Teachers Resources
and Notes for
A Cross-Cultural
Introduction to
Bioethics
Darryl R.J. Macer, Ph.D.
(Editor)
(draft version 3, 22 January 2007)
Eubios Ethics Institute 2006
2
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Eubios Ethics Institute
Bangkok
Christchurch
Tsukuba Science City
The Eubios Ethics Institute is a non-profit group that aims to stimulate the discussion of ethical
issues, and how we may use new technology in ways consistent with "good life". An important
part of this dialogue is to function as an information source for those with similar concerns.
Other publications are listed at the end of this book. The views expressed in this book do not
necessarily represent the views of the Eubios Ethics Institute or UNESCO.
Copyright © 2006 Eubios Ethics Institute
All rights reserved. The copyright for the complete publication is held by the Eubios Ethics Institute.
No part of this publication may be reproduced except for personal use, and non-profit educational use,
without the prior written permission of the Eubios Ethics Institute.
Cataloging-in-Publication data
Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics / editor, Darryl R.J.
Macer.
Christchurch, N.Z. : Eubios Ethics Institute ©2006.
1 v.
100 pp. A4 size. ISBN 0-908897-24-3
1. Bioethics. 2. Medical ethics 3. Environmental Ethics 4. Bioethics Education 5. Genetics 6.
Neurosciences I. Macer, Darryl R.J. (Darryl Raymund Johnson), 1962- IV. Eubios Ethics Institute. V.
Title (Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics).
Key Words: Asia, Biodiversity, Bioethics, Bioethics Education, Biotechnology, Body, Cloning,
Education for Sustainable Development (ESD), Economics, Energy, Environment, Environmental
Ethics, Eugenics, Genetic Engineering, Genetic Screening, Genetic Therapy, Human Genetic Disease,
Human Genome Project (Scientific, Ethical, Social and Legal Aspects), Medical Ethics, Medical
Genetics (Diagnosis, Treatment and Prevention), Patenting of Life, Peace, Reproductive Technology,
Surrogacy, Sustainable Development.
On-line version and teachers guides, references, Internet links
Project site <http://www.unescobkk.org/index.php?id=2508>
On-line version of the textbook / resource book can be downloaded from
<http://eubios.info/ccib.htm>
On-line version for latest edition of Teacher Resources can be downloaded from
<http://eubios.info/BetCD/BetbkTR.doc>
Further copies can be obtained from the Eubios Ethics Institute.
c/o Darryl Macer, Ph.D.,
Director, Eubios Ethics Institute
c/o UNESCO Bangkok,
920 Sukhumvit Road, Prakanong, Bangkok 10110, THAILAND
Tel: +66-2-391-0577 ext 141
Fax: +66-2-664-3772
Email: d.macer@unescobkk.org
The above address should also be used to send feedback forms from teachers and students!
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
3
Content list
Preface
5
Evaluation and Goals of Bioethics Education
1: Goals of Bioethics
2: Evaluation
3: Stages in moral development
4: Ongoing reassessment and evaluation
5: Participatory Methods
6: References
7
8
11
14
16
17
Explanation of chapters
(Page numbers refer to the page in the textbook)
A. Bioethics and the Ethics of Science and Technology
1. Making Choices, Diversity and Bioethics
1
2. Ethics in History and Love of Life
6
3. Moral Agents
18
4. Ethical limits of Animal Use
22
5. Ethics and Nanotechnology
27
B. Environmental Ethics
1. Ecology and Life
2. Biodiversity and Extinction
3. Ecological Ethics
4. Environmental Science
5. Environmental Economics
6. Sustainable Development
7. Cars and the Ethics of Costs and Benefits
8. Energy Crisis, Resources and Environment
9. Ecotourism
10. The Earth Charter Initiative
30
36
40
43
51
63
73
78
85
93
C. Genetics
1. Genetics, DNA and Mutations
2. Ethics of Genetic Engineering
3. Genetically Modified Foods
4. Testing for Cancer Gene Susceptibility
5. Genetic Privacy and Information
6. The Human Genome Project
7. Eugenics
8. Human Gene Therapy
9. Universal Declaration on the Human Genome and Human Rights
10. International Declaration on Human Genetic Data
98
102
107
110
113
117
121
122
129
134
D. Medical Ethics
1. Informed Consent and Informed Choice
2. Telling the Truth about Terminal Cancer
3. Euthanasia
4. Brain Death
145
147
153
158
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
5. Organ Donation
6. Brain Death and Organ Transplant Drama
7. The Heart Transplant
8. SARS (Severe Acute Respiratory Syndrome)
9. AIDS and Ethics
10. Ethical Principles for Medical Research Involving Human Subjects
11. Bird Flu
12. Indigenous Medicines and Access to Health
164
170
175
176
177
183
188
189
E. Reproduction
1. Lifestyle and Fertility
2. Assisted Reproduction
3. Surrogacy
4. Choosing Your Children’s Sex and Designer Children
5. Prenatal Diagnosis of Genetic Disease
6. Female Infanticide
7. Human Cloning
8. United Nations Declaration on Human Cloning
9. Human Genome Organization (HUGO) Ethics Committee Statement on Stem Cells
192
198
204
205
208
211
214
215
222
F. Neurosciences
1. Advances in Neuroscience and Neuroethics
2. Learning to Remember: The Biological Basis of Memory
3. The Neuroscience of Pleasure, Reward and Addiction
224
229
235
G. Social Ethics
1. Revisiting the Body
2. Child Labour
3. Peace and Peace-keeping
4. Human Rights and Responsibilities
241
251
253
269
Movie Guides and Questions (Samples)
277
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Preface
This teacher’s guide is available for use to accompany the textbook, A Cross-Cultural
Introduction to Bioethics, which is available in both hard copy or as a soft copy to download
without charge from the Internet. The teaching resources and notes include academic
references, further reading, Internet sites and other information that supplements the
text/resource book. This book may be useful for teachers as they teach bioethics, and for
students who wish to write reports and do their own research on the topics in the textbook.
The first section is a general introduction to evaluation of bioethics that I have written to
help teachers examine what bioethics is. There are many goals of bioethics and they are
discussed here.
The order of the teaching resources and notes for each chapter follows the same order as
in the textbook. This book will be regularly updated on-line. Please refer to the textbook itself
for the authors who contributed to the chapters, and who have compiled reference lists for
those who wish to examine the background behind the chapters. The student and teacher
feedback forms are printed in the textbook, and can be downloaded with the preface of the
book. The on-line version of that book can be downloaded from <http://eubios.info/ccib.htm>
Bioethics could be defined as the study of ethical issues and decision-making associated
with the use of living organisms. Bioethics includes both medical ethics and environmental
ethics. Bioethics is learning how to balance different benefits, risks and duties. Concepts of
bioethics can be seen in literature, art, music, culture, philosophy, and religion, throughout
history. Every culture has developed bioethics, and in this book there is a range of teaching
resources that can be used that are written from a cross-cultural perspective by a variety of
authors.
In order to have a sustainable future, we need to promote bioethical maturity. We could
call the bioethical maturity of a society the ability to balance the benefits and risks of
applications of biological or medical technology. It is also reflected in the extent to which
public views are incorporated into policy-making while respecting the duties of society to
ensure individual's informed choice. Awareness of concerns and risks should be maintained,
and debated, for it may lessen the possibility of misuse of these technologies. Other important
ideals of bioethics such as autonomy and justice need to be protected and included when
balancing benefits and risks.
Bioethics is not about thinking that we can always find one correct solution to ethical
problems. Ethical principles and issues need to be balanced. Many people already attempt to
do so unconsciously. The balance varies more between two persons within any one culture than
between any two. A mature society is one that has developed some of the social and
behavioural tools to balance these bioethical principles, and apply them to new situations
raised by technology.
The objectives of this guide and the on-line multilingual resources at UNESCO
Bangkok website and the teaching pack on the Eubios CD are to provide a free on-line
resource teachers and students can use to learn about bioethics, and think more widely about
life. A variety of styles are used, and we would like feedback from teachers, students, anyone
who wishes to use it.
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
List serves function in English for educators and students, and persons from a wide
range of countries have tried these resources, and contributed to this project over the past three
years.
Internet site <http://www.unescobkk.org/index.php?id=2508>
Internet site <http://eubios.info/betext.htm>
Education listserve <http://groups.yahoo.com/group/Bioethicseducation/>
Student listserve <http://groups.yahoo.com/group/ Bioethics_for_students/>
Teaching Guides, References, Internet links (this document)
<http://eubios.info/BetCD/BetbkTR.doc>
This project aims to produce free on-line teaching materials for bioethics education in
different countries. The main products will be: 1) Materials for teaching bioethics; 2) A
textbook that could be used in school and university classes to teach about bioethical issues;
and 3) A network of teachers in different countries.
The Eubios Ethics Institute website has over 2000 files available for download,
including the UNESCO/IUBS/Eubios Living Bioethics Dictionary, and regular News updates.
Further copies of chapters and updates, teaching guides, evaluation sheets, etc. are available
upon request. We are also interested in assembling student projects and different teachers'
materials in a global site that all can use, and can inform us all. We welcome improvement and
additions to this project.
The project described herein will continue under the framework of a Bioethics
Education Textbook Project of UNESCO Bangkok, continuing to gather more teaching
resources in multiple languages from around the world and make them openly available. A
network of educators to improve global bioethics education has been developed under the
International Bioethics Education Network. The lessons from the project need to be developed
in the context of policy and curriculum in a number of countries.
Darryl Macer, Ph.D.
Editor
All suggestions to
Darryl Macer, Ph.D.,
Director, Eubios Ethics Institute
c/o UNESCO Bangkok,
920 Sukhumvit Road, Prakanong, Bangkok 10110, THAILAND
d.macer@unescobkk.org
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Evaluation and Goals of Bioethics Education
1: Goals of Bioethics
There can be several goals of bioethics education, and each could be associated with
different measures in evaluation. There does not exist a consensus in the academic literature
and teaching community on the most important goals to measure nor on the best criteria to
assess whether the education is successful. For more than 60 years it has been recorded that
both quantitative and qualitative data are important in social science research, as was said by
Merton and Kendall (1946), "Social scientists have come to abandon the spurious choice
between qualitative and quantitative data: they are concerned rather with the combination of
both which makes use of the most valuable features of each. The problem becomes one of the
determining at which points they should adopt the one, and at which the other, approach". Thus
an appropriate methodological tool should contain methods to utilize and assess both types of
data.
The goals of bioethics that were important to measure were found to include: 1)
Increasing respect for life; 2) Balancing benefits and risks of Science and Technology; 3)
Understanding better the diversity of views of different persons; 4) Understanding the breadth
of questions that are posed by advanced science and technology; 5) Being able to integrate the
use of scientific facts and ethical principles and argumentation in discussing cases involving
moral dilemmas; 6) Being able to take different viewpoints such as biocentric and ecocentric
perspectives. We do not need to achieve all goals to consider a class to be successful, and
different teachers and schools put a different amount of emphasis on each goal.
One important goal of teaching about bioethical issues is to get students to critically
evaluate the issues (Conner, 2003). In a Mexican case (Rodriguez, 2005), bioethics classes
were used as a way to improve the general behaviour and study aptitude of students. Each
institution is likely to put a different amount of emphasis on each goal. Also, different activities
are likely to enable some goals to be met and not others (Macer, 2004c). Therefore we do not
need to assess all the institutional objectives when evaluating the success of the trials. Instead,
case studies of how students and teachers responded were also sought to give a wider
descriptive account of various approaches.
One of the goals of this project was to examine criteria that could be used to measure
the success of bioethics education, and the effectiveness of different forms of education for
making mature citizens. There is a consensus among many Western scholars that the balancing
of four main bioethical principles, which are Autonomy, Justice, Beneficence and nonmaleficence, is central to making better decisions (Beauchamp and Childress, 1994). These
principles are introduced in chapter 1 of the text. Autonomy includes ideas such as respect for
privacy, respect for personal choice. Justice is to respect the autonomy of others, and to treat
persons equally. Beneficence is to try to do good, and non-maleficence is to avoid harm.
When solving or trying to reach a consensus about bioethical problems, these four main
principles can be a good guide in balancing which ideas should be mostly weighed. One
measure of bioethics education could then be whether students are able to use these principles
in decision-making, which was examined by presence of these keywords in discourse (oral or
written). In the future the use of principles as expressed in the UNESCO Universal Declaration
on Bioethics and Human Rights (2005) will also be analyzed to broaden the description of
bioethical reasoning.
Still, reaching a good decision is often difficult, which also may not be the same if
made in different times and situations. Another approach that is common in education is to
teach learners to break down ethical dilemmas into manageable problems, for example, the
separation of action, consequence and motives connected to a moral decision. This separation
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
is reflected on the different bioethical theories, and some of these are introduced in chapter 2.
Utilitarianism is an example of a bioethical theory, which looks at the consequences of an
action, and is based on the work of Jeremy Bentham and John Stuart Mill. This principle
asserts that we ought always to produce the maximal balance of happiness or pleasure over
pain, or good over harm, or positive value over disvalue. Utilitarianism can be then broken
down into rule utilitarianism, and act utilitarianism. “A rule utilitarian may use moral rules as
authoritative instrumental rules, so the morally right action is conformity to a system of rules,
and the criterion of the rightness of the rule is the production of as much general happiness as
possible (Macer, 1998a)”. Act utilitarians on the other hand, look at the particular act only, and
object to moral rules to be only an approximate guides, which could be broken if maximal
good is not obtained. Another example of a bioethical theory is rights based theories of
Immanuel Kant, and human rights law (Beauchamp and Childress, 1994; Macer, 1998a). The
use of utilitarian-style logic and rights arguments were also examined among the discourse.
The evaluation tools developed here could be extended to look for presence of other concepts
such as virtue ethics for example.
