Report of the 8th Asian Bioethics Conference

The 8th Asian Bioethics Conference
Century Park Hotel, Bangkok, Thailand
March 19-23, 2007

http://www.stc.arts.chula.ac.th/ABC2007/

Soraj Hongladarom
Center for Ethics of Science and Technology and Department of Philosophy
Chulalongkorn University

The Eighth Asian Bioethics Conference (ABC2007), organized by the Center for Ethics of Science and Technology and the College of Public Health, Chulalongkorn University, was held at the Century Park hotel in Bangkok, Thailand from March 19 to 23, 2007. It was preceded by an international workshop on “Technology and Culture: Genetics and its Social and Ethical Implications in Asia and Europe,” which was held on March 17 and 18 at the nearby Ibis Siam Hotel. The workshop was supported by a grant from the Asia-Europe Workshop Series, Asia-Europe Foundation and the European Alliance for Asian Studies. Many participants in the workshop stayed on to take part in the 8th ABC also. The ABC2007 conference was one of the series of conferences organized on behalf of the Asian Bioethics Association (ABA), a professional group of scholars and scientists in diverse disciplines who agreed that Asian voices and Asian perspectives on the vast number of issues that surround biomedical ethics today were needed. Prof. Hyakudai Sakamoto, one of the founders of the Association, was well known for his view on “Asian bioethics,” namely a distinct species of bioethics that encapsulates Asian voice. One thing that distinguishes it from the more mainstream, Western bioethics is that Asian bioethics emphasizes the collective, communitarian value system as opposed to the more individualistic one found in the West. However, after its foundation in 1997, the orientation of the Asian Bioethics Association has become broader, and now it includes all perspectives. The Association then functions more as a holding organization that allow diverse viewpoints and ideas to flourish rather than something with fixed agenda.


Nonetheless, the majority of the conference presenters still hailed from Asia, and understandably viewpoints and insights based on the traditional beliefs and religions played a large part in the conference. A look at the conference program shows that all major regions in Asia was represented. This includes the Middle East (or to put it in a less popular term, Western Asia), Central Asia, South Asia, South-east Asia, and the Far East. What is perhaps a rather rare event was that presenters from both Israel and the Arabic countries (one came from Jordan, another from Saudi Arabia, and one from Israel) came to this conference, something that does not happen often. A large number came from the Indian subcontinent. Many also came from mainland China and Taiwan, which was also another encouraging situation. At this conference a large number of presenters from poorer countries in the Indian subcontinent and elsewhere were able to come because of the generous grant from the Wellcome Trust and the World Health Organization, and here I would like to acknowledge with gratitude their contribution here.


The conference was not the sole prerogative of Asians by any means, however. We had a large contingent from other continents, most notably Europe and Oceania. Some participants came from as far away as the United States and Canada, and there was one participant from Kenya, who was the only one from Africa at the conference. The conference was also supported by the UNESCO, whose regional office in Bangkok is the largest one outside of their main headquarter in Paris. Many participants already had ties with the UNESCO, and in fact the conference also doubled as the Second UNESCO Bangkok Bioethics Roundtable, which was organized by Darryl Macer, Regional Advisor on Sciences and Human Sciences in Asia and Pacific, UNESCO.


In all more than 200 participants came to attend the conference, and more than 120 papers were presented. Since the ABA had a policy of no parallel sessions at the conference, the conference had then to spread to five full days, with 24 or more papers presented each day. This limited the time each paper could be presented to only fifteen minutes. Nonetheless, the presenters did very well considering the limited amount of time they had; the points were generally made clearly and succinctly, and toward the wrapping up session on Friday afternoon there were quite a large number of exhausted conference “survivors” who sticked to the event until the very end to congratulate each other and to witness the conclusion and the announcement that the next ABC would be held in Yokjakarta, Indonesia in 2008.


