Yesterday, BBC World broadcasted a report on organ transplants in Japan, which was made by a BBC correspondent in Tokyo. I happened to see the report, but it seemed to me that it was a very biased one. The reason was that they have not made a sufficient research on the debate about brain death and organ transplantation in Japan.

They stressed that Japan is the country where very few organs have been transplanted (Yes, this is true), and that it is impossible for a child to get hearts from dead donors (Yes, this is also true), and they said that in Japan a number of organs are "wasted" (Well, what do they mean by this word? In Japan, such an improper word is not used in the context of organ transplants any more today), and they questioned why Japanese do not wish to donate their organs to save patients and children.

The biggest problem is that in Japan the brain death controversy has not yet been settled among lay people and among specialists. About 30% of the population do not accept the idea that a brain dead person is dead. Unlike UK and other countries, Japanese people have experienced a nation-wide debate on brain death in 1980s and 90s, and not a few of them know questionable data about brain death. Some weeks ago a Japanese news show finally aired the videotape of "lazarus sign," in which a brain dead patient's both arms voluntarily move around his body in a complicated way as if he had clear consciousness. This video was taken by medial stuff in an intensive care unit of a hospital. Such signs have been observed in a number of hospitals around the world, but the information have not been offered to lay people until today. (Although lazarus sign does not show the consciousness of the brain dead patient, this fact eloquently shows that the reality of brain death is contrary to lay people's intuition about it.)

Many Japanese people still hesitate to accept brain death as human death. There are many specialists around the world who do not think brain death as human death, but their voices do not reach lay people in their countries because the mass media does not try to report them. Unlike those countries, the Japanese mass media has tried to report various information on brain death, and as a result, Japanese people have been provided with not only positive data but also negative data about brain death.

The viewers of BBC World would probably have had the impression that the Japanese are the "egoistic" people who does not wish to donate their organs after they die. This is because BBC did not report in their program the importance of the brain death controversy in Japan. This is the reason I say that BBC's report was heavily biased.

Please read the related paper: "Reconsidering Brain Death: A Lesson from Japan’s Fifteen Years of Experience" (Hastings Center Report, 2001)

Photo: Konoe Kaikan building, Tokyo

What's New: .

Post a comment / See comments (Blog)

Reuters reported on Nov.1 that the parents of a 6-year-old girl with severe developmental disability decided to stop her growth permanently by injecting estrogen. This therapy was successful, and the girl has stopped growing. (The report suggests that the parents live in Seattle, USA). Do you think such a therapy is morally acceptable?

The parents say that it is extremely difficult to care for a child with profound developmental disabilities, particularly after menstruation begins.

Caring for children with profound developmental disabilities can be difficult and demanding, they note. For children with severe combined neurologic and cognitive impairment who are unable to move without assistance, all the necessities of life -- dressing, bathing, transporting -- must be provided by caregivers, usually parents, and these tasks become increasing difficult, if not impossible, as the child increases in size.

They were concerned about having to turn over care to "strangers" and also about the complications that would arise when the child started menstruating. (web)

What we have to discuss is whether the difficulty of caring could constitute a sufficient reason for halting the growth of a child. It might be acceptable to halt the growth in case that the growth causes to the child an unbearable pain that cannot be cured by any medications. But in the above case, it is the parents, not the child herself, that experience the difficulties of caring.

I don't think this kind of therapy is defendable. I have found a couple of Japanese blogs that discussed this case. Both are negative about the parents' decision. 25 years ago, a Japanese woman with disability was sterilized because of the difficulties of caring for her menstruation. A group of disabled people denounced this case. They believed that there must have been many other similar cases among disabled women living in nursing homes.

Anyway, in the both cases, menstruation seems to be a crucial point. I believe feminist bioethicists have to say something about the important role that menstruation played in these cases. Is menstruation an experience that should be deleted from the life of a severely disabled woman (girl) who cannot care for it herself?

