(JP) Rules needed on bioethics

[Guest guest]

http://www.yomiuri.co.jp/dy/features/science/20061230TDY04001.htm

 

Rules needed on bioethics

Masago Minami / Yomiuri Shimbun Staff Writer

 

Two stunning events occurred this autumn on the

medical front--one was a surrogate birth by a woman in

her 50s who received an egg from her daughter in her

30s, and the other was a series of transplants of

diseased kidneys. These incidents called into question

once again bioethics and medical ethics.

 

Yahiro Netsu, director of the Suwa Maternity Clinic in

Shimosuwamachi, Nagano Prefecture, announced in

mid-October he had helped the woman in her 50s give

birth to her own grandchild through a surrogate birth.

 

 

Several days before that announcement, the government

of Shinagawa Ward, Tokyo, appealed to the Supreme

Court to overturn a Tokyo High Court decision that

ordered it to accept a birth registration for twins

filed by Aki Mukai, a TV personality, and her husband.

The twins were born in the United States through a

surrogate birth.

 

In 1998, the gynecologist in question announced that

he had conducted in vitro fertilization using eggs

provided by persons other than married couples,

thereby violating rules set by the Japan Society of

Obstetrics and Gynecology (JSOG). He argued that the

rules failed to meet the needs of patients receiving

fertilization treatment.

 

This triggered a debate on assisted reproductive

technologies. In 2003, an advisory panel of the

Health, Labor and Welfare Ministry compiled a report

after holding 56 meetings, proposing to ban surrogate

births and punish violators. The JSOG endorsed the

proposals.

 

Legislation on this matter was supposed to be drawn

up, but no bills saw the light of day because those

concerned failed to iron out differences in opinion.

In the meantime, a case occurred in which a baby was

born through fertilization using frozen sperm taken

from the father before his death.

 

Netsu raised a similar issue again in mid-October. The

Justice and health ministers jointly asked the Science

Council of Japan in late November to deliberate on

issues related to the assisted reproduction

technologies.

 

Meanwhile, at Uwajima Tokushukai Hospital in Ehime

Prefecture, diseased kidneys were found to have been

transplanted to other patients, raising issues

concerning the medical validity of extracting diseased

organs for transplant and whether appropriate

procedures were followed on informed consent.

 

Makoto Mannami, who transplanted the kidneys, said he

considered it better to use the diseased kidneys--for

the benefit of patients who desperately wanted

transplants--than to discard them. But the surgeon was

criticized for his failure to conduct animal tests and

clinical research, which are necessary before applying

a new medical treatment. Some said what he had done

was tantamount to an experiment on the human body.

After conducting an investigation, the health ministry

will consider whether it is appropriate to revise

guidelines for the application of the Organ Transplant

Law.

 

Reproduction concerns human birth while organ

transplants are closely connected with preventing

death. The problem common to both reproduction and

transplants, which seem to be unrelated to each other,

is whether the human body should be used for medical

experiments--namely, an issue of bioethics.

 

Since Juro Wada of Sapporo Medical University Hospital

conducted the nation's first heart transplant in 1968,

debate continued for nearly 30 years over whether

brain death marks the end of life. Under the Organ

Transplant Law enforced in 1997, organ transplant from

a brain-dead donor became possible under certain

rules. The 50th transplant of that kind was carried

out this month. But there continues to be a shortage

of organs for use in transplants. Cases of live organ

transplants have been increasing to meet the growing

demand of patients, with the kinds of organs for

transplant now including the liver, pancreas and

lungs.

 

On the other hand, there are no legal restrictions on

auxiliary reproductive medicine. Based on views

expressed by the Japan Society of Obstetrics and

Gynecology, society members exercised self-restraint.

But there was a situation in the past in which a new

treatment method was applied at the discretion of a

physician without sufficiently confirming its safety

and suitability, and the society was forced to take

countermeasures after problems arose.

 

Take the case of artificial insemination, for example.

This had been employed by some doctors as a

fertilization treatment since the 1950s, but the

society did not announce governing rules to its

members until the mid-1990s, when it became a social

issue.

 

In most cases, these medical technologies were applied

by doctors in desperate situations as there were no

alternatives. The doctors involved in the most recent

surrogate birth case and the diseased kidney

transplants also said they had done so because it was

what their patients wanted. But since medical

technologies using human bodies involve the dignity of

life and human rights, their impacts are not limited

to patients alone.

 

Shinichi Oshima, vice director of the Japan Society

for Transplantation and director of the National

Center for Geriatrics and Gerontology, said: " Doctors

should never be allowed to decide on the use of

technology related to bioethics based on their own

discretion. That's a lesson we learned from the heart

transplant conducted by Dr. Wada. "

 

Oshima pointed out that society has the right to

decide. So how has society dealt with the issue?

 

Social concern increased and debates were held

whenever a problem arose. But that did not lead to

continued in-depth debates.

 

Shohei Yonemoto, who is the director of the Center of

Life Science and Society and has conducted extensive

international comparative research on the process for

working out science and technology policies, said,

" Japan lacks a process in which a report is drawn up

after evaluating specialized technologies from medical

and social viewpoints and sorting out issues. "

 

In the United States, a specialized bureau was

established within Congress in the early 1970s to

contribute to legislating bills related to bioethics.

European countries, for their part, established

specialized sections in their parliaments and have

reportedly enacted laws concerning bioethics since the

1990s.

 

Though rather late in the day, the Science Council of

Japan will start deliberations on reproductive

assistance medicine. The council must discuss the

matter thoroughly to get an overall picture of the

issue. For that purpose, experts should present

sufficient information to assist these discussions.

 

Even if society directs the course of bioethics, the

role of experts is still a problem as they employ

advanced medical technologies. Medical professional

organizations must set codes of ethics and rules on

medical technologies and ensure that their members

comply with them. But institutionally, Japanese

medical societies do not have such functions.

 

Such organizations will find it unavoidable to tackle

the task of formulating rules on medical ethics and

the use of technologies that embodies their medical

professionalism.

 

(Dec. 30, 2006)