
The suggested UK HFEA code of practice is in BME 192
(2004), 8-11. A debate on ethics of ART and genetics is
Conscience 24 (Winter 2003-4), 10-8; GeneWatch 17 (March
2004), 11, 14. A booklet called Bloodlines has been made by
Backbone media (www.pbs.org/bloodlines, 2003). Community
attitudes to ART in Australia are reviewed in MJA 179 (2003),
536-8. On ART mistakes, JME 29 (2003), 205-6. The UK will
give couples three times access to IVF under NHS, BMJ 328
(2004), 482. Calls for open access to IVF are in BMJ 327
(2003), 1226. On health impacts of IVF, Nature 428 (2004),
590; and the success of IVF, NS (17 Jan. 2004), 7. An online
egg service now exists, NS (28 Feb. 2004), 4;
www.ManNotIncluded.com. Italy is expected to pass a new law
on ART, BMJ 328 (2004), 9. The desire of infertile patients for
multiple births is discussed in F&S 81 (2004), 500-4, 526. A
study of why couples discontinue IVF is F&S 81 (2004),258-
61.
The definition of infertility is discussed in Bioethics
Research Notes 15 (Dec 2003), 45-7. Research using mice
suggests adult females may produce eggs, Science 303 (2004),
1593. Mouse eggs have been fertilized by artificial sperm, NS
(13 Dec. 2003), 19.
73
Sex selection is discussed in Indian J. Medical Ethics 1
(2004), 53; GeneWatch 17 (Jan. 2004), 3-5; BMJ 327 (2003),
1007. The UK HFEA has recommended a ban on it, BMJ 327
(2003), 1123. Gamete donor anonymity is discussed in Health
Law Review 12 (2003), 39-45; F&S 81 (2004),527-30. On
family members as gamete donors or surrogates, F&S 81
(2004), 1124-9. The UK is expected to remove anonymity for
sperm donors, BMJ 328 (2004), 244. Israel is allowing the
removal of sperm from dead men at the request of their wives,
BMJ 327 (2003), 1187. Genetic paternity testing is discussed in
CQHE 13 (2004), 49-60. On use of ARTs for HIV infection,
JME 29 (2003), 313-29. Scandinavian recommendations on
sperm donation and women as research subjects are in BME
191 (2004), 8-11. On suggested legal changes to the regulation
of ART in New Zealand, New Zealand Bioethics J. 4 (2003), 4-
7. On human chimeras, NS (15 Nov. 2003), 34-6.
Fetal Environment & Neonates
Genetic susceptibility to neural tube defects vary with
offspring phenotype, Clin. Gen. 64 (2003), 424-8. Use of folic
acid is supported in NEJM 350 (2004), 101-3. A call for
systematic identification of drugs that cause birth defects is
NEJM 349 (2003), 2556-9.
The increasing use of cesareans in Europe are discussed in
Time (5 April 2004), 42-9. Shaken baby syndrome is discussed
in BMJ 328 (2004), 719-21; BME 193 (2004), 13-7. Low breast
feeding rates in the USA is reviewed in AJPH 93 (2003), 2000-
10.
Papers on the topic of birth order and rebelliousness in
children are in Politics & the Life Sciences 19 (2000), 135-246.
On mentoring to reduce risk of antisocial behaviour in children,
BMJ 328 (2004), 512-4. The ethics of male circumcision are
discussed in Amer. J. Bioethics 3 (Spring 2003), 35-48. On
perinatal mortality in rural China, BMJ 327 (2003), 1318-22.
The FDA has issued an alert on possible suicidal risk from use
of antidepressants in children, JAMA 290 (2003), 2334-5;
Science 303 (2004), 745. Autism is discussed in Lancet 363
(2004), 742-3; BMJ 328 (2004), 226-7, 364; Nature 426 (2003),
373; 428 (2004), 470-1. The importance of grandparents in
human education is discussed in Nature 428 (2004), 116-8,
650-2, 128-9.
Genetic Disease Markers
Mutations in dynein motor complex cause motor neuron
disease, Clin. Gen. 64 (2003), 377-81. A study of the genetic
epidemiology of alpha-1 antitrypsin deficiency is Clin. Gen. 64
(2003), 382-97. A series of papers on genetics and physiology
are in J. Physiology 554 (1 Jan. 2004), 1-244. Genetics and
migraine are discussed in Amer. J. Pharmacogenomics 2
(2002), 329-43. There has been extensive gene traffic on the
mammalian X chromosome, Science 303 (2004), 537-40.
Papers on serotonin transporter genetics and behaviour are
in Genes, Brain and Behaviour 2 (2003), 332-80. Techniques to
map quantitative traits using multiple phenotypes are reported
in Human Heredity 55 (2003), 1-26.
Obesity and genetics are discussed in Clin. Gen. 64 (2003),
380-1.