Of course, in the above case, menstruation is only one of the reasons for stopping her growth, but I feel we must not belittle the fact that the parents refered to menstruation when they justified their decision to stop the growth of their daughter.

Photo: The Supreme Court, Tokyo

What's New: .

Post a comment / See comments (Blog)

I am now reading Hans Jonas's paper, "The Burden and Blessing of Mortality" (Hastings Center Report, 1992). Hans Jonas is not only famous for his research on the philosophy of Gnosis, but for his books on environmental ethics and bioethics. I think he is the most important philosopher in the field of bioethics so far. He died in 1993, hence, this paper is considered to be one of the most important in the later days of his life.

I will write about this paper in the next post. Please give me time to think.

Photo: The Supreme Court, Tokyo

What's New: .

Post a comment / See comments (Blog)

Hans Jonas's paper, "The Burden and Blessing of Mortality" was published in Hastings Center Report in 1992, a year previous to his death, 1993. This is the "swan song" of Hans Jonas. Jonas tries to insist that death is both painful and mercy to us mortals. His old fashioned English was not easy to read through for a non-native speaker like me, but I was deeply moved by his speculation and his style.

He distinguishes two facts: "we can die" and "we must die," and he says that the former is the burden and the latter is the blessing. We can easily understand that the former is a burden to us mortals, but why is the latter a blessing?

In the first half of his paper, he discusses the importance of metabolism for organisms. This part is a resume of his philosophy of organism. In this paper, he writes, "Life says yes to itself" because life maitains itself by continued metabolism (p.36). His philosophy of life is really interesting and queer. He is probably one of the most important philosophers in the 20th century.

In the latter half of his paper, he talks about why radical life extension is problematic to humans. Firstly, it interferes "the ever-repeated turnover of generations." He borrows the term "natality" from Hannah Arendt and says as follows:

It denotes the fact that we all have been born, which means that each of us had a beginning when others already had long been there, and this endures that there will always be such that see the world for the first time, see things with new eyes, wonder where others are dulled by habit, start out from where they had arrived. Youth with its fumbling and follies, its eagerness and questioning is the eternal hope of mankind. (p.39)

Secondly, radical life extension is not desirable for an individual. Even if our vital functions continued unimpaired, "there are limits to what our brains can store and keep adding to." Hence extended life will be either life without the past memories, or living only in the past without a real present (p.40).

Hans Jonas does not clearly state why mortality is blessing for us, but I feel he wanted to say that only "death" can prevent us from experiencing such miserable life described above, hence death appears as a blessing to us mortals which are apt to follow the temptation to live as long as possible even if their life is actually miserable.

Reading Jonas, I have come to think that one of the most important topics in the age of life extension would be how to pursue a sort of death, or suicide, without despair, that is to say, that with self-affirmation from the bottom of one's heart. This is not what Jonas wanted to say, but I believe he must have thought about it in a corner of his mind when he wrote this paper just before his death.

Photo: White stork, Toyo'oka, Hyogo, Japan

What's New: .

Post a comment / See comments (Blog)

Today I have read David Gems's paper, "Is More Life Always Better? The New Biology of Aging and the Meaning of Life," Hastings Cneter Report, July-August, 2003. Gems talks about various facets of life extension, biology of aging, and the meaning of life in the age of advanced biotechnology. The year 2003 was the year when Leon Kass's Presidential Report was published (and also the year my Painless Civlization was published in Japanese).

In the first section, he writes the following remark:

... I want to suggest that aging research raises philosophical questions about the shape and purpose of life that bioethics has thus far failed to address. (p.32)

I agree with him on this point. What we need is the philosophy of life in the age of advanced technology. He discusses a number of interesting points, and I believe each of them is indispensable to the discussion of the ethical aspect of life extension, however, I couldn't find a decisive clue to resolve difficult philosophical problems surrounding aging and immortality (but I want to hasten to add that his paper was really interesting and I have studied a lot from his argument).