Integration of scientific facts is also important in moral reasoning. Science educators
discovered during the last few decades that the most efficient way to educate science is to
discuss the science together with examples of technology and put the facts into the social
context. This method of teaching is generally called the Science, Technology, and Society
(STS) approach (Yager, 1990; Ramsey, 1993). Advances in biology and medicine have led to
another pressure upon educators, namely how students can be prepared to face the ethical
dilemmas that the technology often raises. Many chapters in the text incorporate both teaching
of biological facts and ethics. The ethical issues associated with biology are generally grouped
under the phrase "bioethics". Bioethics is one part of the approach of STS, and a survey of
bioethics teaching is also one method to measure the extent that society issues are included
(Macer et al., 1996; Macer, 1999). In general there are less teachers using STS approaches in
Asia than in the USA (Kumano, 1991), and Australasia (Macer et al. 1996), but it is growing
still. Even within one country, such as the USA, there are a diversity of views on how to effect
efficient education of social issues and even the science itself (Waks & Barchi, 1992). In the
project in Korea the partner teachers at high school level are a STS network of teachers, and
the Chinese school has a STS approach to teaching biology. In some other countries, such as
New Zealand, STS approaches are integrated into a broad participatory paradigm of education
across all subjects.
2: Evaluation
Crucial to the exercise of development of bioethics is a method of evaluation that allows
for improvement of materials and meeting better the needs of students in different countries.
This project has looked at several methods of evaluation including: development of specific
evaluation forms for student and teacher responses to chapters and the textbook or course;
ways to analyze the content of student essays and reports; forums where educators and
researchers can discuss and improve the content of the textbook and materials, and discuss
evaluation; and ways to assess various styles of student feedback from different programs.
In the text there are evaluation sheets that were developed as an evaluation tool, and are
included in the second edition of the Bioethics Text/Resource book, A Cross-Cultural
Introduction to Bioethics (Macer, 2006). The publication of this book and some translations of
the chapters in the book in several languages, including Chinese, Japanese, Korean, Tamil and
Thai, allows trials of the textbook to be also conducted in local language in selected pilot
countries. Comparisons in the way which bioethics dilemmas are used in different countries are
made, though longer term comparisons will be required. There are also country-by-country
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
update summaries included here.
In current assessment of high school students there is a trend from merely making lists
of many examples, or listing the positive and negative sides of an argument towards making
students exhibit their reasoning as well. One of the common goals of school education is that
students can produce a good argument. Stephen Toulmin’s model has become popular in
development of students’ argumentation skills (Toulmin et al. 1984). It is summarized in the
figure below, that an argument consists of integrating the following:
A conclusion or claim – assertions or conclusions about an event or theory
Facts – data that is used as evidence to support the assertion
Warrants – the statement that explains the link between the data and the claims
Backing – underlying assumptions which are often not made explicit
Rebuttals – statements that contradict the data, warrant or backing of an argument
To create an argument a person needs to state their claim, then support it with facts
(data) that are arranged logically. For each fact, they should give the evidence for the fact
(warrant), and for each warrant, state the quality of its validity (backing). Then for each
warrant and its backing, people should think of an opposing point of view (rebuttal). They then
consider further possible warrants and backing for the rebuttals. At the end then they review,
having argued the rebuttals, do they need to qualify their original claim?
The mental mapping project, or human behaviourome project (Macer, 1992) identified
9 classes of ideas, and attempts to explain the linkages between ideas in the construction of
moral choices by different persons (Macer, 2002). The practical applications of that model are
yet to reach a stage at which teachers could simply assess the moral development of their
students. The Ideas, Evidence and Argument in Science Education (IDEAS) project of Osborne
et al. in the UK [http://www.kcl.ac.uk/depsta/education/ideas.html], has as its a goal the
assistance of teachers in developing their skills to teach about ideas, evidence and argument in
science. The materials they wish to develop include worksheets and video clips to enable
teachers to teach children to develop and evidence scientific argument. They suggest teachers
should focus on the features of argument shown in the right of the diagram below and suggest
that prompt sheets, based around Toulmin’s model of argument are helpful in promoting
children's ability to argue.
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
The IDEAS project suggests the following criteria can be used in evaluating students’
arguments. Is there a claim? Does the argument have data to support the claim? Does the
argument link the data to the claim? Are there further justifications to support the case? Is there
any anticipation of a counter argument and how it could be opposed?
Ratcliffe and Grace (2003) outline the knowledge, understanding and skills that
students studying ethical issues in science acquire and that can be used to design assessment
questions. They listed several different levels of knowledge:
Conceptual knowledge: Learners can demonstrate understanding of: underpinning science
concepts and the nature of scientific endeavour; probability and risk; the scope of the issue –
personal, local, national, global, political and societal context; and environmental sustainability.
Procedural knowledge: Learners can engage successfully in: processes of opinion
forming/decision making using a partial and possibly biased information base; cost-benefit
analysis; evidence evaluation including media reporting; and ethical reasoning.
Attitudes and beliefs: Learners can: clarify personal and societal values and ideas of
responsibility; and recognize how values and beliefs are brought to bear, alongside other
factors, in considering socio-scientific issues.
As with the above examples of questions that Kohlberg used for the linkage of student
arguments to moral stages of development, there are a number of ways that could be developed
into evaluation tools for assessment of bioethics education.
One of the difficult questions in bioethics education is how to evaluate the usefulness of
the materials provided, beyond mere student or teacher satisfaction. One concept that has been
used by Macer is whether students demonstrate "bioethical maturity" in some way. “Bioethical
maturity assumes a certain level of recognition of weighing up the different arguments that can
be used to discuss an issue, the different ethical frameworks that can be used, and comparisons
and balancing of the benefits and risks of the dilemmas (Macer, 2002). This process also gives
an indication as to how many different ideas people have, and the way they understand the
dilemmas, and is ongoing as part of the behaviourome project (Macer, 2002; 2004b).
Classroom observations, audio and video tape recordings, and written essays and homework
done by the students were collected. This feedback is being continually used to modify the
texts and accompanying questions and materials for teachers. Another way to assess the
usefulness of the materials for developing ethical principles in making ethical decisions was to
look for key words and concepts in the answers students give to oral questions.
Evaluation must be done ethically (Alderson & Morrow, 2003), and there are a variety
of methods in research which can be applied for evaluation depending on the style of class and
purpose (Cohen et al., 2003). It is very important to examine the future direction of bioethics
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
11
education and how this might enable people to question scientific endeavours and what impact
their moral decisions will have on them as individuals and upon their societies. The skills that
are required to do this involve the ability to identify existing ideas and beliefs, listen to others,
be aware of multiple perspectives, find out relevant information and communicate the findings
to others. These skills cannot be ‘given’ to students through a didactic approach to teaching,
where the teacher imparts the knowledge. Instead, students need to experience situations that
will allow them to develop these skills through interacting with the teacher and with each other.
This project allows sharing of cases and experience in a range of cultures as well.
When bioethics is applied to professional behaviour, such as in medical ethics, methods
to evaluate have included the way students conduct a patient examination
(http://wings.buffalo.edu/faculty/research/bioethics/eval.html). In Buffalo University Bioethics
program (Singer et al., 1993), they applied the technology of the objective structured clinical
examination (OSCE) (Cohen et al., 1991) using standardized patients to the evaluation of
bioethics. Methods to evaluate the clinical-ethical abilities of medical students, post-graduate
trainees, and practising physicians that have been used include multiple-choice and true/false
questions (Howe and Jones, 1984), case write-ups (Siegler et al, 1982; Doyal et al., 1987;
Redmon, 1989; Hebert et al., 1990), audio-taped interviews with standardized patients (Miles
et al., 1990), and instruments based on Kohlberg's cognitive moral development theory (Self et
al., 1989).
The reliability and validity of these methods have seldom been examined. Auvinen et al.
(2004) applied the use of Kohlberg’s stages of moral development to assess ethics teaching in
nursing students in Finland, and they found significantly higher ethical maturity when nurses
actually had to deal with ethical dilemmas in their practical training in clinics.
3: Stages in moral development
In discussions held during project meetings in 2005 there has been a consensus that the
theory of moral development developed by Lawrence Kohlberg, and what has come to be
called Kohlberg's stages of moral development, does not universally apply when teaching
bioethics. The problems are not only with non-Western students, but researchers in Australia
and New Zealand have also found that it does not serve as a model. Kohlberg's (1969) theory
holds that moral reasoning, which he thought to be the basis for ethical behavior, has
developmental stages that are universal. He followed the development of moral judgment
beyond the ages originally studied by Jean Piaget looking at moral development thoughout life,
and created a model based on six identifiable stages of moral development (Scharf, 1978).
Kohlberg's six stages were grouped into three levels: pre-conventional, conventional,
and post-conventional. He claimed it is not possible to regress backwards in stages nor to
'jump' stages; each stage provides new perspective and is considered "more comprehensive,
differentiated, and integrated than its predecessors." A brief explanation follows.
Level 1: Pre-Conventional
The pre-conventional level of moral reasoning is especially common in children, and
said to be up to the age of 9 in U.S. children he studied, although adults can also exhibit this
level of reasoning. Reasoners in the pre-conventional level judge the morality of an action by
its direct consequences. The pre-conventional level consists of the first and second stages of
moral development, and are purely concerned with the self (egocentric). In stage one
(obedience), individuals focus on the direct consequences that their actions will have for
themselves. For example, an action is perceived as morally wrong if the person who commits it
gets punished. In addition, there is no recognition that others' points of view are any different
from one's own view.
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Stage two is a self-interest orientation, right behavior being defined by what is in one's
own best interest. Stage two reasoning shows a limited interest in the needs of others, but only
to a point where it might further one's own interests, such as "you scratch my back, and I'll
scratch yours." In stage two, concern for others is not based on loyalty or intrinsic respect.
Lacking a perspective of society in the pre-conventional level, this should not be confused with
stage 5 (social contract) as all actions are performed to serve one's own needs or interests.
Level 2: Conventional
The conventional level of moral reasoning is typical of adolescents (age 9+ years) and
adults. Persons who reason in a conventional way judge the morality of actions by comparing
these actions to societal views and expectations. The conventional level consists of the third
and fourth stages of moral development. In Stage three, the self enters society by filling social
roles. Individuals are receptive of approval or disapproval from other people as it reflects
society's accordance with the perceived role. They try to be a good boy or good girl to live up
to these expectations, having learned that there is inherent value in doing so. Stage three
reasoning may judge the morality of an action by evaluating its consequences in terms of a
person's relationships, which now begin to include things like respect, gratitude and the golden
rule. Desire to maintain rules and authority exists only to further support these stereotypical
social roles.
In Stage four, it is important to obey laws and social conventions because of their
importance in maintaining a functioning society. Moral reasoning in stage four is thus beyond
the need for approval exhibited in stage three, because the individual believes that society must
transcend individual needs. If one person violates a law, perhaps everyone would - thus there is
an obligation and a duty to uphold laws and rules. As a cultural observation, this is a very
common attitude in Asian and Pacific communities.
Level 3: Post-Conventional
The post-conventional level, also known as the principled level, consists of stages five
and six of moral development. Realization that individuals are separate entities from society is
important in North American society where Kohlberg developed his theory and so he judged it
to be a higher level of morality. In that culture one's own perspective should be viewed before
the society's is considered. Interestingly, the post-conventional level, especially stage six, is
sometimes mistaken for pre-conventional behaviors. In Stage five, individuals are viewed as
holding different opinions and values, all of which should be respected and honoured in order
to be impartial. However he considered some issues are not relative like life and choice. Laws
are regarded as social contracts rather than dictums, and those that do not promote general
social welfare should be changed when necessary to meet the greatest good for the greatest
number of people (a utilitarian view).
In Stage six, moral reasoning is based on abstract reasoning using universal ethical
principles. Decisions are made in an absolute way rather than in a conditional way. In addition,
laws are valid only insofar as they are grounded in justice, and that a commitment to justice
carries with it an obligation to disobey unjust laws. While Kohlberg insisted that stage six
exists, he had difficulty finding participants who use it.
Implications
After Kohlberg's stage 4, the transition from stage four to stage five, people have
become disaffected with the arbitrary nature of law and order reasoning and he said they
become moral relativists. This transition stage may result in either progress to stage five or in
regression to stage four. As has become clear during the bioethics education project, there is
such a range of cultural, family and school value systems across the world, that students of one
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
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age in one country will most likely be in different stages at different times, even if all persons
did follow this progression from stage 1 to stage 6 in moral reasoning, and not revert back to
other levels. Stage six would correspond to a person that followed the textbook bioethics of
Beauchamp and Childress (1995). Macer (1998) has argued that bioethics is love of life, and
that principalism based on following the standard ethical principles alone is not sufficient as
an explanation of why people behave the way they do. The role of religious values is also
obviously important, as concepts like karma and removal of oneself from the matters of the
world do affect the values systems people use when approaching moral dilemmas.
Kohlberg used moral dilemmas to determine which stage of moral reasoning a person
uses. The dilemmas are short stories that describe situations in which a person has to make a
moral decision, yet they provide no solution. The participant is asked what the right course of
action is, as well as an explanation why. This style is still commonly used as case-based ethics
teaching. There is a need to develop more local cases for dialogues between Asian and Pacific
cultures.
A dilemma that Kohlberg used in his original research was the druggist's dilemma:
Heinz Steals the Drug In Europe. A woman was near death from a special kind of cancer.
There was one drug that the doctors thought might save her. It was a form of radium that a
druggist in the same town had recently discovered. The drug was expensive to make, but the
druggist was charging ten times what the drug cost him to produce. He paid $200 for the
radium and charged $2,000 for a small dose of the drug. The sick woman's husband, Heinz,
went to everyone he knew to borrow the money, but he could only get together about $ 1,000
which is half of what it cost. He told the druggist that his wife was dying and asked him to sell
it cheaper or let him pay later. But the druggist said: "No, I discovered the drug and I'm going
to make money from it." So Heinz got desperate and broke into the man's store to steal the drug
for his wife (Kohlberg, 1969).
Should Heinz break into the laboratory to steal the drug for his wife? Why or why not?