Genetic Screening Methodology
Use of a one primer array for testing over 10,000 SNPs is
reported in Genome Research 14 (2004), 414-25; also see
Nature 427 (2004), 91; 428 (2004), 377-8. They can also be
used for bacteria testing, Nature 428 (2004), 359. Microarrays
are discussed for cancer profiling in Lancet 362 (2003), 1428,
74 Eubios Journal of Asian and International Bioethics 14 (March 2004)
1439-44; Nature 428 (2004), 379-80; Science 303 (2004),
1754-5. The question will be how many conditions to screen
for, BMJ 327 (2003), 1117.
On first trimester screening for Down syndrome, NEJM 350
(2004), 619-21; Prenatal Diagnosis 23 (2003), 1086-91.
Detection of cell-free fetal DNA in maternal blood is
progressing, JAMA 291 (2004), 1114-9, 1127, 1135-7; Prenatal
Diagnosis 23 (2003), 1077-82. Genetic testing of sperm may
become possible, NS (1 Nov. 2003), 19. On preimplantation
diagnosis for chromosomal translocations in miscarriage, F&S
81 (2004), 30-4.
Newborn screening may be expanded, JAMA 290 (2003),
2564-72, 2606-8; MJA 179 (2003), 400-1, 412-5; AJMG 125C
(2004), 35-41.
DNA Fingerprinting & Privacy
The text of the UNESCO International Declaration on
Human genetic Data can be viewed on the UNESCO IBC
homepage. It is also reproduced in BME 192 (2004), 13-20. The
text of the European Group of Experts in Science and New
Technologies on Genetic testing in the workplace is in BME
192 (2004), 21-4. The general use of medical examinations for
employment is discussed in J. Law & Med. 11 (Aug. 2003), 93-
102. On genetic privacy, NEJM 350 (2004), 1452-3; NS (20
March 2004), 20-1. A study of patient information privacy in
public lifts in hospitals is in BMJ 327 (2003), 1024-5; and in
hospitals, Nursing Times 99 (2 Dec. 2003), 18-21; JME 29
(2003), 220-4, 348-52. China's freedom of information bill is
reviewed in NS (13 Dec. 2003), 21.
A paper on the implications of genetic testing for the UK
insurance industry is Community Genetics 5 (2002), 102-9. A
comparison of insurance and testing in different countries is
Simon, J. "Genetic testing and insurance: An international
comparison", IJB 14 (Sept. 2003), 59-78; and on the general
topic, Monash Bioethics Review 22 (Jan. 2003), 25-41; Lancet
363 (2004), 395-6; Eur. J. HG 11 (2003), 909-10. On law and
biological and family identity, IJB 14 (Sept. 2003), 81-92.
A review of the proposed expansion of US federal DNA
databases is GeneWatch 17 (March 2004), 3-6. DNA evidence
in crime is discussed in NEJM 350 (2004), 313-4; NS (1 Nov.
2003), 18. National DNA databases need to be made safer,
Lancet 362 (2003), 1761-2. The ethics of stored tissue archives
is discussed in JME 29 (2003), 343-7; BMJ 327 (2003), 1304;
Lancet 363 (2004), 377. On the Icelandic DNA database
coding, Bioethics 18 (2004), 27-49. The German National
Ethics Council has a new opnion on Biobanks for research
(Contact Email: kontakt@ethikrat.org). A proposal for a new
way to distribute and store genetic resources is in Nature
Reviews Genetics 5 (2004), 223-37.
There is criticism of the use of ethnic profiling by Japanese
police, Nature 427 (2004), 383. A criticism of the short 4 week
period given in the UK for public comments on biobank is in
BME 191 (2004), 1.
Ethics & Genetic Screening
A paper on Pakistani attitudes towards carrier testing for
thalassemia in adults is Community Genetics 5 (2002), 120-7.
Attitudes towards screening for late onset genetic diseases in
Flanders are reported in Community Genetics 5 (2002), 128-37.
A Netherlands Health Council report on screening for Down
syndrome in early pregnancy is Network 19 (March 2004), 24-
5. Maternal education in France modified the age-related
increase in prevalence of Down syndrome, Prenatal Diagnosis
24 (2004), 79-82. Discussion of screening for cancer
susceptibility is in NEJM 349 (2003), 2080-1; Annual Report of
GenomeCanada 2002/2003; BMJ 328 (2004), 148-51; JMG 40
(2003), 807-14. The dilemmas for a Jewish rabbi discussing
prenatal diagnosis are discussed in NS (14 Feb. 2004), 44-7.
Genetic counseling is discussed in BMJ 327 (2003), 1038-40;
AJHG 74 (2004), 393-4; NZFP 30 (2003), 420-4. An obituary
to Dorothy Wertz is in NatGen 4 (2003), 295. Providing
audiotapes and extra material minimizes anxiety in more
persons about the testing, Prenatal Diagnosis 23 (2003),1060-
7.
