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  1. 1. A Cross-Cultural Introduction to Bioethics Darryl R.J. Macer, Ph.D. (Editor) Eubios Ethics Institute 2006
  2. 2. ii A Cross-Cultural Introduction to Bioethics Eubios Ethics Institute Bangkok Christchurch Tsukuba Science City The Eubios Ethics Institute is a non-profit group that aims to stimulate the discussion of ethical issues, and how we may use new technology in ways consistent with "good life". An important part of this dialogue is to function as an information source for those with similar concerns. Other publications are listed at the end of this book. The views expressed in this book do not necessarily represent the views of the Eubios Ethics Institute or UNESCO. Copyright © 2006 Eubios Ethics Institute All rights reserved. The copyright for the complete publication is held by the Eubios Ethics Institute. No part of this publication may be reproduced except for personal use, and non-profit educational use, without the prior written permission of the Eubios Ethics Institute. Cataloging-in-Publication data A Cross-Cultural Introduction to Bioethics / editor, Darryl R.J. Macer. Christchurch, N.Z. : Eubios Ethics Institute ©2006. 1 v. xx +280 pp. A4 size. ISBN 0-908897-23-5 1. Bioethics. 2. Medical ethics 3. Environmental Ethics 4. Bioethics Education 5. Genetics 6. Neurosciences I. Macer, Darryl R.J. (Darryl Raymund Johnson), 1962- IV. Eubios Ethics Institute. V. Title (A Cross-Cultural Introduction to Bioethics). Key Words: Asia, Biodiversity, Bioethics, Bioethics Education, Biotechnology, Body, Cloning, Education for Sustainable Development (ESD), Economics, Energy, Environment, Environmental Ethics, Eugenics, Genetic Engineering, Genetic Screening, Genetic Therapy, Human Genetic Disease, Human Genome Project (Scientific, Ethical, Social and Legal Aspects), Medical Ethics, Medical Genetics (Diagnosis, Treatment and Prevention), Patenting of Life, Peace, Reproductive Technology, Surrogacy, Sustainable Development. On-line version and teachers guides, references, Internet links Project site <http://www.unescobkk.org/index.php?id=2508> Further copies can be obtained from the Eubios Ethics Institute. For teachers involved in the Bioethics Education Project (open to all), this book is free. For others contributions are appreciated by cheque, or bank or postal order, or VISA or MASTERCARD for the following amounts (includes post). Applications from developing countries for free copies should also be addressed as below, and special arrangements for teaching trials. US $20 Euro 15 UK £10 NZ $30 A$33 C$33 ¥ 2000 payable to the "Eubios Ethics Institute"; c/o Darryl Macer, Ph.D., Director, Eubios Ethics Institute c/o UNESCO Bangkok, 920 Sukhumvit Road, Prakanong, Bangkok 10110, THAILAND Tel: +66-2-391-0577 ext 141 Fax: +66-2-664-3772 Email: d.macer@unescobkk.org The above address should also be used to send feedback forms from teachers and students!
  3. 3. A Cross-Cultural Introduction to Bioethics iii Content list Preface v Feedback Forms Teacher Feedback Forms vii Student Feedback Forms xiii Authorship and Acknowledgments xviii Authors’ Profiles xviii A. Bioethics and the Ethics of Science and Technology 1. Making Choices, Diversity and Bioethics 1 2. Ethics in History and Love of Life 6 3. Moral Agents 18 4. Ethical limits of Animal Use 22 5. Ethics and Nanotechnology 27 B. Environmental Ethics 1. Ecology and Life 30 2. Biodiversity and Extinction 36 3. Ecological Ethics 40 4. Environmental Science 43 5. Environmental Economics 51 6. Sustainable Development 63 7. Cars and the Ethics of Costs and Benefits 73 8. Energy Crisis, Resources and Environment 78 9. Ecotourism 85 10. The Earth Charter Initiative 93 C. Genetics 1. Genetics, DNA and Mutations 98 2. Ethics of Genetic Engineering 102 3. Genetically Modified Foods 107 4. Testing for Cancer Gene Susceptibility 110 5. Genetic Privacy and Information 113 6. The Human Genome Project 117 7. Eugenics 121 8. Human Gene Therapy 122 9. Universal Declaration on the Human Genome and Human Rights 129 10. International Declaration on Human Genetic Data 134 D. Medical Ethics 1. Informed Consent and Informed Choice 145 2. Telling the Truth about Terminal Cancer 147 3. Euthanasia 153 4. Brain Death 158 5. Organ Donation 164 6. Brain Death and Organ Transplant Drama 170
  4. 4. iv A Cross-Cultural Introduction to Bioethics 7. The Heart Transplant 175 8. SARS (Severe Acute Respiratory Syndrome) 176 9. AIDS and Ethics 177 10. Ethical Principles for Medical Research Involving Human Subjects 183 11. Bird Flu 188 12. Indigenous Medicines and Access to Health 189 E. Reproduction 1. Lifestyle and Fertility 192 2. Assisted Reproduction 198 3. Surrogacy 204 4. Choosing Your Children’s Sex and Designer Children 205 5. Prenatal Diagnosis of Genetic Disease 208 6. Female Infanticide 211 7. Human Cloning 214 8. United Nations Declaration on Human Cloning 215 9. Human Genome Organization (HUGO) Ethics Committee Statement on Stem Cells 222 F. Neurosciences 1. Advances in Neuroscience and Neuroethics 224 2. Learning to Remember: The Biological Basis of Memory 229 3. The Neuroscience of Pleasure, Reward and Addiction 235 G. Social Ethics 1. Revisiting the Body 241 2. Child Labour 251 3. Peace and Peace-keeping 253 4. Human Rights and Responsibilities 269 Movie Guides and Questions (Samples) 277 Note that the Teaching Guides, References, Internet links, are in a separate document that can be downloaded from the Internet site http://www.unescobkk.org/index.php?id=2508 or <http://www2.unescobkk.org/eubios/BetCD/BetbkTR.doc> Update : Download a copy of the UNESCO Universal Declaration on Bioethics and Human Rights, and make an analysis of this framework that was agreed by all member countries of the world in October 2005 for bioethics. <http://www2.unescobkk.org/eubios/udbhr.pdf>
