The Future of Bioethics: International Dialogues addresses 21 topics in bioethics and envisions their future. The topics are divided into Part I, “Progress of Biomedical Technologies and Ethics,” and Part II, “Globalization and Bioethics.” According to its editor, the topics are chosen to convey a sense of aspiring to the formation of global bioethics toward the 21st century.
As the subtitle “International Dialogues” indicates, a distinguishing feature of this book is the assembly of researchers from various backgrounds and regions and the collection of exchanges from their discussions. Researchers from no fewer than 15 countries have contributed to the content. Each chapter is organized into a primary topic article followed by a commentary and a response to that commentary by the author of the primary topic article, with one topic being discussed by authors from different backgrounds. The international dialogues include discussions of differences in regulations between countries (chapters 1, 6, 11, 12, and 13) and tensions between unique cultures and international regulations based on universal values (chapters 8 and 18).
Part I: Progress of Biomedical Technologies and Ethics
Part I, “Progress of Biomedical Technologies and Ethics,” discusses ethical issues that arise with the development of biomedical technologies and is divided into four sections.
Section A: Regenerative Medicine
Chapter 1 steps away from the tendency of existing ethical debates to focus on the moral standing of human embryos and instead discusses potential issues that could arise when regenerative medicine is applied in clinical settings. Chapter 2 addresses neurotransplantation and nerve repair, points of intersection between neuroethics and regenerative medicine, and the implications of such research.
Section B: Enhancement
Chapter 3 discusses whether or not “moral technologies” and “moral enhancement,” which, using neuroscience, create changes in order to make human motives and behaviors moral, damage our freedom and autonomy. Chapter 4 considers enhancement within the context of “eugenics.” Specifically, it studies the two questions of whether a parent enhancing a child should be allowed, and whether a parent should be required to enhance a child. Chapter 5 addresses “doping” as a question of enhancement in sports, and debates the reasons why it should be prohibited.
Section C: Emerging Problems in Research Ethics
Chapter 6 debates the question of how cells and tissues extracted from humans should be treated, from the perspective of “proprietary rights.” Chapter 7 studies the question of whether wide-scale genetic studies can promote tailored medical care by passing on research findings to research participants. Chapter 8, keeping in mind the progress of health studies in developing countries, conceptualizes new forms and methods for international health studies.
Section D: Synthetic Biology and Chimeras
Chapter 9 studies questions accompanying the development of synthetic biology, from the viewpoint of humans playing God, and its negative impact on the natural environment. Chapter 10 debates the generation of human–animal chimeras. In response to arguments that it threatens moral boundaries, it is discussed that such repulsion toward new technologies deserves political consideration although it impedes the progress of humanity. Chapter 11 considers ethical issues that accompany the generation of chimeras from the perspective that it violates the natural order, poses a risk of damage to human dignity, and introduces public health risks.
Whereas Part I focuses on bioethical issues that arise with technological developments, Part II takes as its subject bioethical issues which have come about as a function of changes in social climate—aging, commercialization, and globalization—within the framework of existing technologies.
Part II: Globalization and Bioethics
Section A: Organ Transplant
This section explores issues of exploitation of organ transplants that have crossed country borders, harm in transplants from living individuals, and transplant tourism. In view of the actual state of chronic organ shortage, each of these articles, while continuing to fundamentally promote the expansion of organ transplantation, also reviews the necessary ethical considerations.
Section B: Public Health Ethics
This section begins by presenting a debate on what public health ethics is and goes on to discuss the decision-making process for medical resource distribution on a macro level, a major theme in public health ethics. These meta-level discussions provide a big picture snapshot of topics in public health ethics and provide a path toward further development in this area.
Section C: Care in the Aging Society
This section takes on end-of-life care and chronic diseases within the context of an aging society. It includes not only issues that arise in discussions of care families and costs of care burden, but also focuses on the new issues of international flow of nursing care providers and introduction of surveillance cameras into care settings.
Section D: Rethinking Medical Professionalism
This section takes as its theme the professional ethics of health care providers who, in midst of societal and technological changes that have been discussed up to this point, must face difficult judgments in health care practices. Discussions in the section focus on virtue ethics, clinical ethics consultations, and informed consent, all of which are reconsidered from various perspectives. Indeed, it is not simply that an individual ethical sense is required of health care providers, but rather the issue of what type of professional ethics is required within cultural and institutional backgrounds.
Conclusion
An impressive asset of this book is the productive two-way dialogue between primary topic article authors and their commentators, with both parties seeking to learn from each other and to advance our understanding of the issues, despite sometimes disagreeing about foundational matters. In such ways this book serves as an instructive model for students about how bioethical debates can make genuine progress with these issues. Also, the unprecedented level of engagement here between Eastern and Western scholars in bioethics helps to clarify whether or not seeking universal prescriptions and global solutions regarding the problems addressed here are realistically achievable aims. Undergraduate students in bioethics learn much from the critical reflections on new frontiers in bioethics, such as the ethics of regenerative medicine, human enhancement, synthetic biology, and medical tourism, particularly in light of the some of the innovative scientific research which has been conducted in some of these fields by scientists in Asian countries. And postgraduate bioethics students find the discussions of informed consent, aged care, and health care resource allocation in different cultural contexts highly illuminating and refreshingly different from traditional work on these topics.
By its nature, bioethics is a field that requires ceaseless adaptation to progress and changes in society and technology. In the face of such extreme changes, it is important to understand that we must not delay conclusions using equivocal wording such as “further discussion is necessary.” As discussed above, this book addresses changes in both technology and society and summarizes actual face-to-face discussions and critiques, rather than simply indicating the potential for debate. Seen in this light, The Future of Bioethics: International Dialogues offers a solid foundation for developing serious and thoughtful discussions aimed at fueling progress in the field of bioethics.