A new supplement report is Parens, E., "Genetic differences
and human identities. On why talking about behavioral
genetics is important and difficult", Special Supplement, HCR
34 (Jan. 2004), S1-36. The ethics of funding and controlling
genetic research on behaviour is discussed in light of the
Nuffield Council report in Genes, Brain and Behaviour 2
(2003), 321-31. On ethics of pharmacogenetics, BIOForum
Europe 6 (Nov. 2003), 319-21; a review of the Nuffield
Council report is BME 193 (2004), 18-21. Population genetic
screening is debated in Eur. J. HG 11 (2003), 903-5; MJA 179
(2003), 517-8. A series of papers in English and French on
genetics and ethics are in IJB 14 (Sept. 2003), 11-226; also
papers in English in Developing World Bioethics 3 (2003), 103-
85; J. Clinical Ethics 13 (2002), 316-23; NEJM 349 (2003),
1870-3.
Ethics of preimplantation diagnosis is discussed in JME
29 (2003), 213-6, 217-9; JAMA 291 (2004), 927+. Discussion
of the ethics of selecting children is in Bioethics 18 (2004), 72-
83; JME 29 (2003), 369-70.
On eugenics, IJB 14 (Sept. 2003), 17-32; Monash Bioethics
Review 20 (April 2001), 11-43; BMJ 328 (2004), 411. Gene
culture coevolution is seen between cattle milk protein genes
and human lactase genes, NatGen 35 (2003), 311-7. IQ and
economics is discussed in Heredity 92 (2004), 359-62. On
nature versus nurture, NatGen 35 (2003), 199-200. Past
treatments for homosexuality are discussed in BMJ 328 (2004),
427-32; also see NS (17 Jan. 2004), 36-9. Disability is
discussed in CQHE 13 (2004), 34-40. Stutterers have sued over
a research study, BME 191 (2004), 3-4. Racism in USA is
discussed in Amer. J. Bioethics 3 (Spring 2003), 1-11. Lessons
from the Holocaust for teaching nursing ethics are given in
Nursing Ethics 11 (2004), 138-49.
Gene Therapy
China is the first country to approve commercial use of gene
therapy, NatBio 22 (2004), 3-4; NatMed. 10 (2004), 9. It is for a
type of cancer therapy. US FDA regulation of adverse gene
therapy events is discussed in Politics & the Life Sciences 19
(2000), 261-8. Arguments against modification of the germline
are in Salvi, M. "What is wrong in modifying the human
germline?", IJB 14 (Sept. 2003), 33-44. Arguing for freedom is
Robertson, JA., "Procreative liberty in the era of genomics",
Amer. J. Law & Medicine 29 (2003), 439-87. Enhancement is
discussed in NEJM 350 (2004), 1368; Bioethics 18 (2004), 1-
26; BMJ 327 (2003), 1293328 (2004), 715; NatMed. 10 (2004),
227; NatBio 11 (2003), 1280-1. Regulation of gene therapy in
Japan is discussed in NatBio 22 (2004), 343-5. In general on
gene therapy, Science & Medicine (June 2003), 122-4; Nature
427 (2004), 779-81.
A website for gene therapy trials in USA is
www.gemcris.od.nig.gov. On gene therapy for diabetics, Amer.
J. Pharmacogenomics 2 (2002), 129-34. Gene therapy
prospects for ParkinsonIs disease are reviewed in Amer. J.
Pharmacogenomics 2 (2002), 135-46. The clinical protocol for
 Eubios Journal of Asian and International Bioethics 14 (March 2004)
a phase 1 vaccine safety and chemotherapy dose-finding trial of
an allogenic GM-CSF secreting breast cancer vaccine is in
Human Gene Therapy 15 (2004), 313-37. Possible links of
certain gene therapy to leukemia are discussed in JAMA 290
(2003), 2535.
Human Genome Project (HGP)
A paper explaining HapMap is International HapMap
Consoritum, "The International HapMap project", Nature 426
(2003), 789-96. Discussion of HapMap is also in Nature 426
(2003), 739. A paper on the way genomics is being applied is
Bittles, AH. "Genomics and the changing profile of human
disease", Biology International 45 (2003), 3-8. A letter by LL
Cavalli-Sforza on the HGDP is in Nature 428 (2004), 467.
Discussion of the concept of race is in SA (Dec. 2003), 50-7;
Nature 427 (2004), 123-4, 275-8, 487-8; EJAIB 14 (March
2004).