Like many cases of bioethics, from a theoretical point of view, it is not important what the
participant thinks that Heinz should do. The point of interest is the justification that the
participant offers. Below are examples of possible arguments that belong to the six stages. It is
important to keep in mind that these arguments are only examples. It is possible that a
participant reaches a completely different conclusion using the same stage of reasoning:
Stage one (obedience): Heinz should not steal the medicine, because he will consequently be
put in prison.
Stage two (self-interest): Heinz should steal the medicine, because he will be much happier if
he saves his wife, even if he will have to serve a prison sentence.
Stage three (conformity): Heinz should steal the medicine, because his wife expects it.
Stage four (law-and-order): Heinz should not steal the medicine, because the law prohibits
stealing.
Stage five (human rights): Heinz should steal the medicine, because everyone has a right to
live, regardless of the law. Or: Heinz should not steal the medicine, because the scientist has a
right to fair compensation.
Stage six (universal human ethics): Heinz should steal the medicine, because saving a human
life is a more fundamental value than the property rights of another person. Or: Heinz should
not steal the medicine, because that violates the golden rule of honesty and respect.
One criticism of Kohlberg's theory is that it emphasizes justice to the exclusion of
other values. As a consequence of this, it may not adequately address the arguments of people
who value other moral aspects of actions more highly. His theory was the result of empirical
research using only male participants (aged 10, 13, and 16 in Chicago in the 1960s). Carol
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Gilligan argued that Kohlberg's theory therefore did not adequately describe the concerns of
women. She developed an alternative theory of moral reasoning that is based on the value of
care. Among studies of ethics there is a tendency in some studies to find females have higher
regard for ethics theories (Ford and Richardson, 1994). Gilligan's theory illustrates that
theories on moral development do not need to focus on the value of justice. Other
psychologists have challenged the assumption that moral action is primarily reached by formal
reasoning. People often make moral judgments without weighing concerns such as fairness,
law, human rights and abstract ethical values. If this is true, the arguments that Kohlberg and
other rationalist psychologists have analyzed are often no more than post hoc rationalizations
of intuitive decisions. This would mean that moral reasoning is less relevant to moral action
than it seems (Crain, 1985).
4: Ongoing reassessment and evaluation
After pilot trials the set of evaluation sheets that appear in the initial pages of A CrossCultural Introduction to Bioethics (Macer, 2006; pp. vii-xvii), were developed. There was a
balance in the development of specific evaluation forms for student and teacher responses to
chapters and the textbook or course between examination of the way that the thinking
progressed and the privacy of the respondents. In the simple questions the respondents were
asked to choose from one of: SA (Strongly agree), A (Agree), PA (Partially agree), NA (Not
applicable), PD (Partially disagree), D (disagree), SD (Strongly disagree). The results to date
show that the students are very positive to the materials and topics. Significant numbers
wanted to have longer to discuss the materials and topics, though in these trials the class times
varied. In all classes the students felt that they had enjoyed a meaningful discussion, as would
be expected given that I had tried to use participatory methods for involving students and long
question and answer periods during points in the reading of the written chapters. The teachers
were unanimous in strongly disagreeing with Q8, thus judging the materials to be adequate,
and strongly agreeing with the chapter’s utility. They also wanted more time for the discussion.
The comments given in the response forms are the most useful parts of the form. The
open question (Q2) asks students to list keywords, and the students usually wrote a few
keywords about the chapter, often the title plus a principle that was emphasized during the
lecture. The open comments in Q9 looked at what the students had learned through reading the
chapter and in response to this question usually a sentence or two were written. The answers
are coded and analyzed, for example as to whether the comment illustrated they had learned
about both sides of view. If the questionnaire directly asked whether they had learned about
different points of view more would say so, but still most students focused on the facts or
keywords of the chapter in their comments.
One of the concerns in developing cross-cultural materials is whether some contents
are not appropriate in a culture. This concern was also raised in Catholic schools that used the
first edition of the textbook, though they judged all the contents to be appropriate. Q10 asked
whether there was any content not culturally appropriate. This is a decision teachers must make,
and feedback on this is useful as both students and teachers may have different impressions.
At the end of the questionnaire (Q19) there was a space for student comments and
suggestions. This type of feedback was very useful for the future of the materials and the pilot
programs, and for providing feedback to the government Ministries and Boards of Education
for the increased coverage of bioethics. As had been called for by teachers for many years
(Asada et al. 1996; Macer et al. 1996; Pandian and Macer, 1998; Macer and Ong, 1999), the
students also request more bioethics classes.
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
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Text analysis of student reports for keywords is one of the valuable ways to evaluate
students thinking also. Currently we are extending categorization methods that have been
developed (e.g. Maekawa & Macer, 2005, 2006). The abbreviations used for some of the
general coding categories are below:
Both Sides of View (BV): More than one side of an argument or a question being mentioned.
Sometimes the views were not clearly stated in individual sentences so the judgment of the
report containing a BV or not had to be made after the full evaluation of the report.
Personal vs. Other Persons’ Views (PO): The writer’s point of view (e.g., an “I think”
statement) plus other people’s point of views being stated regardless of whether they concurred
with those of the writer or not. Views/feelings of non-humans were not included in this
category.
Scientific Facts (SF): A concrete and/or detailed scientific fact more intellectually demanding
than common sense or the broad theme of the report. Generally this was not merely the citation
of sentences from reference material(s).
Quantitative Facts (QF): The use of statistics and/or numbers in a factual manner.
Environment and Biocentric Ideas (EB): A statement made mentioning concerns for the
environment or ecological concerns, or for example the care or treatment of animals raised as a
concern. Generally people tend to reason and write from an anthropocentric viewpoint.
Utilitarian Views (UV): A utilitarian view is judging an act as being morally acceptable based
on the opinion that the benefits of the action to one group or individual will outweigh the risks
or harm produced affecting a larger population. It is also considering the balancing of society
versus individuals .will be greater than that for an individuals, not limited to human beings.
Principles and Keywords (PK): A keyword denoting an ethical principle or connotation of
one regardless of whether being directly stated or not. If only the term “rights” was mentioned,
it was marked as R and not PK. Keywords included specific bioethics principles and keywords
such as benefit & risk assessment, informed consent, enhancement, public welfare, autonomy,
justice, equality of life, animal welfare etc.
Rights (R): Clear mention of a right or a connotation of a right. This was limited to the rights
of human beings. R is a specialized category of PK.
Number of Ideas (NI): An idea is a distinct message unit, statement or concept that may be
from the materials or from the writer’s own thinking. Key words and concepts were numbered
when going through the reports and the same idea when repeated was not scored twice.
Main Idea (MI): The selection of a main idea was based on the main themes of the argument.
It is related to the causal relationship between two or more ideas. Often the sentence answering
the topic question was chosen as the main idea.
Example comments below give some explanation of the coding:
"Animals are life as we are. I think all life should be allowed to live. So I think that they have
a right to live. " (R)
" I thought my knowing was worth dissecting without consciousness. " (UV)
" We have legal rights (R) which shield us from unjust things. Instead of it, we have to fulfill
duties. " (PK)
" I don’t agree to give animals legal rights. (R) But I think that we should not kill animals
uselessly (BV) and it is important we protect the environment. " (EB)
" All cells of transgenic animals have injected genes. Injected genes can be expressed in
specific tissues with proper promoters. " (SF)
"I do not want to use animal tests for the safety of cosmetics, but some other people think that
it is better to have everything tested on animals." (PO)
The first quotation mentions rights, which can vary in other reports such as right to
choose, right to information, and right to death, just to mention a few. The second quotation
mentions utilitarian views. Other utilitarian views include comments such as "If it can cure
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
many people, animal experiments are inevitable" or "For the progress of science there are
always some sacrifice". The third quotation is an example of a specific bioethics principle and
keyword, "duty". The next example shows both sides of view where this person disagrees to
give legal rights to animals, but considers unnecessary killing. Also the importance of
environmental protection is mentioned for animals to be able to live in their natural habitat,
which is a rare case. The next example shows some scientific background, SF. The last
example takes that of the writer versus other persons on animal testing, but the key point is
comparing their own opinion with others.
Changes in the frequency of keywords and concepts need to be measured against
several variables, including internal factors connected to the class such as the wording of the
title, the nature of the materials used, the comments given by the teacher, and the comments
made during the class. Results are being developed and will appear on the project listserve,
preserving student anonymity.
5: Participatory Methods
There are various other ways to assess various styles of student feedback from
different programs. Some of these are direct participatory class feedback. There are different
ways to describe the participation of students, for example, in the largest lecture in India 800
students and 40 teachers listened for 3 hours to a special lecture, whereas in smaller class
courses in China 32 students attended a series of 32 90 minute class periods involving 10
teachers. In order to teach bioethics a longer series of sustainable lectures in smaller class
groups is a better model, however, still general introductions can stimulate interest in schools
for the subject.
In the case of large classes there are methods that can be used to improve the
participation of students such as talking in pairs while sitting in the class, or working in small
groups of three or more persons to discuss particular questions from the text. Participatory
methods have been used in science education (Bryce, 2004) and in medical ethics education
(Sass, 1999).
One participatory method that can be used is to get students to stand in a line to form a
continuum line based on their view between two extremes along a moral continuum. After
some students give their explanations for why they are standing at that point in the line then
students may move to the appropriate point in the moral continuum. Then after a modified
question can be used and the students move along the continuum to their new positions. This
can include a transition from an abstract question, such as whether they support the use of
reproductive human cloning, to a personal question, such as whether they would use
reproductive cloning if that was the only way for them to have a genetically related child.
Use of donuts (where two circles of people are made and they dialogue for 1 minute
each and then the circle shifts around one person so that they repeat the exercise) or fishbowls
(where you have 3 circles and the outside person is only recording and making note on the
conversations between the other two persons), are two interactive discussion methods that can
be used in classes with many persons.
Student debates and presentation of reports can allow more in-depth analysis of issues
by students, whether as individuals or in small groups, and then the debates can occur within
the same class, between different classes, institutions or even countries by the use of video
conferencing.
6: References
The
website
of
the
book
and
teaching
resources
is
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2006 < http://www.unescobkk.org/index.php?id=2508>
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http://www.unescobkk.org/index.php?id=2508
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Asada, Y. & Macer, D.R.J. (1998) “High school bioethics education network in Japan”, pp.
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2006 < http://www.unescobkk.org/index.php?id=2508>
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Section A. Bioethics and the Ethics of Science and Technology
Chapter A1: Making Choices, Diversity and Principles of Bioethics
There are numerous books and materials on bioethics, and these are written in many
languages. Often newspapers and magazines have discussed these issues, and the cases in those
articles can be useful to stimulate students. In these teaching materials there are numerous
examples from different topics that can be used to show bioethics in real situations.
There are also a number of institutions offering bioethics courses, and some distance
learning courses targeted to persons of particular value systems, such as the Jesuit Distance
Education
Network,
Center
for
Online
Bioethics
Education
[http://www.ajcunet.edu/distanceeducation.aspx?bid=543]. Some of these sites offer their own
exclusive bioethics resources, but these are not openly available.
One of the new sites on bioethics education that has not adopted an open access
approach is the BioEthics Education Project [http://www.beep.ac.uk/content/index.php]. BEEP
is funded by the Wellcome Trust and is based at the Graduate School of Education, University
of Bristol, UK. The introduction reads well, saying: "It is an interactive website and virtual
learning environment for secondary school science teachers and their students. It is a teaching
resource developed to highlight the moral, ethical, social, economic, environmental and
technological implications and applications of biology." It also is aimed at web-based
evaluation, "BEEP is also a research project; we aim to investigate whether online discussion
can be used successfully to support school science teachers. Thus use of the website will be
evaluated by researchers at the University of Bristol. Data on method of use and user opinion
will be collected and documents and presentations may be published concerning the project.
However, end user contribution will be anonymised so that no individual or school will be
identifiable in such publications." It provides a list of topics and ties these to several UK school
curricula. The copyright clause is restrictive however, stating: "Pages on BEEP are protected
by copyright. No images, parts of images, or any other part of our website may be permanently
copied or reproduced in any form or reproduced on any other website or stored in or
transmitted to or from any other electronic or digital form in whole or in part without our prior
written permission. In addition you may not alter, manipulate, add to or delete an image or any
part of an image. You may access and download the contents of these pages and store a copy
of them on a temporary basis for the sole purpose of viewing those pages." Thus for teachers to
store, modify the pages to be suitable for their own local needs, use them, and place the pages
on their own websites would be breaking this copyright.
Download a copy of the UNESCO Universal Declaration on Bioethics and Human Rights, and
make an analysis of this framework that was agreed by all member countries of the world in
October 2005 for bioethics. <http://eubios.info/udbhr.pdf>
Online resources
See papers on the Eubios Ethics Institute website, including News in Bioethics and Biotechnology
<http://eubios.info/NBB.htm>
UNESCO Ethics home page
<http://www.unesco.org/ethics>
UNESCO Bangkok SHS home page
<http://www.unescobkk.org/index.php?id=1313">
There are several internationally agreed declarations on bioethics that are useful for
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
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background, including:
UNESCO Universal Declaration on the Human Genome and Human Rights (1997; Chapter
C9)
<http://eubios.info/unesco.htm>
UNESCO Universal Declaration on Bioethics and Human Rights (19 October, 2005)
<http://eubios.info/udbhr.pdf>
UNESCO, Establishing Bioethics Committees, 2005 72pp.
<http://eubios.info/UNESCO/ebc.pdf>
Bergstrom, Philip, ed, Ethics in Asia-Pacific, 2004, 372pp.