  5. 5. A Cross-Cultural Introduction to Bioethics v Preface Bioethics could be defined as the study of ethical issues and decision-making associated with the use of living organisms. Bioethics includes both medical ethics and environmental ethics. Bioethics is learning how to balance different benefits, risks and duties. Concepts of bioethics can be seen in literature, art, music, culture, philosophy, and religion, throughout history. Every culture has developed bioethics, and in this book there is a range of teaching resources that can be used that are written from a cross-cultural perspective by a variety of authors. In order to have a sustainable future, we need to promote bioethical maturity. We could call the bioethical maturity of a society the ability to balance the benefits and risks of applications of biological or medical technology. It is also reflected in the extent to which public views are incorporated into policy-making while respecting the duties of society to ensure individual's informed choice. Awareness of concerns and risks should be maintained, and debated, for it may lessen the possibility of misuse of these technologies. Other important ideals of bioethics such as autonomy and justice need to be protected and included when balancing benefits and risks. Bioethics is not about thinking that we can always find one correct solution to ethical problems. Ethical principles and issues need to be balanced. Many people already attempt to do so unconsciously. The balance varies more between two persons within any one culture than between any two. A mature society is one that has developed some of the social and behavioural tools to balance these bioethical principles, and apply them to new situations raised by technology. The title of this book is A Cross-Cultural Introduction to Bioethics, which includes second editions of the chapters in the 2004 textbook Bioethics for Informed Citizens Across Cultures, with a doubling of size due to the presence of more chapters. The chapters can be used at a variety of levels and at different years of teaching. They are combined here in one formulation that has worked in some cultures, but other teachers may wish to use only some of the chapters. Inside a school, the different chapters may fit into the curriculum across several years of education, supplementing existing courses in disciplines such as social studies, ethics, biology, science, history and foreign language classes. The objectives of this book (and on-line resources at UNESCO Bangkok website and the teaching pack on the Eubios CD/DVD) are to provide a free on-line resource teachers and students can use to learn about bioethics, and think more widely about life. A variety of styles are used, and we would like feedback from teachers, students, anyone who wishes to use it. List serves function in English for educators and students, and persons from a wide range of countries have tried these resources, and contributed to this project over the past three years. Internet site <http://www.unescobkk.org/index.php?id=2508> Internet site <http://www2.unescobkk.org/eubios/betext.htm> Education listserve <http://groups.yahoo.com/group/Bioethicseducation/> Student listserve <http://groups.yahoo.com/group/ Bioethics_for_students/> This project aims to produce free on-line teaching materials for bioethics education in different countries. The main products will be: 1) Materials for teaching bioethics; 2) A textbook that could be used in school and university classes to teach about bioethical issues; and 3) A network of teachers in different countries.
  6. 6. vi A Cross-Cultural Introduction to Bioethics There has been consensus among those involved that we can measure the success of bioethics education in several ways. Some goals of bioethics include: 1) Increasing respect for life; 2) Balancing benefits and risks of Science and Technology; 3) Understanding better the diversity of views of different persons. We do not need to achieve all three goals to consider education to be successful, and different teachers and institutions put a different amount of emphasis on each goal. This book has pages for students at many levels of learning, and for teachers. Please access the on-line site for a growing list of chapters and teaching materials and resources in different languages (currently, Korean, Japanese, Spanish, Chinese and Tamil). Chapters as well as whole sections and the textbook can be used in any way the educators wish. It is suggested that teachers select the appropriate length of text (from the introductory styles in the one page versions to the detailed long versions) to give to students to read, but that students can read all the text if they have time and interest. There are also detailed lists of websites and academic references that both teachers and more senior students who wish to spend more time reading about these issues may use. The versions of chapters and materials that are on-line are in colour, but this book is printed for economic reasons in monochrome. The Eubios Ethics Institute website has about 2000 files available for download, including the UNESCO/IUBS/Eubios Living Bioethics Dictionary, and regular News updates. Further copies of chapters and updates, teaching guides, evaluation sheets, etc. are available upon request. We are also interested in assembling student projects and different teachers' materials in a global site that all can use, and can inform us all. We welcome improvement and additions to this project. Short backgrounds of some authors are in the section on Authorship and Acknowledgments. In the case that no author is mentioned on the first page the author was the editor. We also thank the essential financial support of Sasakawa Peace Foundation for the project 2003-2005, and the ongoing support of UNESCO Bangkok. Above all we thank the thousands of students and hundreds of teachers from many countries who have already shared their comments to help improve the materials. That feedback is essential to further improvement of the materials, and the feedback forms follow this. The limit to this project is only the imagination of those involved. Darryl Macer, Ph.D. Editor January, 2006

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