The charitable trust as a model for genomic databanks is
discussed in NEJM 350 (2004), 85-6. On genomic medicine,
NEJM 349 (2003), 2170-1; Nature Reviews Genetics 5 (2004),
311-7. On comparisons to chimpanzees, Nature 427 (2004),
208-9; Genomics and Proteomics 3 (Nov. 2003), 18-23. On the
rat genome sequence, Nature 428 (2004), 493-521; Science
303 (2004), 455-8; and the dog genome, Heredity 92 (2004),
273-4. Genomics of cacao is discussed in Trends in Plant
Sciences 8 (2003), 561-3. On the environmental genome
shotgun sequencing of the Sargasso sea, Science 304 (2004),
58-60, 66-74. On human chromosome 13 sequence, Nature 428
(2004), 522-35.
A study of the way language and distance isolate persons
genetically in Belgium is Annals Hum. Gen. 68 (2003), 1-16.
The number of SNPs loci for detecting population structure is
between 65-100 independent loci, Human Heredity 55 (2003),
37-45.
General Medical Ethics
Papers on gender in India and religion are in Dharma
Deepaka 7 (2003), 45-68. A study of books and journals on
medical ethics in the Turkish republic period is Turkish J.
Medical Ethics 4 (2003), 240-5. Empirical bioethics is
discussed in Health Care Analysis 11 (2003), 3-13. Papers on
ethics in indigenous health research are discussed in Monash
Bioethics Review 22 (Oct. 2003), 8-44.
Obligations of researchers to subjects for clinical care is
discussed in HCR 34 (Jan. 2004), 25-33. Divergent standards
for consent in research are reviewed in BME 194 (2004), 13-21.
The information materials are also often difficult to read for
participants, BME 192 (2004), 13-6. The guidelines of the
Swiss Academy of Medical Sciences on research on prisoners
are in BME 192 (2004), 7-11. A series of papers from a
conference on Placebos: Ethics and Health Care Research are
in Science and Engineering Ethics 10 (2004), 1-197. Papers on
ethics committees include New Zealand Bioethics J. 4 (2003),
8-15.
The role of Japanese NGOs and the Hermit Crabs Home
mental health project is Nursing Ethics 11 (2004), 203-4.
A discussion of human dignity is in CQHE 13 (2004), 7-14.
Law & Medical Ethics
European researchers have signed an Internet petition
calling for changes in the proposed EU rules on patient trials,
mainly against the extra paperwork, Nature 427 (2004), 276.
On Canadian Medical Law a book review is CMAJ 169
(2003), 447. The principle of disclosure in regulatory science is
75
discussed in Science 302 (2003), 2073. Data safety monitoring
boards are discussed in NEJM 350 (2004), 1143-7. The use of
scientific evidence in court is discussed in SA (Dec. 2003), 12-
3; NS (31 Jan. 2004), 3. The EU has criticized the execution in
Arkansas on 6 January 2004 of a mentally ill prisoner
forcefully medicated, Lancet 363 (2004), 220. Accusations of
bias have prompted a review of ethical guidelines, Nature 426
(2003), 741.
Wrong diagnoses are killing patients, NS (21 Feb. 2004),
12-3. Medical mistakes are reported in BMJ 328 (2004), 55,
199-202; BME 194 (2004), 17-24. A study of persons who were
operated on immediately after an intraoperative death found no
increase in mortality however a longer stay in hospital, BMJ
328 (2004), 379-82. The new UK Council for the Regulation of
healthcare professionals has expressed concern over some
GMC rulings, BMJ 328 (2004), 541. The GMC has admitted
some mistakes in the past, BMJ 327 (2003), 1248. On self-
regulation of medical professionals in the UK, BMJ 328 (2004),
248. A UK national system for reporting medical errors has
been launched, BMJ 328 (2004), 481. There is allegation of
unauthorized human experiments in the UK being made against
the person who is involved in claiming links between MMR
vaccine and autism (see Diseases and Vaccine News section),
BMJ 328 (2004), 726.
A discussion of the German National Ethics Council is
BIOforum Europe 5 (Sept. 2003), 240-1. They have recently
released a report on ethics of biobanks, and an English
summary is available (www.ethikrat.org). Papers on bioethics
committees and democracy are in Bioethics 17 (2003), 301-68.
An introduction to the New Zealand Bioethics Council is in
New Zealand Bioethics J. 5 (2004), 13-5. More information is
on their web site, www.bioethics.go.nz. A new newsletter is
being produced by the European Group of Ethics in Science
and New Technologies to the European Commission, called
"Ethically Speaking", since Feb 2003
(http://europa.eu.int/comm./European_group_ethics).
The UK may make an ethical code for scientists working
with potentially dangerous research that could be misused by
terrorists, Lancet 362 (2003), 1634. There has been widespread
criticism of the US broadcast of the videotape of the
medical exam of Saddam Hussein, BMJ 328 (10 Jan. 2004).