<http://eubios.info/UNESCO/ethap.pdf>
UNESCO, The Precautionary Principle, COMEST Precautionary Principle Expert Group, 2005
<http://eubios.info/UNESCO/precprin.pdf>
Report on Nanotechnology, COMEST Nanotechnology and ethics expert group, 2005
<http://eubios.info/UNESCO/nano.pdf>
UNESCO International Bioethics Committee, Report of the IBC on the Possibility of
Elaborating a Universal Instrument on Bioethics (2003), Giovanni Berlinguer and Leonardo De
Castro (Rapporteurs)
<http://eubios.info/UNESCO/ibc2003.pdf>
UNESCO International Bioethics Committee, Report of the IBC on Pre-implantation Genetic
Diagnosis and Germ-line Intervention (2003),
Hans Galjaard (Rapporteur)
<http://eubios.info/UNESCO/ibc2003ip.pdf>
UNESCO International Bioethics Committee, Human Genetic Data: Preliminary Study by the
IBC on its Collection, Processing, Storage and Use (2002), Sylvia Rumball and Alexander
McCall Smith (Rapporteurs)
<http://eubios.info/UNESCO/ibc2002.pdf>
UNESCO International Bioethics Committee, Report of the IBC on Ethics, Intellectual
Property and Genomics (2002), Justice Michael Kirby (Rapporteur)
<http://eubios.info/UNESCO/ibc2002ip.pdf>
UNESCO International Bioethics Committee, Report of the IBC on Solidarity and
International Co-operation between Developed and Developing Countries concerning the
Human Genome (2001), Mehmet Öztürk (Rapporteur)
<http://eubios.info/UNESCO/ibc2001.pdf>
UNESCO International Bioethics Committee, The Use of Embryonic Stem Cells in
Therapeutic Research (2001), Alexander McCall Smith and Michel Revel (Rapporteurs)
<http://eubios.info/UNESCO/ibc2001sc.pdf>
UNESCO International Bioethics Committee, Report on Confidentiality and Genetic Data
(2000), Working Group of the IBC on Confidentiality and Genetic Data
<http://eubios.info/UNESCO/ibc2000.pdf>
UNESCO International Bioethics Committee, Ethical Considerations Regarding Access to
Experimental Treatment and Experimentation on Human Subjects (1996), Harold Edgar and
Ricardo Cruz-Coke (Rapporteurs)
<http://eubios.info/UNESCO/ibc1996.pdf>
UNESCO International Bioethics Committee, Food, Plant Biotechnology and Ethics (1995),
Darryl Macer (Rapporteur)
<http://eubios.info/UNESCO/ibc1995pg.pdf>
UNESCO International Bioethics Committee, Bioethics and Human Population Genetics
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Research (1995), Chee Heng Leng, Laila El-Hamamsy, John Fleming, Norio Fujiki, Genoveva
Keyeux, Bartha Maria Knoppers and Darryl Macer
<http://eubios.info/UNESCO/ibc1995pg.pdf>
UNESCO International Bioethics Committee, Genetic Counselling (1995), Michel Revel
(Rapporteur)
<http://eubios.info/UNESCO/ibc1995gc.pdf>
UNESCO International Bioethics Committee, Ethics and Neurosciences (1995), Mr JeanDidier Vincent (Rapporteur)
<http://eubios.info/UNESCO/ibc1995ns.pdf>
UNESCO International Bioethics Committee, Report on Human Gene Therapy (1994), Mr
Harold Edgar and Mr Thomas Tursz (Rapporteurs)
<http://eubios.info/UNESCO/ibc1994.pdf>
UNESCO International Bioethics Committee, Report on Genetic Screening and Testing (1994),
Mr David Shapiro (Rapporteur)
<http://eubios.info/UNESCO/ibc1994gs.pdf>
UNESCO International Bioethics Committee, Advice of the IBC on the Patentability of the
Human Genome, 2001.
<http://eubios.info/UNESCO/ibcpatent.pdf>
See links < http://eubios.info/Info.htm>
Site: Joint Centre for Bioethics (University of Toronto)
WWW: http://www.utoronto.ca/jcb/Resources/resources.html
Site: Council of Europe Home Page
WWW: http://www.coe.fr/oviedo/edito-e.htm
Site: National Consultative Ethics Committee for Health and Life Sciences (France)
WWW: http://www.ccne-ethique.org/home.htm
Site: Library of Bioethics and Medical Humanities Texts and Documents
WWW: http://wings.buffalo.edu/faculty/research/bioethics/texts.html
Site: National Bioethics Advisory Commission (Former one, USA)
WWW: http://bioethics.gov
Site: Nuffield Council on Bioethics
WWW: http://www.nuffield.org/bioethics/
Site: Online Ethics Center for Engineering and Science (Case Western Reserve University)
WWW: http://onlineethics.org/index.html
Site: Distance Learning Programs of Study (Medical College of Wisconsin)
WWW: http://www.mcw.edu/bioethics/depage.html
Site: Ethics Updates (University of San Diego Values Institute)
WWW: http://ethics.acusd.edu
Site: Syllabus Exchange Catalog (Kennedy Institute of Ethics)
WWW: http://www.georgetown.edu/research/nrcbl/syllabus/
Site: Kennedy Institute of Ethics, High School Bioethics Project
WWW: http://bioethics.georgetown.edu/hsbioethics/
Site: The University of Pennsylvania High School Bioethics Project
WWW: http://bioethics.net/hsbioethics/
Site: National Health Museum, Access Excellence: Issues and Bioethics
WWW: http://www.accessexcellence.org/AB/IE/
Site: McGraw Hill General and Human Biology: Bioethics Case Studies
WWW:http://www.mhhe.com/biosci/genbio/olc_linkedcontent/bioethics_cases/index.html
Site: Howard Hughes Medical Institute Bulletin
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
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WWW: http://www.hhmi.org/bulletin/mar2002/ethics/highschool.html
Further reading
Tom Beauchamp and James Childress (2001) Principles of Biomedical Ethics. Fifth Edition.
Oxford University Press, Oxford.
Chapter A2: Ethics in history and love of life
Background
This chapter is designed to give students a more theoretical background to different theories of
ethics. It is written at a higher level than chapter A1, to give some references to ethics theories
especially for students who have not had a detailed background in ethical theories.
Further reading
Darryl Macer (1998) Bioethics is Love of Life. Eubios Ethics Institute.
Available on-line in English and Japanese translation.
<http://eubios.info/bll.htm>
Chapter A3: Moral agents
Background
This chapter is designed to introduce ways to distinguish between different living organisms,
and other beings, in terms of their moral status. The concept of moral status is central to
whether a being can be ascribed intrinsic moral values in ethical debates. The chapter opens the
way for teachers to examine more controversial issues in bioethics, then those described in the
textbook, for example, the moral status of the human embryo. It is best to consider chapter A3
before doing A4.
Perhaps the most important lesson to learn is that life is not so easy, and neither is bioethics.
To make an ethical decision means balancing alternatives, and benefits and risks of harm. One
way to do this is to think about the factors that are involved on each side before making
decisions. Different people may do this a little differently; perhaps the final question of animal
rights is how much right do people have to choose different answers.
Further reading
Darryl Macer (1998) Bioethics is Love of Life. Eubios Ethics Institute.
Available on-line in English and Japanese translation.
<http://eubios.info/bll.htm>
Chapter A4: Ethical Limits of Animal Use
Background
In a survey of bioethical issues conducted in Australia, New Zealand and Japan in 1993, there
was much division over whether animal experiments were necessary or not. Some teachers
took strong positions on either side of the question whether some animal experiments are
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
necessary to teach biology in high school. There are also many types of experiment, for
example, observation in nature, in the class, dissection, and some experiments were described
that caused painful death to vertebrates. The purpose of this summary is not to take sides, but
we should ask the question what type of experiment is necessary, and how much is learnt.
One key lesson for students is moderation and balancing. Rather than having extreme views
being argued in the class this issue allows students to imagine what it is like to be another
animal. It is not likely that anyone will actually go on to do experiments on chimpanzees in
their life. However, it is extremely likely that everyone will eat fish, swat a fly, cook a steak,
use products or drugs developed with animal experiments, and at least use the money
supported by exports of animal products for your education. If you are studying biology, you
probably want to understand how animals can live, and sometimes you need to see animal
experiments, whether in life, or on video, or in a book. The impressions from each example can
be different.
The data being obtained from animal experiments does have implications for all thinking
beings about our place in the world, so the issue can be related to many topics. Absolutes are
often difficult, but it is ethically important to make balanced choices. It is ethically consistent
to try to use lower organisms, cells, or computer models for animal experiments; but at some
stage of testing, both animal and human trials are necessary.
What is a scientific question?
Bioethics must have a basis from all data, including reasoning, philosophy and biological
knowledge. Bioethics considers both biological data and values. There are many non-scientific
questions, like ‘What is the value of life?’, ‘What is the value of love?’, and ‘What is the
meaning of existence?’. Scientific questions are those we can disprove by experiment; whereas,
there are many issues in bioethics that we cannot test in the laboratory.
A scientific question would be to examine how similar the DNA of humans, chimpanzees and
mice are. The complete genome sequence of mice and humans is known, and available on the
Internet. Comparisons of chimpanzee genome and humans reveal 99% similarity, and that
there may be few different genes between these two species. Up to 75% of the 30,000 genes
that both chimpanzees and humans have may be involved in determining our behaviour.
Further information
There are numerous books and materials on animal experiments and animal rights, and these
are written in many languages. Often they are written from the extreme support or extreme
protest against animal use.
Often newspapers and magazines have discussed these issues, and the cases in those articles
can be useful to stimulate students. In these teaching materials there are numerous examples
from different topics that can be used to show bioethics in real situations.
Online resources
See papers on the Eubios Ethics Institute website, including News in Bioethics and Biotechnology
< http://eubios.info/NBB.htm >
See links < http://eubios.info/Info.htm >
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
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There are many resources on the use of animals, and it is interesting to compare materials
produced by organisations on the extremes of this debate with each other.
Videos may be available from many animal rights or medical research supporting organisations
in your local country.
Chapter A5: Ethics and Nanotechnology
Background
Nanotechnology is a new area of science and technology that is being widely supported. The
application of the precautionary principle to consider this is one of the emerging trends in new
areas of science and technology.
Further reading
Air Force Science and Technology Board (2002) Implications of Emerging Micro and
Nanotechnology. National Academies Press.
Baum, Rudy, ed. (2003) Point – Counterpoint: Nanotechnology: Drexler and Smalley Make the
Case For and Against ‘Molecular Assemblers’. Chemical and Engineering News 81:48
pp.37-42
Bergstrom, Philip, ed, Ethics in Asia-Pacific, 2004, 372pp.
<http://eubios.info/UNESCO/ethap.pdf>
BioThailand (2005) The International Conference in BioNanotechnology. In: BioThailand
2005 Book of Abstracts. National Center for Genetic Engineering and Biotechnology,
National Science and Technology Development Agency, and Ministry of Science and
Technology. Bangkok. p.1-42
COMEST Report on Nanotechnology, COMEST Nanotechnology and ethics expert group,
2005
<http://eubios.info/UNESCO/nano.pdf>
Drexler, K. Eric (1986) Engines of Creation: The Coming Era of Nanotechnology. Anchor
Books, Doubleday, NY/London/Toronto/Sydney/Auckland. 299pp.
Drexler, K. Eric (1992) Nanosystems: Molecular Machinery, Manufacturing and Computation.
Wiley Interscience. 576pp.
Freitas, Robert A. Jr. (1999) Nanomedicine: Volume I - Basic Capabilities. Landes Bioscience,
Georgetown, Texas. See full text at www.nanomedicine.com/NMI.htm
Feynman, Richard P. (1960) There’s Plenty of Room at the Bottom. Engineering and Science
Volume 23, No.5. See text at www.zyvex.com/nanotech/feynman.html
Joy, Bill (2000) Why the Future Doesn’t Need Us. Wired 8.04: 238-263 and see online:
www.wired.com/wired/archive/8.04/joy.html
Kelly, Kevin (1994) Out of Control: The New Biology of Machines. Fourth Estate, London and
Addison Wesley, USA. 666 pp.
Nalwa, Hari Singh, ed. (2004) Encyclopedia of Nanoscience and Nanotechnology. American
Scientific Publishers. 10 volumes, ~10,000 pp.
National Academy of Engineering (2004) The Engineer of 2020: Visions of Engineering in the
New Century. National Academies Press.
National Academy of Sciences (2004) Emerging Technologies and Ethical Issues in
Engineering: Papers from a Workshop, October 14-15, 2003. National Academies Press.
National Nanotechnology Initiative (2002) Small Wonders, Endless Frontiers: A Review of the
National Nanotechnology Initiative. National Academies Press. See www.nano.gov
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
National Academy of Engineering (2005) Tenth Annual Symposium on Frontiers of
Engineering. Rob Phillips, ed., National Academies Press.
Regis, Ed (1995) Nano! Bantam Books, Toronto, New York, London & Sydney. 307pp.
Scientific American (2001) Nanotechnology Special Issue. Scientific American September
2001, 94pp. See www.sciam.com/nanotech
Smalley, Richard (2002) Oral Testimony given before the US House of Representatives
Subcommittee on Science on Future Directions of the DOE Office of Science. 1-4. See
also the Smalley Group – Rice University website: http://smalley.rice.edu
UNESCO, The Precautionary Principle, COMEST Precautionary Principle Expert Group, 2005
<http://eubios.info/UNESCO/precprin.pdf>
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2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
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Section B. Environmental Ethics
Chapter B1: Ecology and Life
Sample answer to Student Activity
Basic network diagram showing flows of energy and matter through a simple ecosystem (extra
marks for additional features; for example cycles of respiratory and photosynthetic gases, or
even the role of the caterpillar in pollination after metamorphosis).
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Further reading
Begon, Michael, Harper, John L. and Townsend, Colin R. (1986) Ecology: Individuals,
Populations and Communities. Blackwell Scientific Publications, Oxford. 876pp.
Bentley, Peter J. (2001) Digital Biology. Headline Book Publishing, London. 277pp.
Capra, Fritjov (1997) The Web of Life: A New Synthesis of Mind and Matter. Flamingo,
HarperCollins, London. 320pp.
Carson. Rachel (1962) Silent Spring. Penguin Books, London. 317pp.
Cohen, Jack and Stewart, Ian (1994) The Collapse of Chaos: Discovering Simplicity in a
Complex World. Penguin Books, London. 495pp.
