The Future of Bioethics AAkkaabbaayyaasshhii112200331133OOUUKK__PPrree..iinndddd ii 1100//2233//22001133 88::3377::2299 PPMM AAkkaabbaayyaasshhii112200331133OOUUKK__PPrree..iinndddd iiii 1100//2233//22001133 88::3377::3300 PPMM The Future of Bioethics International Dialogues edited by Akira Akabayashi 1 AAkkaabbaayyaasshhii112200331133OOUUKK__PPrree..iinndddd iiiiii 1100//2233//22001133 88::3377::3300 PPMM 3 Great Clarendon Street, Oxford, ox2 6dp, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © The several contributors 2014 The moral rights of the author have been asserted First Edition published in 2014 Impression: 1 All rights reserved. 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AAkkaabbaayyaasshhii112200331133OOUUKK__PPrree..iinndddd iivv 1100//2233//22001133 88::3377::3300 PPMM Preface Evolving and cutting-edge medical technologies, such as developments in neurosci- ence and regenerative medicine, show exceptional promise in improving human health. However, they also engender unprecedented ethical, legal, and social problems that require both global and local responses. Issues related to new technologies are further confounded by the eff ect of globaliza- tion on social change, made possible by astounding developments in information tech- nology and transportation. These changes aff ect bioethics in two ways. They lead to issues around the movement of people and populations, in particular the migration of patients and care workers across continents, and those caused by enormous interna- tional medical research studies involving participants from many countries and cultures. Second, global issues call for global eff orts and global solutions. Mobilization of human- kind’s ethical wisdom is required to address these in a manner that transcends cultural and national diff erences. Establishing culturally and ethically informed dialogue is the critical fi rst step toward resolving these diverse problems. This is the fi rst book on bioethics that presents a genuine engagement between schol- ars and practitioners from East and West: the fi rst book in the discipline of bioethics for the globalized world of the future. We address the emerging issues in bioethics. We aim to set the agenda for the future, focusing on new developments and their potential for change. Most studies in bioethics advocating East–West dialogue have either attempted cross-cultural comparison or proposed Eastern philosophical paradigms as a counter to Western ideas. The tacit premise of previous writing on East–West dialogue is therefore a strain of relativism. From the Eastern perspective, Western views are treated as a cultur- al construct that should be referenced as models, but are not appropriate to be utilized in their existing form. To Westerners, Eastern interpretation represents ways of thinking that should be recognized but can never truly be understood in their complexity within Western cultures. For this reason, Asians place Western conceptions of bioethics on the critical chopping block, and approach them as something to be overcome. In contrast, although Westerners occasionally comment on current conditions in Asian countries, they rarely fully engage with bioethical discussions led by Asian researchers, and neither express agreement nor fully critique such views. In a globalized world, simply maintain- ing a respectful distance from other cultures is no longer suffi cient. The time has come for us to engage actively with diff erent cultural perspectives, rath- er than hearing them and rather than listening attentively to them. The most prominent characteristic of this collection’s development derives from the way in which the book has been developed. First, the contributors met to discuss and identify the issues at the cutting edge of bioethics. Then the leading researchers off ered primary topic articles (PTAs). Next, researchers from various countries wrote commentaries to which the PTA authors replied. At each stage, the contributors communicated with each other to ensure genuine engagement while revising their contributions in light of ongoing AAkkaabbaayyaasshhii112200331133OOUUKK__PPrree..iinndddd vv 1100//2233//22001133 88::3377::3300 PPMM vi preface dialogue. The commentary authors included leading researchers as well as promising, relatively young researchers. Thus, the book aims not only at a cross-cultural dialogue, but a dialogue between researchers of diff erent generations. The book comprises two parts. Part I looks at bioethical issues that arise from new medical technologies such as regenerative medicine, enhancement, research ethics, and synthetic biology. Part II addresses challenging dilemmas that result from the globaliza- tion of social change, such as transplantation tourism, public health ethics, care in the aging society, and professionalism. One can imagine, from a glance at the table of contents and contributing authors, what an important contribution this collection will be. Therefore a lengthy preface is unnecessary. I hope that the readers will enjoy this honest dialogue between researchers from both the East and West. While these 21 chapters do not cover all topics that are likely to arise over the course of this century, they cover particularly challenging issues faced by current researchers. Dialogue must span both local and global levels. This, to me, is “the future of bioethics.” July 2013 Akira Akabayashi University of Tokyo AAkkaabbaayyaasshhii112200331133OOUUKK__PPrree..iinndddd vvii 1100//2233//22001133 88::3377::3300 PPMM Acknowledgements I would fi rst like to express my appreciation to the editorial advisory board members, Drs. Arthur Caplan, Alastair Campbell, Tony Hope, Tom Murray, and Julian Savulescu. Especially, this book could not have been published without the help of Tony and Julian, who provided valuable editing assistance and advice. I would also like to thank Drs. Keiichiro Yamamoto, Hitoshi Arima, Satoshi Kodama, and Deborah Zion for their comments and insightful suggestions. This book was supported in part by grants from the University of Tokyo Global Center of Excellence (GCOE) Program funded by the Japanese Ministry of Education, Culture, Sports, Science and Technology, and the Uehiro Foundation on Ethics and Education. AAkkaabbaayyaasshhii112200331133OOUUKK__PPrree..iinndddd vviiii 1100//2233//22001133 88::3377::3300 PPMM AAkkaabbaayyaasshhii112200331133OOUUKK__PPrree..iinndddd vviiiiii 1100//2233//22001133 88::3377::3300 PPMM Contents List of Abbreviations x vii List of Contributors x xi Part I. Progress of Biomedical Technologies and Ethics Section A: Regenerative Medicine 1.1 Primary Topic Article: The Ethics of Regenerative Medicine: Broadening the Scope beyond the Moral Status of Embryos 5 Tamra Lysaght and Alastair V. Campbell 1.2 C ommentary: Stem Cell Clinical Research: The Biology Determines the Ethics 27 Douglas Sipp 1.3 C ommentary: Regenerative Medicine and Science Literacy 31 Eisuke Nakazawa 1.4 C ommentary: Regenerative Medicine, Politics, and the High Price of Moral Constraint 35 Aric Bendorf and Ian Kerridge 1.5 R esponse to Commentaries 4 0 Tamra Lysaght and Alastair V. Campbell 2.1 Primary Topic Article: Neural Repair as a Case Study in Neuroethics 46 D. Gareth Jones 2.2 Commentary: Some Issues in Neuroethics 65 Jing Bai and Renzong Qiu 2.3 Commentary: Public Participation as a Potential Counter Strategy against Unethical Optimism 69 Taichi Isobe, Nozomi Mizushima, and Osamu Sakura 2.4 Commentary: Three Problems with Treatments for Parkinson’s Disease 75 Yukihiro Nobuhara 2.5 Response to Commentaries: The Optimism of Misguided V entures in Repairing the Brain 8 0 D. Gareth Jones Section B: Enhancement 3.1 Primary Topic Article: Autonomy and the Ethics of Biological Behaviour Modifi cation 91 Julian Savulescu, Thomas Douglas, and Ingmar Persson AAkkaabbaayyaasshhii112200331133OOUUKK__PPrree..iinndddd iixx 1100//2233//22001133 88::3377::3300 PPMM