Basically, he is in favor of life extension. What he fears most is the unfair distribution of life extension technology, especially the possibility that such technology could be monopolized by "the hands of a few undying individuals -- and particularly into the hands of tyrants" (p.38). He says:

Even under tyranny one can at least wait, and hope to outlive one's oppressor. For this reason alone, anti-aging treatments represent a very serious threat to humanity in the long term (p.34).

Then he examines the objections to life extension. Many people say that if we become immortal we will be bored with our life, but Gems doubts this assumption. He says he can imagine people who can continue to "enjoy endless repetition of the same experience" (p.35).

This argument made me think that people who are able to adapt to immortal society would be those who can enjoy endless repetition of the same experience, and those who cannot enjoy it might be automatically eliminated from such a society in the form of various types of suicide. Of course, it may be possible to alter someone's personality, by future genetic technology, into a new one which makes him/her fond of repetition. But isn't this nothing but a dystopia?

In the second half of his paper, Gems talks about age polyethism and the importance of the type of life plan. This is an interesting thought experiment. His last words are:

Thus, extension of lifespan might not simply be more of the same, but rather, it could create a larger foundation upon which a life of greater scope, possibility, and achievement may be constructed. (p.38)

Well, I have to say again that I am not a bioconservative, and I am not a Christian. I am agnostic and I want to support women's right to abortion. But I don't agree with the argument that life extension has no ethical or philosophical problems. I understand that I will have to articulate the reason why I think so. Please give me (plenty of) time to think. Anyway, I enjoyed Gems's paper. His discussion was really interesting and helpful.

Photo: Toyo'oka, Hyogo, Japan

What's New: .

Post a comment / See comments (Blog)

I was asked to write a short self-introduction for an English newsletter. The following is the first part of it. This will be edited and printed next year. I am not sure if the newsletter will be published on the web.

I was born in 1958 in Kochi prefecture, Japan, and studied philosophy and ethics at the University of Tokyo. First I intended to study quantum physics but I shifted my course to philosophy and ethics, particularly European ones. I researched the philosophy of Wittgenstein and published some papers. Simultaneously, I was strongly interested in medical ethics and environmental ethics. At that time, in the 1980s, Japanese academicians began trying to introduce American bioethics into Japan, hence, I studied English literatures on bioethics and environmental ethics, but I was very frustrated with their discussion. I felt that their discussion failed to grasp the importance of “human relationships,” and the “relationship” between debated topics and the researcher him/herself.

A nation-wide debate on brain death began in the mid-1980s. I has been deeply involved in this debate from the late 1980s to the present. Japan is a country where there has been a very few organ transplants from brain dead donors. One of the reasons of this would be that Japan has had a great amount of nation-wide debate on this topic, including not only specialists but lay citizens. In Japan, 30% of the population do not think that brain death is human death. I published the book, “Brain Dead Person” in 1989, and stressed that brain death should be viewed from the perspective of “human relationships,” particularly in terms of the human relationship between a brain dead patient and his/her family members.

I stressed the importance of psychological & spiritual relationships between a brain dead patient and his/her family members surrounding the patient. A very unique “reality” exists in this relationship, which cannot be understood by the doctors or coordinators who are basically strangers to the patient and the family. This approach, together with other important books on brain death written by other authors, created an interesting approach to bioethics, namely, “human relationship oriented analysis to brain death.” I coined the words “life studies” and proposed a new research area inside and outside of bioethics.

Speaking of brain death, two bills on the revision of current transplantation law are now presented to the Diet. One of them is based on the proposal that Dr. Sugimoto and I publicly proposed in 2001. If you are interested in the Japanese debate on brain death and organ transplantation please visit our website and read papers and materials on this topic.

(To be continued...)

Photo: Kyoto Tower, Kyoto

What's New: .

Post a comment / See comments (Blog)