Cousteau, Jacques (1953) The Silent World. Penguin Books, London. 156pp.
Croall, Stephen and Rankin, William (1981) Ecology for Beginners. Pantheon Books, New
York. 175pp.
Darwin, Charles R. (1859) On The Origin of Species by Means of Natural Selection. John
Murray, London.
Dawkins, Richard (1989) The Selfish Gene. New Edition. Oxford University Press, Oxford.
352pp. (first published 1976)
Deutsch, David (1997) The Fabric of Reality. Penguin Books, London. 390pp.
Dyson, George (1997) Darwin Among the Machines. Penguin Books, London. 286pp.
Gould, Stephen Jay (1989) Wonderful Life: The Burgess Shale and the Nature of History. W.W.
Norton, New York.
Johnson, Steven (2001) Emergence: The Connected Lives of Ants, Brains, Cities and Software.
Penguin Books, London. 288pp.
Keeton, William T. and Gould, James L. (1986) Biological Science. Fourth Edition. Norton
International Student Edition, W.W. Norton, New York. 1175pp.
Lewin, Roger (1993) Complexity: Life at the Edge of Chaos. Phoenix Paperbacks, London.
234pp.
Margulis, Lynn and Sagan, Dorion (1995) What Is Life? Weidenfeld and Nicolson, London.
207pp.
O'Connor, Joseph and McDermott, Ian (1997) The Art of Systems Thinking. Thorson's,
HarperCollins, London. 265pp.
Ridley, Matt (1996) The Origins of Virtue. Viking, London.
Weber, Walter J. Jr. (2001) Environmental Systems and Processes: Principles, Modeling and
Design. Wiley-Interscience, John Wiley & Sons, New York. 556pp.
Wilson, Edward O. (1992) The Diversity of Life. Penguin Books, London. 406pp.
Chapter B2: Biodiversity and Extinction
Further reading
Briggs, John C. (1994) Mass Extinctions: Fact or Fallacy? In: Glen, William, ed. Mass
Extinction Debates: How Science Works in a Crisis. Stanford University Press. p.230236
Caughley, Graeme (1994) Review: Directions in Conservation Biology. J. Animal Ecology 63:
215-244
Frankham, Richard, Ballou, Jonathan D. and Briscoe, David A. (2002) Introduction to
Conservation Genetics. Cambridge University Press, Cambridge. 617pp.
Gould, Stephen J. and Eldridge, Niles. (1993) Punctuated Equilibrium Comes of Age. Nature
366: 223-227
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
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Hoegh-Guldberg, Hans, and Hoegh-Guldberg, Ove (2004) The Implications of Climate Change
for Australia's Great Barrier Reef. WWF Australia and Qld Tourism Industry Council.
I.U.C.N. (World Conservation Union) (1994) IUCN Red List Categories (As Approved by the
40th Meeting of the IUCN Council). Species Survival Commission, I.U.C.N., Gland,
Switzerland. 21pp.
Jeffries, Michael J. (1997) Biodiversity and Conservation. Routledge Introductions to
Environment Series, London & NY. 208pp.
Leakey, Richard and Lewin, Roger (1996) The Sixth Extinction: Biodiversity and its Survival.
Phoenix, Orion Books, London. 271pp.
Mollison, Bill (1988) Permaculture: A Designers’ Manual. Tagari Publications, Tyalgum NSW.
576pp.
Raven, P.H (1990) The Politics of Preserving Biodiversity. BioScience 40: 769-74
Rees, Martin (2003) Our Final Century. Will Civilization Survive the Twenty-First Century?
Arrow Books, Random House, London. 228pp.
Shiva, Vandana (1991) Ecology and the Politics of Survival. UN University Press, New Delhi.
Van Valen, Leigh (1994) Concepts and the Nature of Selection by Extinction: Is Generalization
Possible? In: Glen, William, ed. Mass Extinction Debates: How Science Works in a
Crisis. Stanford University Press. p.200-216.
Ward, Peter (1995) The End of Evolution: Dinosaurs, Mass Extinction and Biodiversity.
Weidenfeld & Nicholson, Orion Publishing Group, London. 302pp.
Wilson, Edward O. (1992) The Diversity of Life. Penguin Books, London. 406pp.
Wilson, Edward O. (2002) The Future of Life. Little Brown/Abacus, London. 232pp.
Chapter B3: Ecological Ethics
Further reading
Chief Seattle, Chief of the Dwamish (1854) Response upon Surrendering His Land to
Governor Isaac Stevens in 1854.
Cocks, Doug (2003) Deep Futures - Our Prospects for Survival. University of New South
Wales Press, Sydney, & McGill-Queens University Press, Montreal. 332pp
Cooper, N.S. and Carling, R.C.J., eds. (1996) Ecologists and Ethical Judgements. Chapman &
Hall, London.
Eckersley, Richard, ed. (1998) Measuring Progress: Is Life Getting Better? C.S.I.R.O.
Publishing, Collingwood, Vic., Australia. 382pp.
Harding, Ronnie, ed. (1998) Environmental Decision-Making: The Roles of Scientists,
Engineers and the Public. The Federation Press, Leichhardt, NSW. 366pp.
Hayward, Tim (1994) Ecological Thought: An Introduction. Polity Press, Blackwell,
Cambridge.
Hertsgaard, Mark (1999) Earth Odyssey: Around the World in Search of Our Environmental
Future. Abacus, London. 372pp.
Light, Andrew and Rolston, Holmes III, eds. (2003) Environmental Ethics: An Anthology.
Blackwell Philosophy Anthologies, Blackwell, Malden, Oxford, Melbourne & Berlin.
526pp.+index
Lovelock, James (1979) Gaia: A New Look at Life On Earth. Oxford University Press, Oxford.
157pp.
Macer, Darryl (1998) Bioethics Is Love of Life: An Alternative Textbook. Eubios Ethics
Institute, Christchurch & Tsukuba.160pp.
Myers, Norman, ed. (1984) Gaia: An Atlas of Planet Management. Gaia Books, Anchor,
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Doubleday, New York. 272pp.
Pollard, Irina (2002) Life, Love and Children: A Practical Introduction to Bioscience Ethics
and Bioethics. Kluwer Academic Publishers, Boston. 269pp.
Roszak, Theodore (1992) The Voice of the Earth. Touchstone, Simon & Schuster, New York.
367pp.
Seuss, Dr. (1971) The Lorax. Random House, New York.
Singer, Peter (1975) Animal Liberation. New York Review/Random House, New York.
Suzuki, David and McConnell, Amanda (1997) The Sacred Balance: Rediscovering Our Place
in Nature. Allen & Unwin, St. Leonards, NSW. 261pp.
Chapter B4: Environmental Science
Online resources
A.C.F. (Australian Conservation Foundation) web site: www.peg.apc.org/~acfenv/
American
Library
Association
Task
Force
on
the
Environment:
www.ala.org/alaorg/rtables/srrt/tfoe/
Australian Coastal Atlas web site: www.environment.gov.au/marine/coastal_atlas
Australian Geographer: www.tandf.co.uk/journals
Australian National Trust: www.austnattrust.com.au
Bat Conservation International: www.batcon.org/
Best
Environmental
Directories
(for
over
600
environmental
subjects):
www.ulb.ac.be/ceese/meta/cds.html
Biodiversity
(Australian
govt.):
www.biodiversity.environment.gov.au/plants
/threaten/action_plans/
BioOne: www.BioOne.org
Center for International Earth Science Information Network (CIESIN): www.ciesin.org/
CogniScope (global systems analysis method): www.cwaltd.com/index1.htm
Columbia Earthscape: www.earthscape.org
Community Biodiversity Network (Earth Alive!): www.cbn.org.au
Data Libraries & Archives Online: www.datalib.ubc.ca/datalib/gen/data_libr.html
Destination Earth Program (NASA): www.earth.nasa.gov/
Earth Day Network: www.earthday.net
Earth Garden Books: www.earthlink.com.au/earthgarden
Earth Network: www.ecouncil.ac.cr
Earth Observing System (NASA): http://eos.nasa.gov/imswelcome
Earth Viewer: www.fourmilab.ch/earthview/vplanet.html
Earthquake Information: www.civeng.carleton.ca/cgi-bin/quakes/
Earthwatch: http://gaia.earthwatch.org/ and www.earthwatch.org/
Ecology Action Centre: www.cfn.cs.dal.ca/Environment/EAC?EAC-Home.html
Ecotourism Society web site: www.ecotourism.org
Eco-Village Information Service: www.gaia.org/
EnviroLink: http://envirolink.org and www.envirolink.org:/start_web.html
EnviroNet
(E.R.I.N.
Australia):
www.erin.gov.au/net/neid.html
and
www.erin.gov.au/net.environet.html
Environment Australia (Australian Government): www.environment.gov.au
Environment
Education
Resource
Directory
(Australia):
www.environment.gov.au/net/aeen.html
Environment Canada: www.atlenv.bed.ns.doe.ca/
Environmental Defense: www.environmentaldefense.org
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
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Environmental Journals & Serials Online: http://155.187.10.12/library/serials.html
Environmental Law Alliance Worldwide: www.igc.org/elaw/
Environmental
Network
Room
(environmental
scepticism
links):
http://environmental.networkroom.com/directorybytopic/myths/
Environmental Organisation Directory and Search Engine: www.webdirectory.com
Environmental Weeds Home Page (Australia): http://weeds.merriweb.com.au
The Environmentalist (journal): www.wkap.nl/journals/environmentalist
E.P.A. (Environmental Protection Agency, U.S.): www.epa.gov/
E.R.I.N. (Environmental Resources Information Network, Australia) Environment Portfolio:
www.erin.gov.au/portfolio/environment/env_port.html
Gaia Forest Conservation Archives: http://forests.org/gaia.html
Geological Society of America (GSA): www.geosociety.org
Global Change Data and Research Program: www.gcdis.usgcrp.gov and www.usgcrp.gov
Global Change Research Information Office: www.gcrio.org/
Global Change Master Directory (NASA):
http://gcmd.gsfc.nasa.gov/ and
http://gcmd.nasa.gov/
Gould League: www.schnet.edu.au/
Green Cross International: www.gci.ch
Green Net (green charities): www.green.net.au
Green Net (UK/European Focus): www.gn.apc.org
Green Page: www.vcomm.net/enviro/greenpg.html
Greenpeace International web site: www.greenpeace.org
Journal of Bioeconomics: www.wkap.nl/journals/journal.bioeconomics
Journal of Environmental Planning & Management: www.tandf.co.uk/online.html
Journal of Risk and Uncertainty: www.wkap.nl/journals/jru
N.A.S.A. (U.S. National Aeronautics & Space Administration): www.nasa.gov
National
Parks
&
Wildlife
Service
(N.S.W.
Plans
of
Management):
www.npws.nsw.gov.au/news/exhibition/POM/index.html
Natural Resources Management Project: www.nrm.or.id
N.S.W. Environmental Impact Assessments: www.duap.nsw.gov.au/eis~2.htm
Planet Ark (Reuters environmental news): www.planetark.org
Planet Earth Home Page: www.planetearth.net/info.html and www.nosc.mil/
planet_earth/info.html
Rainforest Action Network: www.ran.org
Remotely Sensed Land Data: http://ghrc.msfc.nasa.gov/
Science (journal): www.sciencemag.org
Society of Environmental Journalists: www.sej.org
Space Calendar: www.jpl.nasa.gov/calendar/
State
of
the
Environment
&
Indicators
Technical
Papers:
www.erin.gov.au/environment/epcg/soe.html
State
of
the
Environment
Report
(Australia):
www.environment.gov.au/epcg/soe/soe96/soe96.html
Urban Ecosystems: www.wkap.nl/journals/urban_ecosystems
Water Quality and Ecosystem Modeling: www.wkap.nl/journals/waterqual
World Conservation Monitoring Centre: www.wcmc.org.uk/
World Data Center-A for Remotely Sensed Land Data: http://ghrc.msfc.nasa.gov/
World
Wide
Web
Resources
Environment
(directory):
www.uky.edu/Subject/environment.htm#a11
Worldwatch Institute: www.worldwatch.org
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Further reading
Barrow, John D. (1998) Impossibility: The Limits of Science and the Science of Limits. Vintage,
Random House, London. 279pp.
Barrow, C. J. (2000) Social Impact Assessment: An Introduction. Arnold Publishers & Oxford
University Press, London/New York. 222pp.+index
Buchanan, Mark (2000) Ubiquity: The Science of History. Phoenix, London. 230pp.
Chalmers, A.F. (1999) What is this thing called Science? Third Edition. University of
Queensland Press, St Lucia. 266pp. first published 1976
Clark, John R. (1996) Coastal Zone Management Handbook. Lewis Publishers, CRC Press,
Boca Raton, Fl. 694pp.
Cocks, Doug (2003) Deep Futures - Our Prospects for Survival. University of New South
Wales Press, Sydney, & McGill-Queens University Press, Montreal. 332pp
Dodge, Martin and Kitchin, Rob (2001) Mapping Cyberspace Routledge, London 260pp
Eckersley, Richard, ed. (1998) Measuring Progress: Is Life Getting Better? C.S.I.R.O.
Publishing, Collingwood, Vic., Australia. 382pp.
Fairweather, Peter G. (1989) Environmental Impact Assessment: Where is the Science in EIA?
Search 20(5): 141-144
Falconer, Allan and Foresman, Joyce (2002) A System for Survival: GIS and Sustainable
Development. ESRI Press, Redlands, California. 116pp.
Glasson, John, Therivel, Riki and Chadwick, Andrew (1994) Introduction to Environmental
Impact Assessment: Principles and Procedures, Process, Practice and Prospects. UCL
Press, University College, London.
Hall, Stephen S. (1992) Mapping the Next Millennium: How Computer-Driven Cartography is
Revolutionizing the Face of Science. Vintage, Random House, New York. 477pp.
Harding, Ronnie, ed. (1998) Environmental Decision-Making: The Roles of Scientists,
Engineers and the Public. The Federation Press, Leichhardt, NSW. 366pp.