Scientific Ethics
The conflicts of interests of research ethics committees are
discussed in BME 191 (2004), 13-7. On conflicts of interest,
NEJM 350 (2004), 327-32; BMJ 328 (2004), 742-3; Science
303 (2004), 603-4, 1447, 1749; JME 30 (2004), 1-52; Nature
428 (2004), 589; JAMA 290 (2003), 2521; Lancet 363 (2004),
380; NatMed. 10 (2004), 16.
Medical journals have conflicts of interest in the publication
of book reviews, Science and Engineering Ethics 9 (2003),
471-82. Peer review is discussed in BMJ 328 (2004), 657-8,
673-5, 658; NEJM 350 (2004), 103-4; Nature 427 (2004), 196;
Science 303 (2004), 1945. A call for medical editors to accept
an ethical code is made in Nature 428 (2004), 5; NS (6 March
2004), 11. The US policy on editing papers from certain
countries is being relaxed after much criticism, Science 303
(2004), 1742; Nature 427 (2004), 663; BMJ 328 (2004), 543;
NatMed. 10 (2004), 107. Plagiarism is discussed in Nature 427
(2004), 1, 3, 666, 777; and fraud in Nature 427 (2004), 393.
Authorship is discussed in Nature 426 (2003), 602.
In general on improving scientific ethics, BMJ 327 (2003),
1436-9, 328 (2004), 66, 187; MJA 180 (2004), 149-51; Nature
427 (2004), 1, 381; Science 303 (2004), 298, 606. Open access
76 Eubios Journal of Asian and International Bioethics 14 (March 2004)

to research is important for improving quality of research, Health Costs

Lancet 362 (2003), 1510, 1575-7; Science 303 (2004), 1467,
1777-8.
Euthanasia & Terminal Care
A paper in Italian on palliative care is in Bioetica e Cultura
12 (No. 2, 2003), 225-32. A paper on the regulatory
frameworks for long term restraints among the elderly, Health
Law Review 12 (2003), 22-8. On palliative care, BMJ 328
(2004), 725; MJA 180 (2004), 207-8; Lancet 362 (2003), 1812-
3; JAMA 290 (2003), 2485. A study on the effects of
bereavement on family caregivers of persons with dementia is
in NEJM 349 (2003), 1936-42; 350 (2004), 733-4.
Artificial hydration for PVS patients is discussed in
National Catholic Bioethics Quarterly 3 (2003), 719-30; Lancet
362 (2003), 1465. On withdrawal of life-sustaining treatment,
Bioethics Outlook 14 (June 2003), 1-7; NEJM 349 (2003),
2565-7. Canadian law and advance directives is discussed in J.
Law & Med. 11 (Aug. 2003), 59-73. A study of the impact of
living wills in Japan is JME 29 (2003), 248-52. On advance
care planning, NEJM 350 (2004), 7-8. Finnish nurses and
physicians views on end of life are in Nursing Ethics 11 (2004),
165-78. On ageism in science, Science and Engineering Ethics
9 (2003), 445-52. Cultural issues in suicide are discussed in
NEJM 349 (2003), 2276-8. On refusal by patients of foods and
fluids, NEJM 349 (2003), 1777-8.
A Council of Europe ruling on euthanasia and assisted
dying is in BME 192 (2004), 3-4. End of life practices in
Europe are discussed in JAMA 290 (2003), 2938-9. A survey of
ethical issues experienced by nursing in caring for elderly
persons is Nursing Ethics 11 (2004), 150-64. Choices by older
persons in the UK is discussed in BMJ 328 (2004), 4-5; Nature
428 (2004), 116-8.
The ethics of health care for illegal immigrants is an issue
facing many countries, HCR 34 (Jan. 2004), 34-41; Lancet 362
(2003), 2019-20. Human rights and the poor are discussed in
NEJM 350 (2004), 737; BMJ 327 (2003), 1232; Lancet 362
(2003), 1591. Human rights and Australian international policy
is discussed in MJA 180 (2004), 163-5. On the constitutional
obligations in South Africa to treat using antiretroviral
medicines, Health Law Review 12 (2003), 9-15.
A report on US health disparities is Science 303 (2004),
451. Futility is discussed in Nursing Ethics 11 (2004), 77-83.
Internet
The Hellenic Republic (Greece) National Bioethics
Commission has a book summarizing their English decisions,
and also a web site: www.bioethics.gr
Prepared by Darryl Macer
Human Behaviourome Project
There is a very active discussion on the Internet listserve.
There wil lalso be a series of appers presented at
TRT9/ABC5 and further papers appearing in a online
book form soon. 9 methods working groups are working,
see the listserve. All Emails and files are open for
viewing at: http://groups.yahoo.com/group/behaviourome
Contact: Darryl Macer.
IAB Genetics & Bioethics Network: On-line
The complete address list is updated on the Internet. Send all
changes to Darryl Macer.