The Opening Panel


Due to the large number of papers, it is impossible to summarize all the papers delivered at the conference, so the following will only be a series of snapshots and impressions that I got from the conference. The conference opened in the morning of March 19 with a panel of dignitaries consisting of the Thai Minister of Science and Technology, Prof. Yongyuth Yuthavong, himself an accomplished biochemist who had worked in development of antimalarial drugs. The other panellists were the President of Chulalongkorn University, Prof. Darryl Macer, Prof. Hyakudai Sakamoto, the Founder of the ABA, and Prof. Jayapaul Azariah, current President of the ABA and Prof. Leonardo de Castro from the University of the Philippines. After the welcoming address given by Prof. Suchada on behalf of the host university, Prof. Yongyuth then presented a clear overview of the necessity of ethical considerations in the conduct of science and technology, especially on good governance of science and technology. The Minister emphasized voluntary codes of conduct for scientists, such as the 1973 voluntary moratorium on genetic engineering. Jayapaul Azariah talked about the need for ethical considerations in the face of the current global environmental and ensuring political crises. Two panellists discussed the issue of what is distinctively Asian about Asian bioethics. The main question was whether there is even such a thing as Asian bioethics, or merely bioethical studies and deliberations conducted in Asia. Hyakudai Sakamoto defended his earlier view that there was a distinct Asian character that should be incorporated to bioethics. He admitted that his style of Asian bioethics may have been limited only to Japanese, or at most Far-eastern Asian cultural milieu. Leonardo de Castro, in what could be regarded as a keynote talk of the conference, took up on this theme and outlined four majar challenges that were facing bioethicists and other scientists today. There are challenges of identity, of growing together, of the unknown and of democratization. Though he did not give a specific answer of the thorny question of the identity of Asian bioethics, he did touch upon a set of crucial questions that need to be carefully deliberated. Take the challenges of identity for example. The force of globalization does not limit itself to the economy only, but it has made itself clearly felt in other areas, especially in culture. Asian bioethics, as a system of deliberation of issues arising from advances in life sciences and biotechnology that is informed by Asian traditional beliefs, thus is facing a challenge, not of losing its putative identity (that much is still being contended), but how to find a right balance between one's own traditional belief system that defines one's cultural identity and the need for opening up and communicating with the whole world. This is one serious issue that is raised often at the conference and will certainly be a topic of many other conferences to come.


Religious and Cultural Perspectives

It is understandable that a conference on “Asian bioethics” did have a lot of papers dealing with religious perspectives on a variety of bioethical issues. Among the religions most represented at the conference were Buddhism (after all, 95 percent of the Thai population are Buddhists), Islam, and Confucianism. There were panels devoted specifically to each of these main religious traditions. Susantha Goonatilake from Sri Lanka opened the panel on Buddhist bioethics with an argument that the Buddhist conception of “Non-Self” should be a foundation of the new bioethics. Due to the advances in life sciences and biotechnology, to the effect that what has hitherto constituted the human mind and human body is continually being made ambiguous through wilful manipulations of the body, the mind and their interactions. Goonatilake contended that the Buddhist theory of Non-Self, which does not posit the existence of an eternal soul or any substantive entity that functions as the individual self, is in a better position that the theories available in the West. Moving from metaphysics to epistemology, Somparn Promta from Chulalongkorn University continued by asking what should be made known and what should not according to Buddhism. Taking a liberal position, Somparn argued that Buddhism did not have any qualms in principle against issues such as reproductive cloning or human enhancements. So long as no harm is done to anybody through these technological activities, Buddhism has nothing against them. In the end, he concluded that what should be made known in biomedical sciences was how to reduce or abolish pain and sickness, and what should not be made known, or what is not necessary to know, was the mere extension of human life without any prospect of meaning attached to it. Somparn asked what was the point in living a few years longer when these longer years consisted of boredom or just plain nothing.

Somparn's and Goonatilake's papers are attempts to base theoretical undertaking on Buddhist insights and thus theirs sound rather abstract and difficult. However, Suntaree Chaisumritchoke, a pharmacist professor from Chulalongkorn, presented a Buddhist model on consumer protection, which could readily be translated to public policy and real world action. She criticized the contemporary model of consumer protection in health care and drug regulatory systems. What was wrong with these models, according to her, was that they were based on the assumption of selfish desires. Advertisements of pharmaceutical products typically stimulated the feelings of greed and desire, emotions that are clearly negative according to Buddhism. The greed and desire engendered by the advertisements thus feed into how the regulatory system is implemented, resulting in the regulatory system being weakened and undermined. A way out, proposed Suntaree, was a Buddhist model that did not stress these negative emotions, but put emphasis on sharing, compassion and altruism. Hence Suntaree was calling for nothing short of a total revamping of the pharmaceutical industry and regulatory system whereby compassion and altruism become the leading principles rather than the profit motives based on selfish desires. It remains to be seen how this will turn out in concrete practices. Certainly this is a topic well worth pursuing further. Supposing that altruism and compassion and the spirit of sharing actually become the basic assumption of the drug industry, what would be the industry look like and how will the complex interaction between the industry, the medical profession, the patient and the society overall turn out to be like?