Hilborn, Ray and Walters, Carl J. (1981) Pitfalls of Environmental Baseline and Process
Studies. EIA Review 2/3: 265-278
Horn, Robert V. (1993) Statistical Indicators for the Economic and Social Sciences. Cambridge
University Press, Cambridge. 227pp.
Huggett, Richard J. (1993) Modelling the Human Impact on Nature: Systems Analysis of
Environmental Problems. Oxford University Press, Oxford. 202pp.
I.P.C.C. (Intergovernmental Panel on Climate Change) (1990) Climate Change: The I.P.C.C.
Scientific Assessment. Houghton, J.T., Jenkins, G.J. and Ephraums, J.J. (eds.) World
Meteorological Organization & United Nations Environment Programme. Cambridge
University Press, Cambridge. 365pp.
I.U.C.N. (World Conservation Union) (1994) Guidelines for Protected Area Management
Categories. Commission on National Parks and Protected Areas and World
Conservation Monitoring Centre for the I.U.C.N., Gland, Switzerland. 261pp.
Jackson, K.F. (1975) The Art of Solving Problems. Hodder & Stoughton, London. 244pp.
Jacobson, Harold K. and Price, Martin F. (1990) A Framework for Research on the Human
Dimensions of Global Environmental Change. ISSC/UNESCO Series 3, International
Social Science Council with UNESCO. 71pp.
Kuhn, Thomas (1970) The Structure of Scientific Revolutions. Second edition. University of
Chicago Press, Chicago. (First edition published 1962).
Leopold, Luna B., Clarke, Frank, Hanshaw, Bruce and Balsley, James (1971) A Procedure for
Evaluating Environmental Impact. U.S. Dept of the Interior, Geological Survey
Circular 645: 1-13
Lomborg, Bjørn (2001) The Skeptical Environmentalist -Measuring the Real State of the World.
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
33
Cambridge University Press. 515pp. (originally published 1998 in Danish). See also
links at: Jim Norton, ed. Correcting Myths from Bjørn Lomborg, http://infopollution.com/lomborg.htm
and
Anti-Lomborg.com
links
at:
http://www.mylinkspage.com/lomborg.html
Maltby, Edward (1997) Ecosystem Management: The Concept and the Strategy. World
Conservation 3/97: 3-4
Mayer, Richard E. (1992) Thinking, Problem Solving, Cognition. Second Edition. W.H.
Freeman & Company, New York. 560pp.
McNeill, John (2000) Something New Under the Sun: an Environmental History of the
Twentieth Century. Penguin Books, London. 421pp.
Milner-Gulland, E.J. and Mace, R., eds. (1998) Conservation of Biological Resources.
Blackwell Science Ltd, Oxford.
National Research Council (1996) Linking Science and Technology to Society’s Environmental
Goals: National Forum on Science and Technology Goals. National Research Council
Policy
Division,
Washington
DC.
520pp.
See
fulltext
link
at:
www.nap.edu/readingroom/records/EV.html
Orians, Gordon H. (1986) The Place of Science in Environmental Problem Solving.
Environment 28(9): 12-41
Peine, John D., ed. (1999) Ecosystem Management for Sustainability: Principles and Practices
Illustrated by a Regional Biosphere Reserve Cooperative. C.R.C Press L.L.C./Lewis
Publishers, Boca Raton, Fl.
Pollard, Morgan (2004) The Modeling of Sustainable Development and its Relevance to a
Human Ideas Map for Bioethics. In: Macer, Darryl, ed. Challenges for Bioethics from
Asia. Eubios Ethics Institute, Christchurch & Tsukuba. p.151-169
Saunders, D.A, Margules, C.R. and Hill, B. (1998) Environmental Indicators for National State
of the Environment Reporting - Biodiversity. Australia: State of the Environment
(Environmental Indicator Reports). Environment Australia, Department of the
Environment, Canberra. 69pp.
Turban, E. and Aronsen, J.E. (1998) Decision Support Systems and Intelligent Systems. 5th
Edition. Prentice-Hall International, Upper Saddle River, New Jersey. 890pp.
Union of Concerned Scientists (1992) World Scientists’ Warning to Humanity. Published on
Internet at: www.ucsusa.org/ucs/about/page.cfm?pageID=1009
Wakeford, Tom and Walters, Martin, eds. (1995) Science for the Earth: Can Science Make the
World a Better Place? John Wiley & Sons, Chichester. 370pp.
Wathern, Peter, ed. (1988) Environmental Impact Assessment: Theory and Practice. Unwin &
Hyman, London.
Wolpert, Lewis (1992) The Unnatural Nature of Science. Faber & Faber, London.188pp.
Wood, C., Dipper, B. and Jones, C. (2000) Auditing the Assessment of the Environmental
Impacts of Planning Projects. J. Environ. Planning & Mgmt 43(1): 23-47
Chapter B5: Environmental Economics
Teachers notes for a suggested Student Activity:
Distribute to each student transparencies or photocopies of the two tables ‘Progressive
Evolution of Ecological Ethics’ (Bioethics of Biodiversity chapter) and ‘Progressive Evolution
of Environmental Ethics’ (Environmental Economics chapter). The tables show the progress
of thought in ecological and environmental ethics from current conservative human behaviour
(generally somewhere on the left side of the tables) through to more ecologically progressive
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
34
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
philosophies required for a brighter environmental future (towards the right side).
Each student can identify and fill in boundaries (or ranges, in different colours) on their copies
of the tables (i.e. wavy boundary lines from top to bottom), which represent their own estimates
of general progress across the tables for:
a) observed current human behaviours worldwide
b) desired future human behaviours (ideal or preferred range of viewpoints) if it were possible
for future global society
From the overlay of these two ranges on top of each other, the important region of
‘unrecognised hopes for the future’ can be identified (as in the simplified sample answer).
Combine all the student estimates into average ranges for the class, and determine whether
their observations of current progress coincide with their wishes for future human progress. In
students today, is there a significant gap between the status quo and their hopes for progress in
ecological and environmental ethics? Remember there are no strictly right or wrong answers
in philosophical issues.
Further Reading
Ayres, Robert (1996) Statistical Measures of Unsustainability. Ecological Economics 16: 239255
Bartelmus, Peter (1994) Environment, Growth and Development: The Concepts and Strategies
of Sustainability. Routledge, London & New York. 163pp.
Bentham, Jeremy (1781) An Introduction to the Principles of Morals and Legislation.
Bircham, Emma and Charlton, John, eds. (2001) Anti-Capitalism: A Guide to the Movement.
Bookmarks Publications Ltd, London & Sydney. 409pp.
Boulding, Kenneth (1966) The Economics of the Coming Spaceship Earth. In: H. Jarrett, ed.,
Environmental Quality in a Growing Economy. Johns Hopkins University Press,
Baltimore.
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
35
Boyden, Stephen, Dovers, Stephen and Shirlow, Megan (1990) Our Biosphere Under Threat:
Ecological Realities and Australia’s Opportunities. Oxford University Press, Oxford.
347pp.
Brennan, Andrew (1996) Ethics, Ecology and Economics. In: Cooper, N.S. and Carling, R.C.J.,
eds. Ecologists and Ethical Judgements. Chapman & Hall, London. 13-26
Brown, Paul and Cameron, Linda (2000) What Can be Done to Reduce Overconsumption?
Ecological Economics 32: 27-41
Cavanagh, John, and Mander, Jerry, eds. (2004) Alternatives to Economic Globalization: A
Better World is Possible. Second edition. A Report of the International Forum on
Globalization. Berrett-Koehler Publishers, San Francisco. 408pp.
Cocks, Doug (1999) Future Makers, Future Takers - Life in Australia 2050. University of New
South Wales Press, Sydney. 332pp.
Cocks, Doug (2003) Deep Futures - Our Prospects for Survival. University of NSW Press,
Sydney, and McGill-Queens University Press, Montreal. 332pp.
Cohen, Joel E. (1995) How Many People can the Earth Support? Norton Paperbacks, New
York & London. 507pp.+index
Colby, M.E. (1991) Environmental Management in Development: The Evolution of Paradigms.
Ecological Economics 3: 193-213
Common, Mick (1995) What Is Ecological Economics? In: Australia & N.Z. Society for
Ecological Economics/Centre for Agricultural & Resource Economics, Ecological
Economics Conference Papers, Coffs Harbour, NSW. 1-16
Common, Michael (1988) Environmental and Resource Economics: An Introduction. Longman
Group UK Ltd, Harlow, Essex. 316pp.+index
Cowell, Richard (1997) Stretching the Limits: Environmental Compensation, Habitat Creation
and Sustainable Development. Trans. Inst. Br. Geogr. 22: 292-306
Croall, Stephen and Rankin, William (1981) Ecology For Beginners. Pantheon Books, New
York. 175pp.
Daly, H. (1977) Steady State Economics. Freeman, San Francisco. Second Edition (1991)
Island Press, New York.
Davenport, Thomas H. (1997) Information Ecology: Mastering the Information and
Knowledge Environment. Oxford University Press, Oxford. 255pp.
Davies, John K. and Kelly, Michael P., eds. (1993) Healthy Cities: Research and Practice.
Routledge, London & New York. 188pp.
Eckersley, Richard, (1998) Perspectives on Progress: Economic Growth, Quality of Life and
Ecological Sustainability. In: Eckersley, Richard, ed. Measuring Progress: Is Life
Getting Better? C.S.I.R.O. Publishing, Collingwood, Victoria. 3-34; 382pp.
Ehrlich, Paul and Ehrlich, Ann (1968) The Population Bomb. Ballantine Books, New York, and
also (1990) The Population Explosion. Hutchinson, London. 320pp.
Ellwood, Wayne (2000) Redesigning the Global Economy New Internationalist 320:7-10
George, Susan (1988) A Fate Worse than Debt: A Radical New Analysis of the Third World
Debt Crisis. Penguin Books, London. 300pp.
Goudzwaard, Bob and de Lange, Harry (1995) Beyond Poverty and Affluence: Toward an
Economy of Care. William Eerdmans, Michigan, and World Council of Churches,
Geneva.165pp. First published in Dutch 1986
Hamilton, Clive (1994) The Mystic Economist. Willow Park Press, Fyshwick, ACT.
Hamilton, Clive (1998) Measuring Changes in Economic Welfare: The Genuine Progress
Indicator for Australia. In: Eckersley, Richard, ed. Measuring Progress: Is Life Getting
Better? C.S.I.R.O. Publishing, Collingwood, VIC. 69-92
Hamilton, Clive (2004) Growth Fetish. Allen & Unwin, Crows Nest, NSW. 262pp.
Handy, Charles (1989) The Age of Unreason. Arrow, Random House, London. 217pp.
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
36
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Handy, Charles (1998) The Hungry Spirit: Beyond Capitalism - A Quest for Purpose in the
Modern World. Arrow Books, Random House, London. 272pp.
Hardin, Garrett (1968) The Tragedy of the Commons. Science 162: 1243-1248
Hawken, Paul (1993) The Ecology of Commerce: A Declaration of Sustainability. Harper
Business, New York. 250pp.
Hawken, Paul, Lovins, Amory B. and Lovins, L. Hunter (2000) Natural Capitalism: The Next
Industrial Revolution. Earthscan Publications, London. 397pp.
Heilbroner, Robert (1953) The Worldly Philosophers: The Lives, Times and Ideas of the Great
Economic Thinkers. Seventh Edition (2000) Penguin, London. 365pp.
I.U.C.N. (World Conservation Union) (1995) Economic Assessment of Protected Areas:
Guidelines for Their Assessment. Economic Benefits of Protected Areas Taskforce,
Commission for National Parks & Protected Areas and Australian Nature Conservation
Agency, on behalf of I.U.C.N., Gland, Switzerland. 142pp.
LeGrain, Philippe (2002) Open World: The Truth about Globalisation. Abacus, London.
Lowe, Ian (1998) Reporting on the State of Our Environment. In: Eckersley, Richard, ed.
Measuring Progress: Is Life Getting Better? C.S.I.R.O. Publishing, Collingwood, VIC.
287-298
Malthus, Thomas Robert (1798) Essay on the Principle of Population.
Marx, Karl (1867) Capital and also Marx and Engels (1848) The Communist Manifesto.
McLuhan, Marshall and Powers, Bruce (1989) The Global Village: Transformations in World
Life and Media in the 21st Century. Oxford University Press, Oxford & New York.
220pp.
Meadows, Donella, Meadows, Dennis, Randers, Jorgen and Behrens, William III (1972) The
Limits to Growth: A Report for the Club of Rome’s Project on the Predicament of
Mankind. Newgate Press/Potomac Associates/Pan Books, London. 205pp.
Meadows, Donella, Meadows, Dennis and Randers, Jorgen (1992) Beyond the Limits: Global
Collapse or a Sustainable Future. Earthscan, London. 300pp.
Meadows et al. (2005) The Limits to Growth: 30 Year Update.
Mill, John Stuart (1857) Principles of Political Economy and also (1863) Utilitarianism.
Monbiot, George (2003) The Age of Consent: A Manifesto for a New World Order. Flamingo,
and Harper Perennial, London. 274pp
Peet, John (1995) Energy and the Contributions of Georgescu-Roegen. In: Australia & N.Z.
Society for Ecological Economics/Centre for Agricultural & Resource Economics,
Ecological Economics Conference Papers, Coffs Harbour. 27-38
Rawls, John (1971) A Theory of Justice. Harvard University Press, Cambridge, Mass.
Ricardo, D. (1817) Principles of Political Economy and Taxation.
Roodman, David Malin (1998) The Natural Wealth of Nations: Harnessing the Market for the
Environment. Worldwatch Environmental Alert Series, W.W. Norton, New York &
London. 304pp.
Sachs, Jeffrey, with foreword by Bono (2005) The End of Poverty: How We Can Make it
Happen in Our Lifetime. Penguin Books, London. 397pp.
Saul, John Ralston (1997) The Unconscious Civilization. CBC Massey Lectures Series,
Penguin Books, Ringwood, VIC. 205pp.