Organ Transplants & Brain Death Bindu Dey

Pharmacogenomic analysis can optimize the dose for drugs Director, Department of Biotechnology
taken for immunosuppression among organ recipients, Amer. J. Ministry of Science and Technology
Pharmacogenomics 2 (2002), 291-301. On the kidney trade in Government of India
Block 2,CGO Complex, Lodi Road, New Delhi
India, Indian J. Medical Ethics 1 (April 2004), 36-7. In general
India
on the organ trade, BMJ 327 (2003), 1009. The use of children Email-bindu@dbt.nic.in
as organ donors is discussed in papers in CQHE 13 (Spring Topics of interest- Health economics and Ethics; Biopharmaceutical
2004), 117-69. Matching kidneys by HLA type is reviewed in industry and Bioethics
NEJM 350 (2004), 545-51. An estimate of the number of
potential organ donors in USA is made in NEJM 349 (2003),
2073-5. Ethics of surrogate consent for living organ donation
are discussed in JAMA 291 (2004), 728, 732-5. Living liver
donation is discussed in BMJ 327 (2003), 1287.
A discussion of the UK Human Tissue Bill is BME 194
(2004), 22-4; BMJ 328 (2004), 533-4. Teaching autopsies are
fading in the UK, BMJ 328 (2004), 165-7. Respect for the dead
is discussed in Ethics 114 (2003), 38-59. The text of the UK
Medical Research Council Interim guidance on ethics of
research involving human material derived from the nervous
system is in BME 193 (2004), 7-11. Tissue typing for bone
marrow transplants to children are discussed in Monash
Bioethics Review 22 (Oct. 2003), 45-55. Research to regenerate
spinal cord is reported in NatBio 22 (2004), 297-305. On
development of an adaptive immune system in cord blood cell
transplanted mice, Science 304 (2004), 104-7.
On xenotransplantation, Politics & the Life Sciences 19
(2000), 247-60; Health Law J. 10 (2002), 31-75.
The artificial heart is discussed in NEJM 350 (2004), 542-3.
Cochlear implants are discussed in BMJ 328 (2004), 420; FDA
Consumer (Nov 2003), 35.
 Eubios Journal of Asian and International Bioethics 14 (March 2004) 77

ABA Membership
Persons who want to confirm their membership of the ABA
must send their completed membership form and fees to the
secretary if your name does not appear in the list on-line,
Darryl Macer, (by Email, fax or airmail).
Membership fees are payable from November, 2002, at the
time of renewal to EJAIB, the official journal of ABA. A three
tier system exists for annual fees:
a) Regular price (US$50 Euro 50 Yen 5000).
This includes the EJAIB journal subscription and free associate
membership of Eubios Ethics Institute.
b) Reduced contribution (the amount is up to the member, and
is also suggested for students)
This includes the EJAIB journal subscription.
c) No fee, because the person is not in a position to pay the fee.
This does not include a hard copy of the EJAIB journal, but
anyone can apply to Eubios Ethics Institute separately for a
hard copy of the Journal, to be considered case by case.
Only those currently paid up persons at the time of
elections (October 2004) [on the current list below marked
(2004)] will be eligible for voting in 2004 elections. All persons
who wish to vote must register with the ABA secretariat
directly, not through country representatives.
Membership fees are payable from October of the
previous year to the completion of the following calendar year (e.g.
at the time of renewal to EJAIB, the official journal of ABA).
A three tier system exists for annual fees:
The following members are to add to the list of members written
in the January 2004 issue of EJAIB (see total list on-line) as of 15
April 2004. (Many members are not yet transferred from the previous
list of ABA members because of lack of fee payment - so names do
not appear).
Dr. Akira Akabayashi
School of Public Health
Kyoto University Graduate School of Medicine,
Yoshida Konoe-cho, Sakyo-ku,
Kyoto, 606-8501, Japan
Tobias Bauer
Rotkaeppchenweg 40
82110 Germering
Germany
Email: to_bauer@gmx.net
Dr.Raúl Garza Garza
Hospital CHristus Muguerza
Av.Hidalgo 2525 pte. Col.Obispado
Monterrey Nuevo León México C.P. 64060 ,
Email:garza@muguerza.com.mx
Dr Hans-Martin Sass
Zentrum Medizinische Ethik
Ruhr Universitaet
Postfach 102148
D-44780, Bochum, GERMANY
Email: SassHM@aol.com
Professor Aruna Sivakami
Dept. of Politics and Public Admn.,
University of Madras
Chennai - 600 005. India
Email: runashiva_24@rediffmail.com
Dr. Yanguang Wang,
Center for Applied Ethics, Chinese Academy of Social Sciences,
5 Jianguomennei Avenue, Beijing 100732, China
Email: ameliaw2002@hotmail.com
Conferences (New from last issue)
A bioethics conference calendar website is:
http://www.who.int/ethics/events/en/
17th Annual Summer Seminar in Clinical Ethics, 2-6
August 2004, University of Washington, USA. Contact:
mbarnard@u.Washington.edu.