Apart from papers on the Buddhist perspectives, there are also other significant number of papers on the Islamic and Confucian perspectives. Bagher Larijani and Farzaneh Zahedi presented a paper on the Islamic view on cloning and stem cell research. According to them most theological perspectives consider the human fetus to be a human being in some form; however, there is a substantial debate on whether human dignity should be accorded to the fetus or not, or to what extent. In Islam, the embryo has the right to life even after its first day after conception. However, the process of ensoulment, based on the opinions of the majority of Muslim scholars, actually takes place toward the end of the fourth month. Thus the authors concluded that stem cell research on the embryo might be acceptable before that time. They also told the audience that their country, Iran, is one of the first countries to permit and to have produced human embryonic stem cells.

Another Iranian presenter, Heday Shadi, mentioned four principles of bioethics from the Islamic perspective. These principles are well known--autonomy, justice beneficence and non-maleficence. Shadi argued that the moral principle on which these four principles is based was agreeable to Islam. However, Islam emphasizes absolute obedience to God and this obedience is bound to shape up the four principles, especially in how they are applied and specified. The difference from the Western viewpoint seems to be that the Islamic perspective puts more emphasis on beneficence, sometimes over individual autonomy.

Traveling east from Iran to the Far East, we found that a large contingent came from Taiwan, and in fact a meeting of the Taiwanese Association for Bioethics was held in conjunction with the conference here. Predictably a large number of papers were on the Confucian perspective. Shui-chuen Lee from National Central University talked about justice and health in the Confucian paradigm. The idea was that the Confucian emphasis on the family and society is bound to play a significant role in the theoretical deliberation on justice in health care, as well as how this is translated into actual practice. Lee pointed out a family-based health care system where each family member helped each other by pooling their funds together and when a family member gets sick he or she draws from the central family fund. Lee argued that this sharing of family medical accounts provides a better incentive to familial solidarity, a key Confucian concept. Lee's account here thus provides a middle ground between the public system favored by the socialist ideal, and the typically Western individualistic system where each individual is on his or her own. It thus avoides the pitfalls of both systems. However, Lee did not mention what would have to be done in the case where an individual is not on an agreeable terms with her family members, or where an individual cannot depend on her family for support. Another interesting paper is on the Confucian conception of genetic privacy by Yen-Ling Kuo. Kuo argued that the individualistic account favored by biobanks in Western countries was inadequate because in the end group information would be needed for the biobanks to fulfill their objectives. Kuo thus mentioned the emerging concept of “group privacy” that has gained ground in recent years, especially concerning privacy of genetic information of populations. According to the Confucian view, the family is the smallest unit on which privacy is based. That is, the privacy is not taken to be that of an individual, but that of a family or a group. Kuo believed that this way of looking at things is more effective than the standard individualist one.

Conclusion

It is actually not possible to report on the more than 120 papers that were presented during the 8th Asian Bioethics Conference. What I have mentioned are only a very few papers dealing with religious and cultural perspectives, which perhaps formed the main point of the conference. During the five days, many participants got to know each other and did a lot of networking. Apart from the exhausting program, the organizers did find time to organize a cultural performance. The performers were none other than the volunteering conference participants themselves. Many came up to the stage singing their national songs, or performed cultural shows in their traditional costumes. Everybody had really a good time. Many participants are indeed looking forward to the 9th Asian Bioethics Conference in Indonesia next year (For more information, please contact the secretary of the executive board of the ABA, Darryl Macer at d.macer@unescobkk.org).

(I would like to thank Prof. David Gurwitz for introducing me to the Wellcome Trust, which resulted in the Trust provided a generous grant which made it possible for many participants from the developing countries to travel to Bangkok for the conference.)