Saul, John Ralston (2005) The Collapse of Globalism and the Reinvention of the World. Viking,
Penguin Group, Camberwell, Vic. 309pp.
Saunders, D.A., Hobbs, R.J. and Margules, C.R. (1991) Biological Consequences of
Ecosystem Fragmentation: A Review. Conservation Biology 5(1): 18-32
Schumacher, E.F. (1973) Small Is Beautiful: A Study of Economics as if People Mattered.
Abacus, Sphere Books, London. 255pp.
Singer, Peter (2002) One World: The Ethics of Globalisation. Yale University Press, US, &
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
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Text Publishing Company, Melbourne. 255pp.
Smith, Adam (1776) An Inquiry Into the Nature and the Wealth of Nations.
Stiglitz, Joseph (2002) Globalization and its Discontents. Penguin Books. 288pp.
Suzuki, David and Dressel, Holly (2002) Good News For a Change: How Everyday People are
Helping the Planet. Stoddart Publishing, Toronto, and Allen & Unwin, Crows Nest,
NSW. 400pp.
Trainer, Ted (1995) The Conserver Society: Alternatives for Sustainability. Zed Books, London.
246pp.
Trudgill, S.T. (1990) Barriers to a Better Environment. Belhaven Press (Pinter Publishers),
London. 151pp.
Turner, R.K., Pierce, D. and Bateman, I. (1994) Environmental Economics: An Elementary
Introduction. Harvester Wheatsheaf, Simon & Schuster International Group,
Hertfordshire. 318pp.+index
Unger, Peter (1996) Living High and Letting Die. Oxford University Press, Oxford & New
York
Veenhoven, R. (1996) Happy Life Expectancy: A Comprehensive Measure of Quality-of-Life
in Nations. Social Indicators Research 39: 1-58
Waters, Malcolm (2001) Globalization. Second Edition. Routledge, London & New York.
247pp. First published in 1995.
Weizsacker, Ernst von, Lovins, Amory B. and Lovins, L. Hunter (1998) Factor Four:
Doubling Wealth, Halving Resource Use. The New Report to the Club of Rome.
Earthscan Publications, London. 322pp.
Welford, Richard (1997) Hijacking Environmentalism: Corporate Responses to Sustainable
Development. Earthscan Publications, London. 251pp.
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Chapter B6: Sustainable Development
Extra activity using the Chair
A new activity from the sustainable development chapter was devised by Lindsey
Conner to involve persons in something active. The book includes a chair with different legs of
sustainable development (Ecological Leg; Social Leg; Cultural Leg; Economic Leg, p. 68), and
a number of items. The items in that list in the book were extended (see below) and stuck onto
polystyrene foam blocks (about 4cm cubes), and then each person in the room takes a block
and they have to assign the blocks to different legs.
People were then thinking about how they could use blocks in other ways but they
thought it visually showed how sustainability is a balancing act. The power of the activity is
that some of the concepts (ideas) on the blocks can go on several legs and the discussion and
reasoning behind putting them on a particular leg is deemed important. People have to explain
their original category and the new one if they had to achieve a balanced chair.
The block names include (for ideas…):
Biodiversity Ecosystems Habitats
Endangered Species Mountains
Sewage
Old Batteries Kakapo
Teachers
Schools
Rivers Physical Processes
Smog Garbage
Natural Resources
Social welfare CultureFreedoms
Counselling services Health & Medical
United Nations
Desires
Politics
Democracy Human Resources
Greenpeace Police Religion
Ethics & Behaviour Legal System Military
Industries
Entertainment Rights
Responsibilities
Family
Values Television
Media Ginseng
Horse racing Economies of scale Common resources Rugby Goods
Services
Employment Product diversity
Car pools
Quality of Life
Production efficiency Fair Trade
Discount travel
Consumerism User pays
Online resources
Academic Information: www.academicinfo.net
Alternative Technology Association: www.ata.org.au
Australian Ethical Investments: www.austethical.com.au
Australian Marine Environment: www.environment.gov.au/marine/
Bioscience-Bioethics Friendship Co-operative: www.bioscience-bioethics.org
Centre
for
Social
and
Environmental
Accounting
Research:
www.dundee.ac.uk/accountancy/csear
C.I.E.S.I.N. (Earth Science Information Network): www.ciesin.org/
Clock of the Long Now (10,000-year clock and library): www.longnow.org
C.O.M.E.S.T (World Commission on the Ethics of Scientific Knowledge and Technology, in
association with UNESCO): www.most.go.th/comest/index.htm
Coral Reef Hotspots: http://manati.wwb.noaa.gov/orad
C.S.I.R.O. (Commonwealth Scientific & Industrial Research Organisation, Australia):
www.csiro.au/csiro/csirores.htm and www.publish.csiro.au
Environment, Development and Sustainability (journal): www.wkap.nl/journals/eds
Environmental and Resource Economics (journal): www.wkap.nl/journals/ere
Environmental Journals & Serials Online: http://155.187.10.12/library/serials.html
Eubios Ethics Institute: www.biol.tsukuba.ac.jp/~macer/Info.html
Fair Trade Foundation: www.fairtrade.org.uk
F.A.O. (Food and Agriculture Organization): www.fao.org/
Foresight Institute: www.foresight.org
Global Change Research Information Office: www.gcrio.org/
G.B.R.M.P.A (Great Barrier Reef Marine Park Authority): www.gbrmpa.gov.au
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
39
Guidelines
for
Assessing
the
Sustainability
of
Australian
Fisheries:
www.environment.gov.au/marine/fisheries/assessment/main.html
Institute for Global Ethics: www.globalethics.org/
Institute for Local Self Reliance: www.ilsr.org
Institute for Policy Studies: www.ips.dc.org
Institute of Development Studies (Devline): www.ids.ac.uk
International Council for Science: www.icsu.org/
International Geosphere-Biosphere Program: www.igbp.kva.se/
International Institute for Environment & Development (I.I.E.D.): www.iied.org
International Institute for Sustainable Development (I.I.S.D.): www.iisd.ca/
International
Journal
of
Sustainable
Development
and
World
Ecology:
www.parthpub.com/susdev/home.html
International Movement for a Just World: www.jaring.my/just/
International Society for Environmental Ethics: www.cep.unt.edu/ISEE.html
I.P.C.C. (Intergovernmental Panel on Climate Change): www.ipcc.ch/index.htm
I.U.C.N. (World Conservation Union): http://iucn.org
Journal of Risk and Uncertainty: www.wkap.nl/journals/jru
Medline (U.S. National Library of Medicine): www.bewell.com/MEDLINE/
Mitigation and Adaptation Strategies for Global Change (journal): www.wkap.nl
/journals/mitigadap
Multinational Monitor: www.essential.org/monitor/
National Academy Press (full texts online): www.nap.edu
National Science Foundation (U.S.): www.nsf.gov/geo/egch/
N.O.A.A. (National Oceanic and Atmospheric Administration, U.S.): www.noaa.gov
Nobel Prize Archive: www.almaz.com/nobel
Notable Citizens of Planet Earth (biographical dictionary): www.tiac.net/users/parallax/
One World (sustainability news and business directory): www.oneworld.com
Permaculture Research Institute: www.permaculture.org.au
Political Resources: www.politicalresources.com
Project Gutenburg (books library): http://promo.net/pg/
Religion Studies: www.academicinfo.net/religindex.html
Science Applications International: www.saic.com
Socially Responsible Investment: www.wiso.gwdg.de/ifbg/sri.html
Socio-Economic Data Application Center: http://sedac.ciesin.org
SustainAbility Ltd: www.sustainability.co.uk
Sustainability WebRing (directory): http://n.webring.com/hub?ring=sustainability
United Nations web site: www.un.org
U.N.D.P. (United Nations Development Program): www.undp.org
U.N.E.P. (United Nations Environment Program): www.unep.org
U.N.E.S.C.O. (United Nations Educational, Scientific & Cultural Organisation):
www.unesco.org
UNESCO/IUBS/EUBIOS
Living
Dictionary
of
Bioethics:
www.biol.tsukuba.ac.jp/~macer/biodict.htm
U.N.F.P.A. (United Nations Population Fund): www.unfpa.org
U.N.I.C.E.F (United Nations Children’s Fund): www.unicef.org
University Corporation for Atmospheric Research: www.ucar.edu/
White House Fact Sheet: Policy Declaration on Environment and Trade:
http://sunsite.utk.edu/FINS/Sustainable_Development/Fins-SD-20.txt
World Data Center-A for Human Interactions in the Environment: www.ciesin.org /homepage/WDC.html
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Workers Rights Consortium: www.workersrights.org
World Bank: www.worldbank.org
World Database of Happiness: www.eur.nl/fsw/research/happiness/
World Development Movement: www.wdm.org.uk
World Intellectual Property Organisation: www.wipo.org/eng/main.htm
World Resources Institute: www.wri.org/meb
World Trade Organisation (W.T.O.): www.wto.org/wto
Worldwatch Institute: www.worldwatch.org
Further reading
Caldwell, L.K. (1994) Sustainable Development: Viable Concept and Attainable Goal?
Environmental Conservation 21(3): 193-195
Carley, Michael and Christie, Ian (1992) Managing Sustainable Development. Earthscan
Publications, London. 303pp.
Carpenter, Richard A. (1994) Can Sustainability be Measured? Ecology International Bulletin
21: 27-36
Clark, Mary E. (1989) Ariadne’s Thread: The Search for New Modes of Thinking. Scholarly
and Reference Division, St. Martin’s Press, New York.
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SA.193-198
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Levin, S.A. (1993) Perspectives on Sustainability. Ecological Applications 3: 545-589
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Resource Management. Ecological Applications 3(4): 555-558
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Conservation: Lessons from History. Science 260: 17-36
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Assault on Democracy and Prosperity. Pluto Press, Annandale, NSW. 269pp.
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224pp.
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Science of Sustainability. Ecological Economics 32: 15-25
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National Centre for Appropriate Technology Inc., Wollongong, NSW. 492pp.
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on Education and Communication, I.U.C.N. (World Conservation Union), Gland,
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Informing Sustainable Development. U.N.S.W. Press, Sydney. 239 pp.
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W.C.E.D. (World Commission on Environment and Development) (1987) Our Common Future.
Brundtland, Gro Harlem, (ed.) Oxford University Press, Oxford. 400pp. Also known as
‘The Brundtland Report’.
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London. 374pp.
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Towards Sustainability. C.S.I.R.O., Collingwood, Victoria. 400pp.
Sustainability Crossword solutions (See p.72 of the textbook for the crossword)
The sustainability crossword includes concepts not just from this chapter, but also from the
range of previous chapters in this Section B “Environmental Ethics”. It is not necessarily easy
to complete, and can potentially be used for marking purposes as a homework assignment.
Please discourage students from writing in the textbook by distributing photocopies or
downloading the crossword from the website at eubios.info/BET/Betcwd.doc
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ACROSS:
3. Responsibilities
11. Support
15. Progress
20. Maps
22. Democracy
25. Emergent
26. Recycle
28. Utopia
29. Next
30. Uni
31. Happiness
33. Rights
34. Ethics
36. Sustainable
38. Wilderness
40. Intrinsic
42. Economics
45. Indicator
47. Demo
49. Sun
51. Long
52. Yes
53. Ism
55. Air
58. Valuation
60. Free
61. Yin
63. EIA
64. Technology
65. Gaia
67. Trees
68. Nest
69. Conserve
70. Sufficiency
DOWN:
1. Positive
2. Us
4. Eg
5. Process
6. Net
7. Bioethics
8. Intra
9. Inter
10. Sustainability
12. Uncertainty
13. Poly
14. Time
15. Pre
16. Respect
17. Strategic
18. Precautionary
19. Complexity
21. Subsist
23. Renew
24. Restrict
27. Clever
28. UN
30. United
32. Sustain
35. Hunger
37. Limits
39. GMO
41. Contents
42. Ecology
43. Organic
44. Systems
46. Reality
48. Models
49. Space
50. Bio
54. Rate
56. Fair
57. Roof
59. Now
60. Fun
62. NGO
66. We
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Chapter B7: Cars and the Ethics of Costs and Benefits
Cars are an integral part of the fabric of every modern society; so, most students will
approach the issue of personal car use with strong predetermined ideas. The quantitative
analysis is a good starting point to encourage rational and objective analysis and dispassionate
reflection.
The project in this chapter to calculate costs and benefits could be presented in two
sessions. In the first session, the issue can be presented and the analysis explained and
demonstrated. Students, either individually or in groups, should be assigned the task of
performing the analysis for homework. In the second session, students should present the
results of their analysis to the class and be encouraged to discuss some of the many questions
raised in the chapter.
Some students or their parents may be uncomfortable sharing some of the data needed
for the quantitative analysis, for example household income and hours worked. If so, then
teachers may provide some typical values for the local community. Other data might be
difficult to obtain; again, teachers might help by providing some reference values for students
to use. It might also be interesting to ask different students or groups of students to perform the
exercise with different types of vehicles, for example very small cars or sport utility vehicles.
Also please share the results of your class analysis with the international bioethics textbook
team; perhaps we can include a comparison table in a future edition.
The topic touches many areas. The basic analysis is simple, but if it is of interest to the
teacher and students, additional projects could be assigned to investigate some of the issues
raised in the chapter after the quantitative analysis. Since one of the goals is broad thinking, the
classroom discussion can be allowed to depart from the topics explicitly mentioned in the
chapter.
Depending on your student's access to Internet, and the way you want to teach, you
could give them the page of useful links. Please let us know whether they were given the links
before or after class reports.
References
1) Otsuka, Yoshimasa (ed.). 2002. Asahi Shimbun Japan Almanac 2003. Tokyo.
2) Federal Highway Administration, U.S. Department of Transportation. October 2001. Vehicle
travel for selected countries. http://www.fhwa.dot.gov/ohim/hs00/pdf/in4.pdf
3) Kondo, Yoshinori, et al. 2002. Analysis of the influence of vehicle travel activity at actual
driving condition on fuel economy and exhaust emission, paper No.99-02: 13-16, presented to
the 2002 annual meeting of the Japan Society of Automotive Engineers, 24-26 Nov. 2002,
Kyoto.