19th International Conference of the European Society for
Philosophy and Medicine and healthcare, 24-27 August, 2005,
Barcelona, Spain, Contact: b.gordijn@efg.umvn.nl
The Seventh World Congress of Bioethics: Deep Listening:
bridging divides in local and global ethics, 9-12 November,
2004, University of NSW, Sydney, Australia. Contact:
paul.mcneill@unsw.edu.au Website linked through IAB site:
http://www.bioethics-international.org/
7th European Assoication for Clinical Pharmacology and
Therapeutics Congress, 25-29 June 2005, Poznan, Poland.
Contact:m Email eacept@horizon-travel.pl, www.eacpt.pl
Sixth Asian Bioethics Conference, 23-25 November, 2005,
Sanliurfa, Turkey. Contact: saksoy@harran.edu.tr
Send papers to EJAIB Editorial Office
Send papers to the editor in electronic form if possible.
Please use reference style used in News section, do not use
automatic footnotes or endnotes. Papers are peer reviewed.
Editorial address:
Prof. Darryl Macer
Institute of Biological Sciences, University of Tsukuba
Tsukuba Science City 305-8572, JAPAN
Fax: Int+81-298-53-6614
Email: macer@sakura.cc.tsukuba.ac.jp

Fr.Ignacimuthu,s.j.
Entomolgy Research Institute,
Loyola College, Chennai - 600 034, India
Email: ignacimuthu@hotmail.com

The Jerusalem Centre for Ethics

Mishkenot Sha'ananim
P.O. Box 8215
Jerusalem 91081, ISRAEL
Email: gilad@mishkenot.org.il

Dra. Martha Marcela Rodriguez Alanis

Clinica Hidalgo, Hidalgo 2428 Pte. Obispado,
Monterrey Nuevo Leon, Mexico C.P. 64600
Email: marcela_rdza@hotmail.com
78 Eubios Journal of Asian and International Bioethics 14 (March 2004)
EJAIB Editor: Darryl Macer
Associate Editors
Jayapaul Azariah (All India Bioethics Association, India),
Frank Leavitt (Ben-Gurion Univ., Beer Sheva, Israel),
Masahiro Morioka (Osaka Prefectural University, Japan).
Managing Editor: Nobuko Yasuhara Macer
Editorial Assistants: Baoqi Su
Editorial Board: Akira Akabayashi (Japan), Sahin
Aksoy (Turkey), Angeles Tan Alora (Philippines),
Atsushi Asai (Japan), Alireza Bagheri (Iran), Gerhold
Becker (Hong Kong), Hasna Begum (Bangladesh),
Minakshi Bhardwaj (UK), Christian Byk (IALES;
France), Ken Daniels (New Zealand), Leonardo de Castro
(The Philippines), Ole Doering (Germany), Norio Fujiki
(MURS Japan), Dena Hsin (Taiwan), Rihito Kimura
(Japan), Abby Lippman (Canada), Margaret Lock
(Canada), H. Ahmad Ludjito (Indonesia), V. Manickavel
(Nepal), Anwar Nasim (Pakistan), Mary Ann Chen Ng,
(Philippines), Jin-Bao Nie (China, New Zealand), Pinit
Ratanakul (Thailand), Qiu Ren Zong (China), Hyakudai
Sakamoto (Japan), Sang-yong Song (Korea); Noritoshi
Tanida (Japan), A.K. Tharien (India), Yanguang Wang
(China), Daniel Wikler (USA), Michael Yesley (USA),
Jeong Ro Yoon (South Korea).
EJAIB - Aims:
1. EJAIB is the official journal of the Asian Bioethics
Association (ABA) and the IUBS Bioethics Program.
2. To review and update news and trends in bioethics from
around the world (about 1000 papers each issue). Bioethics is
broadly defined as life ethics, including both medical and
environmental ethics, and environmental, ethical, legal and
social issues arising from biotechnology.
3. To pay particular attention to issues raised by genetic and
reproductive technology, and other news for the International
Association of Bioethics Genetics Network. To publish letters
on such topics, promoting international debate.
4. To publish research papers, and relevant news, and letters, on
topics within Asian Bioethics, promoting research in bioethics
in the Asian region, and contributing to the interchange of ideas
within and between Asia and global international bioethics.
Asia is defined for the general purposes of this journal as the
geographical area, including the Far East, China, South East
Asia, Oceania, the Indian subcontinent, the Islamic world and
Israel.
5. To promote scientific responsibility, in coordination with
MURS Japan (Universal Movement for Scientific
Responsibility); and the International Union of Biological
Sciences (IUBS) Bioethics Program.
