Rihito Kimura,
Bioethics as a prescription for civic action

NOTES

1 Thus, the recent "bioethical movement" that took place in the United States in the State of Oregon is very interesting to observe. During 1983 and 1984, Oregon Health Decisions (a project of the Oregon Bioethics Conference) held 300 community meetings throughout Oregon. At these meetings, over 5,000 citizens shared their views about the ethical problems facing health care in Oregon. Their concerns were the basis for a slate of proposed resolutions that were debated and voted on by delegates to the Citizens' Health Care Parliament (CHCP), which convened on October 11 and 12, 1984. A "Society Must Decide" booklet was published after the final resolutions were passed by the CHCP (Crawshaw et al., 1985).
2 One of the public policy decisions on bioethical issues was the population control immediately after World War II. The Japanese Diet passed the Eugenic Protection Law (1948), which made easy access to abortion for physical, medical, and economic reasons (Article 14). There was, according to my analysis (Kimura, 1984c), an influential suggestion from the Natural Resource Section of the General Head Quarter of the Occupation Forces of this enactment. According to the present Criminal Code of Japan (Article 212-216 in Chapter 29), abortion is illegal. The Eugenic Protection Law of 1948 permits, however, abortion without prosecution.
Birth rates per 1,000 population were around 35 in 1947 and 11.4 in 1986, which was the lowest recorded in Japanese statistical data. Despite this increased reproductive control a recent trend of some political groups has been to ban appeal to economic reasons for abortions.
3 Huge quantities of factory waste had been emptied into Minamata Bay. This caused mercury contamination of the fish eaten by Minamata's families. It resulted in fetuses born with congenital anomalies, e.g., mental retardation and total paralysis of legs and arms. In this case, due to the influence of industries in Minamata City (contrasted with the limited powers of the citizens), it took more than twenty years to achieve tentative compensation by legal agreement.
4 The dehumanized milieu of psychiatric hospitals in Japan was very precisely reported and analyzed by International teams of the experts who visited Japan recently. See International Commission of Jurists (1986).
5 Given modern medical technology, Japanese health care professionals usually devote their efforts to prolonging the life of dying patients. This is analyzed in Kimura (1986c).
According to the traditional Japanese ethical point of view influenced by Buddhism, the prolongation of life and suffering would not be interpreted as absolutely necessary and ending the life of dying, suffering patients would be regarded as a merciful act (Murakami, 1980).
One of the unique precedents set by the Nagoya High Court accepts the idea of "euthanasia" even though it was not applied to the case under litigation. The criteria for acceptable "mercy killing" are as follows:

(1) The patients are in the situation of suffering from an incurable disease, defined according to modern medical knowledge and technology, and their death is close at hand.
(2) The patients are severely suffering and in pain to the extent the no one could endure.
(3) The purpose should be only for the release of patients from the pain of dying.
(4) In cases in which the patient is competent, the sincere wishes or consent of the patient should be obtained.
(5) This should be performed principally by physicians. If this is impossible, there should be special reasons to comply with the situation.
(6) The method for this performance or the act should be in accordance with ethical propriety.

All of these conditions should be satisfied in order to justify the action of euthanasia, according to the decision by Nagoya Superior Court on December 22, 1962 (Japanese Superior Court, 1965). Since then, there have been no cases to which these criteria have been applied. There have been concerns among the lay-public in Japan regarding the issues of death and dying. A group supporting the right to refuse medical treatment in cases of terminal illness and The Japanese Euthanasia Society were formed in 1975.

6 The following is one of the public policy statements on issues of in vitro fertilization and embryo transfer in Japan relevant to informed consent.

The Official Notice of the Association
October 1983
To the members of the Association;
The committee on I.V.F. etc. established by the Board of Trustees of the Association submitted a report on its opinion regarding the practice of I.V.F. and Embryo Transfer after several discussions and hearing various opinions from several different disciplinary fields.
The Board of Trustees of the Association accepted this report on June 8, 1983. Therefore we announce this report as an official notice to the members of the Association.
This report also has been agreed by the Japanese Society of Infertility, The Japanese Society of Implantation Studies, and the Japanese Society of Andrology.
MASAKUNI SUZUKI___________
President, Japanese Society of OB-GYN
An Opinion Concerning I.V.F. and E.T.
Human I.V.F. and E.T. (hereafter, "this method") is a medical treatment for the treatment of infertility. This method should be practiced with serious consideration for the ethical, legal, and social implications for our country.

1. This method should be practiced only when it is impossible to achieve pregnancy except by this method.
2. Only those who are highly trained physicians in the field of reproductive medicine should practice this method of manipulation and treatment, and then only with the utmost care perform it. Before the application of this method to a patient, there should be a full explanation and indication of the result to the patient. Also consent should be acquired in writing and a copy of the consent should be kept.
3. Those to whom this method may apply should be married and express the wish to have children as well as by in good health with respect to carrying a child, delivering a child, and rearing a child.
4. The treatment of a fertilized egg should be done carefully based on the principle of bioethics.
5. In the practice of this method, genetic manipulation should not be done.
6. In the practice of this method, the privacy of the couple and their children should be respected according to relevant legal regulations.
7. Because of the importance of this method, the institution practicing this method should establish a setting to hear, if necessary, the opinion or wishes from those who are not related directly to this matter.

Official Notice of the Society
March 1985
To the members of the society:
The Japanese Society of OBGYN has been discussing the various aspects of clinical application relating to I.V.F. and E.T. and already has announced its opinion and official notice.
Better clinical application of I.V.F. and E.T. can only be expected with continuing fundamental research. Basic research on fertilization and implantation utilizing human eggs and sperm, etc., should be done in light of important ethical, legal, and social consideration.
In considering these various aspects of the issues, the Committee on I.V.F. and E.T., after having several discussions and hearing the opinions from various disciplinary fields, has submitted the following opinion of the report in serious consideration for the research treating human sperm, egg, and fertilized egg to the Board of Trustees of the Society.
The meeting of the Board (the third one on November 17, 1984) has accepted this. Therefore we announce this as an official notice of the Society.
TOSHI KATO_________________
President, Japanese Society of OB-GYN
An Opinion Concerning Research Concerning the Human Sperm, Egg, and Fertilized Egg
1. The Permissive Limits of the Research
Sperm, egg, and fertilized egg would be used only for the research aiming for the development of fundamental studies in reproductive medical science as well as for the progress of therapeutic treatment of the infertile.

2. The Conditions Relating to Sperm, Egg, and Fertilized Egg
Sperm, egg, and fertilized egg could be used for research investigation by acquiring consent of the donors as well as in keeping the privacy of them.

a. The research on the phenomena of fertility between non-married couples should be done in explaining its purpose and acquiring their full understandings.
b. A fertilized egg can be used for research investigation only within the limit of two weeks.
c. The fertilized egg in the state of developing within the duration mentioned above should be kept frozen.

3. The Disposition After The Research Investigation
The fertilized egg utilized for the research should be kept disposed according to legal standards and to the responsible research methods.

4. Those Who Would Be Dealing With Sperm, Egg, and Fertilized Egg
Physicians are responsible in principle for dealing with human sperm, egg, and fertilized egg and co-investigators who fully recognize the importance of the research would be in charge of the research.

5. The Registration and Report of the Research
In doing research on human sperm, egg, and fertilized egg, the members of this society must give a report according to the procedure outlined by the Society.

7 On June 20, 1986, a strong concern was also expressed by Dr. Haneda (1986), President of the Japan Medical Association, during a personal interview with the author.

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