Eubios Journal of Asian and International Bioethics 14 (March 2004) 79

How to order books or journal or the CD! Please use the renewal form enclosed and prices are
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Eubios Journal of Asian and International Bioethics Other countries/credit card
Price: US$35 Euro 35 UK£20 NZ$40 A$40 C$40 ¥3000 NZ$60
Shaping Genes: Ethics, Law and Science of Using Genetic Technology in Medicine and Agriculture
by Darryl Macer, Oct. 1990, 421pp. Cost: US$20 UK£10 NZ$30 A$25 C$22 ¥2500 Others or credit card NZ$30
Equitable Patent Protection in the Developing World
by William Lesser, May 1991, 150pp. Cost: US$15 UK£8 NZ$20 A$20 C$17 ¥1500 NZ$25
Attitudes to Genetic Engineering: Japanese and International Comparisons (Bilingual)
by Darryl Macer, May 1992 330pp. Cost: US$30 UK£15 NZ$35 A$30 C$30 ¥3000 NZ$40
Human Genome Research & Society Eds: Norio Fujiki & Darryl R.J. Macer July 1992 ISBN 0-908897-03-0 (English),
230pp. ISBN 0-908897-04-9 (Japanese), 240pp. Cost: US$20 UK£10 NZ$30 A$25 C$22 ¥2000 NZ$30
Intractable Neurological Disorders, Human Genome Research and Society Eds: N. Fujiki & D. Macer
Feb. 1994 ISBN 0-908897-06-5 (English), 320pp. ISBN 0-908897-07-3 (Japanese), 340pp.
Cost: US$25 UK£12 NZ$30 A$30 C$27 ¥3000 NZ$40
Bioethics for the People by the People
by Darryl Macer,... May 1994 ISBN 0-908897-05-7, 460pp. Cost: US$30 UK£15 NZ$35 A$35 C$32 ¥3000 NZ$50
Bioethics in High Schools in Australia, Japan and New Zealand,
by D. Macer, Y. Asada, M. Tsuzuki, S. Akiyama, & N.Y. Macer March 1996, ISBN 0-908897-08-1, 200pp.(A4)
Cost: US$25 UK£15 NZ$30 A$30 C$30 ¥2000 NZ$40
Protection of the Human Genome and Scientific Responsibility (Bilingual)
Editors: Michio Okamoto, Norio Fujiki & D.R.J. Macer, April 1996, ISBN 0-908897-09-X, 210pp.
Cost: US$25 UK£15 NZ$30 A$30 C$30 ¥2500 NZ$35
Bioethics in India (includes 115 papers from Jan.1997 conference)
Eds: Jayapaul Azariah, Hilda Azariah & Darryl R.J. Macer June 1998 ISBN 0-908897-10-3, 403 pp.
(Printed in India) Cost: US$30 UK£18 NZ$34 A$36 C$36 ¥3000 NZ$45
Bioethics is Love of Life: An alternative textbook
by Darryl Macer,... July 1998 ISBN 0-908897-13-8, 152pp. Includes pictures!
Cost: US$26 UK£14 NZ$34 A$34 C$32 ¥3000 NZ$40
Bioethics in Asia (includes 118 papers from Nov.1997 conferences, ABC’97 Kobe and Fukui Satellite)
Eds: Norio Fujiki & Darryl R.J. Macer Cost: US$36 UK£20 NZ$40 A$38 C$40 ¥3000 NZ$50
June 1998 ISBN 0-908897-12-X, 478 pp. October 1999 ISBN 0-908897-14-6 (Japanese), 320pp.
Ethical Challenges as we approach the end of the Human Genome Project
Editor: Darryl Macer, April 2000 ISBN 0-908897-15-4, 124pp. Cost: US$20 UK£12 NZ$30 A$30 C$30 ¥2500 NZ$35
Bioethics Education in Japanese High Schools (in Japanese only)
Editor: Darryl Macer April 2000 ISBN 0-908897-16-2, 112pp.
Cost: US$20 UK£12 NZ$30 A$30 C$30 ¥1000 NZ$35
Bioethics and the Impact of Human Genome Research in the 21st Century
Eds: Norio Fujiki, Masakatsu Sudo, & Darryl R.J. Macer March 2001 (English and Japanese bilingual, 350pp).
Cost: US$30 UK£20 NZ$40 A$38 C$40 ¥3000 NZ$50
Bioethics in Asia in the 21st Century Eds: Song Sang-yong, Koo Young-Mo & Darryl R.J. Macer
August 2003 ISBN 0-908897-19-7, 450pp. Cost: US$35 Euro35 UK£20 NZ$40 A$38 C$40 ¥3000 NZ$50
Bioethics for Informed Citizens across Cultures April 2004, 160pp. (A4)
Editor: Darryl Macer Cost: US $20 Euro 15 UK £10 NZ $30 A$33 C$33 ¥ 2000 NZ$35
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80 Eubios Journal of Asian and International Bioethics 14 (March 2004)

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