Online resources
International Road Federation
http://www.irfnet.org/
Publishes World Road Statistics (but expensive)
Victoria Transport Policy Institute http://www.vtpi.org/
Directory of Transportation Libraries and Information Centers
http://ntl.bts.gov/tldir
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OECD Environmentally Sustainable Transport
http://www.oecd.org/topic/0,2686,en_2649_34363_44954_1_1_1_37433,00.html
Centre for Sustainable Transportation
http://www.cstctd.org/CSThomepage.htm
Carfree Times
http://www.carfree.com/cft/index.html
NEMO
http://nemo.uconn.edu/
Union of Concerned Scientists Clean Vehicles Program
http://www.ucsusa.org/clean_vehicles/index.cfm
Sustainable Transportation http://www.sustainable.doe.gov/transprt/trintro.shtml
National Highway Traffic Safety Administration
http://www.nhtsa.dot.gov/
Transportation Research and Injury Prevention Programme (TRIPP) www.iitd.ac.in/tripp
Insurance Institute for Highway Safety and the Highway Loss Data Institute
http://www.carsafety.org/
Royal Society for the Prevention of Accidents
http://www.rospa.co.uk/cms/
Center For Livable Communities
http://www.lgc.org/center/
International Council for Local Environmental Initiatives
www.iclei.org
Institute for Sustainability and Technology Policy http://wwwistp.murdoch.edu.au/
Health Benefits of Cycling
http://www.lcc.org.uk/campaigns/cyclist_safety_health/health_benefits_of_cycling.asp
Chapter B8: The Energy Crisis and the Environment
Background
This chapter introduces issues of energy production and natural resources. The issues are found
in many existing textbooks in many school curricula.
Chapter B9: Ecotourism
Background
This chapter introduces issues of ecotourism using some interesting and simple case studies
and activities. This chapter could also be the basis for some field work and visits to
communities involved in ecotourism projects.
Further reading
Boo, E. (1990) Ecotourism: the Potentials and Pitfalls. W.W.F., Washington D.C.
Bottrill, C.G. and Pearce, D.G. (1995) Ecotourism: Towards a Key Elements Approach to
Operationalising the Concept. J. Sustainable Tourism 3(1): 45-54
Commonwealth Department of Tourism (1994) National Ecotourism Strategy. Australian
Government Publishing Service, Canberra. 68pp.
Goodwin, H. (1996) In Pursuit of Ecotourism. Biodiversity and Conservation 5: 277-291
Honey, M. (1999) Ecotourism and Sustainable Development: Who Owns Paradise? Island
Press: U.S.A., 1999.
International Ecotourism Society web site: www.ecotourism.org
Moore, S. and Carter, B. (1993) Ecotourism in the 21st Century. Tourism Management, April
1993: 123-130
Ng, M.A. (2003) The Ethics and Attitudes towards Ecotourism in the Philippines in Bioethics
in Asia in the 21st Century. Eubios Ethics Institute.
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
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Chapter B10: The Earth Charter
Background
This document may be interesting for understanding commonly agreed issues relating to the
environment.
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Section C. Genetics
Chapter C1: Genetics, DNA and Mutation
There are several topics on medical genetics in these online materials including breast cancer
screening (chapter C4), genetic privacy and information (chapter C5), eugenics (chapter C7),
and gene therapy (chapter C8). Also the movie guide for GATTACA is recommended as a film
directly relevant to genetic privacy and discrimination.
Online resources
See papers on the Eubios Ethics Institute website, including News in Bioethics and Biotechnology
WWW: http://eubios.info/NBB.htm
Universal Declaration on the Human Genome and Human Rights, UNESCO
WWW: http://www.unesco.org/ibc/en/genome/projet/
Site: HumGen (University of Montreal, references of laws)
WWW: www.humgen.umontreal.ca
Site: DNA Learning Center (Cold Spring Harbor Laboratory)
WWW: http://vector.cshl.org
Site: Heredity, Health and Humanity
WWW: http://www.beloit.edu/~biology/genethics/ethics.homepage.html
Site: Human Genome Project Education Resources
WWW: http://www.ornl.gov/hgmis/education/education.html
Site: National Information Resource on Ethics and Human Genetics
WWW: http://bioethics.georgetown.edu/nirehg.html
Site: Council for Responsible Genetics (CRG)
WWW: http://www.gene-watch.org
Site: GeneWatch UK Links
WWW: http://www.genewatch.org/links.htm
Site: Bioethics Resources (Genetics and Ethics)
WWW: http://www.utoronto.ca/jcb/Resources/resources.html
Site: Genethics Literature
WWW: http://www.ethics.ubc.ca/brynw/genlit.html
Site: Genomic and Genetic Resources on the World Wide Web (National Human Genome
Research Institute, National Institutes of Health)
WWW: http://www.nhgri.nih.gov/Data/
Site: DOE Information Bridge
WWW: http://www.osti.gov/bridge/
Site: Genetics and Biotechnology Journals
WWW: http://www.sciencekomm.at/journals/genetics.html
Site: Ethics and Genetics BA Global Conversation (University of Pennsylvania)
WWW: http://www.bioethics.net
Further Reading
Munson, Ronald (Ed.) (2000) Intervention and Reflection: Basic Issues in Medical Ethics.
Sixth Edition, printed in the United States of America, (Chapter 8. Genetics:
Intervention, Control, and Research. pp. 558-645.)
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Marteau, T. and Richards, M., (Eds.) (1996) The Troubled Helix: Social and Psychological
Implications of the New Human Genetics. Cambridge University Press.
Local material from hospitals, national genetics societies and companies offering genetic testing
are available.
Chapter C2: Ethics of Genetic Engineering
Background
The objective of this chapter is to give a brief description to students about Genetic
Engineering, and a balanced view of the ethical concerns raised by the use of new technologies.
Also, class debates can be organised among students on benefits and risks; especially
focusing on their ethical concerns. The groups may debate twice, the second time on the
opposite side of the debate to previously, to encourage better understanding of the issues.
There are many existing resources on the subject, and biology teachers often introduce
some of these issues when explaining the technology.
Online resources
See papers on the Eubios Ethics Institute website, including News in Bioethics and Biotechnology
< http://eubios.info/NBB.htm>
UNESCO, The Precautionary Principle, COMEST Precautionary Principle Expert Group, 2005
<http://eubios.info/UNESCO/precprin.pdf>
UNESCO International Bioethics Committee, Food, Plant Biotechnology and Ethics (1995),
Darryl Macer (Rapporteur)
<http://eubios.info/UNESCO/ibc1995pg.pdf>
There is a vast amount of Internet material, some is unreliable and extreme on both
sides of the issues. Care is needed.
Some useful links include:
http://biosafety.ihe.be/
http://www.fao.org
http://www.cfsan.fda.gov/~lrd/biotechm.html#reg
http://www.srtp.org.uk/whatisrt.shtml
http://reason.com/bi/bi-gmf.shtml
Chapter C3: Genetically modified foods
Background
This issue is hotly debated in the media, on the web, and in each country. In case the students
wish to look at the international regulations, the Codex Alimentarius has adopted codes for
international use on the risk assessment and procedures for use of GM food. National
committees usually have websites with explanation of guidelines. A debate on these topics
using the opposing materials available about the issue can be interesting, and is relevant to the
diets of most persons.
Chapter C4: Testing for Cancer Gene Susceptibility
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
See also chapters C5 “Genetic Privacy and Information” and D2 “Telling the Truth about
Terminal Cancer. The Trash and Treasure note-taking activity is from Big Six Lesson Plans http://ericir.syr.edu/big6/bigsix.html
Jansen, B bjansen@tenet.edu
This procedure can be used as a discriminatory strategy with any text. It explains to students
that a researcher must dig to find words to help answer the questions (treasure) and toss aside
unnecessary sentences, phrases, words, ideas as trash because they do not answer the questions
and therefore are unimportant in this context. The idea is to help students use a focusing
question to search the text.
Teacher Instructions
1. Demonstrate the method using an OHP and transparency of a paragraph of information
on the topic.
2. Choose a question. Write it on the board to demonstrate what the students should do.
3. Read the text on the overhead transparency sentence by sentence to the students. Ask
“Does this sentence answer the question?”
4. If the answer is no, tell the students that that sentence is trash. Go on to the next
sentence.
5. If the answer is yes, read that phrase word by word. They are treasure words and are
written as notes. Underline the words and phrases that answer the question on the
transparency.
6. Keep reading the paragraph sentence by sentence until the text is finished.
Students are impressed when they see how little they have to write.
Some limitations and risks of genetic testing
Limitations
1. The current range of tests does not look for and cannot detect all disease-causing
mutations or susceptibilities to genetic disorders.
2. There are no cures or treatments currently available for some diseases that can be
diagnosed or predicted by genetic testing.
3. Even if the mutation known to be associated with some diseases is absent, the disease
may still develop.
4. There is the possibility that test results are not correct (human error).
5. Some mutations are very variable. Many changes in the same gene can result in a
disorder e.g. cystic fibrosis. Several different mutations can lead to the same disorder.
Risks
1. People may experience psychological anxiety when they are told they have
susceptibility to a genetic disorder.
2. There is a huge risk of misunderstanding and anxiety when people who have been
tested do not get skilled counseling. There is a need to train health professionals in how
to do this.
3. The results of testing can strain family relationships, especially if the family members
do not want to know the implications for them. Family members may withhold
information that could have implications for the rest of the family.
4. Genetic information about individuals is very sensitive. Failure to protect this
information could have far-reaching effects on their well-being. For example it could
lead to social and economic discrimination.
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Resources
UNESCO International Bioethics Committee, Report of the IBC on Pre-implantation Genetic
Diagnosis and Germ-line Intervention (2003), Hans Galjaard (Rapporteur)
<http://eubios.info/UNESCO/ibc2003ip.pdf>
UNESCO International Bioethics Committee, Human Genetic Data: Preliminary Study by the
IBC on its Collection, Processing, Storage and Use (2002), Sylvia Rumball and Alexander
McCall Smith (Rapporteurs)
<http://eubios.info/UNESCO/ibc2002.pdf>
UNESCO International Bioethics Committee, Report on Confidentiality and Genetic Data
(2000), Working Group of the IBC on Confidentiality and Genetic Data
<http://eubios.info/UNESCO/ibc2000.pdf>
UNESCO International Bioethics Committee, Genetic Counselling (1995), Michel Revel
(Rapporteur)
<http://eubios.info/UNESCO/ibc1995gc.pdf>
UNESCO International Bioethics Committee, Report on Genetic Screening and Testing (1994),
Mr David Shapiro (Rapporteur)
<http://eubios.info/UNESCO/ibc1994gs.pdf>
Chapter C5: Genetic Privacy and Information
The use of genetic information in employment and insurance has raised a number of ethical
and social considerations. The ethical principle of justice would support promotion of equal
opportunity for persons, and the ethical principle of avoiding harm would try to protect health
and safety. In insurance, respecting individual decision not to undergo genetic testing can be an
injustice to others who may need to pay a higher premium. We wish to promote individual’s
autonomy in the society, however the interests of others should also be taken into
consideration.
The completion of the first mapping of the human genome has provided huge potential for
research into the ways in which genes relates to people’s lives. There is enthusiastic public
support for promises of better medical diagnosis and treatments. However, there is also fear
about new advances in biotechnology, genetic screening, stem cell research, leading to the lack
of privacy, and the increased possibilities of genetic discrimination. The issue of informed
consent is fundamental in conducting genetic research and protection of individual privacy. We
have yet to make an adequate effort to resolve the ethical and social issues involved in genetic
testing.
A father's discovery that he carries the gene for Huntington’s disease would also mean learning
that his children will have a 50% chance of developing the same disease. This crucial
disclosure of information has particular implications for individuals as members of families.
While individuals may be ambivalent about knowing their own genetic predisposition, concern
for the interests of others requires us to respect their autonomy, that is, their right to know or
not to know. It is very important that this privacy is respected, because this information can
also lead to genetic discrimination.
Biological samples such as blood, saliva, or amniotic fluid (from which fetal cells are
obtained) can be used for testing. The techniques used in your local area could be investigated
by contacting local hospitals.
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Resources
See chapters C9 and C10 for International Declarations on the subject. Also the statements of
the Human Genome Organization Ethics Committee.
<http://eubios.info/index.htm>
UNESCO International Bioethics Committee, Report of the IBC on Pre-implantation Genetic
Diagnosis and Germ-line Intervention (2003), Hans Galjaard (Rapporteur)
<http://eubios.info/UNESCO/ibc2003ip.pdf>
UNESCO International Bioethics Committee, Human Genetic Data: Preliminary Study by the
IBC on its Collection, Processing, Storage and Use (2002), Sylvia Rumball and Alexander
McCall Smith (Rapporteurs)
<http://eubios.info/UNESCO/ibc2002.pdf>
UNESCO International Bioethics Committee, Report on Confidentiality and Genetic Data
(2000), Working Group of the IBC on Confidentiality and Genetic Data
<http://eubios.info/UNESCO/ibc2000.pdf>
UNESCO International Bioethics Committee, Genetic Counselling (1995), Michel Revel
(Rapporteur)
<http://eubios.info/UNESCO/ibc1995gc.pdf>
UNESCO International Bioethics Committee, Report on Genetic Screening and Testing (1994),
Mr David Shapiro (Rapporteur)
<http://eubios.info/UNESCO/ibc1994gs.pdf>
Chapter C6: The Human Genome Project
Resources
UNESCO International Bioethics Committee, Human Genetic Data: Preliminary Study by the
IBC on its Collection, Processing, Storage and Use (2002), Sylvia Rumball and Alexander
McCall Smith (Rapporteurs)
<http://eubios.info/UNESCO/ibc2002.pdf>
UNESCO International Bioethics Committee, Report of the IBC on Ethics, Intellectual
Property and Genomics (2002), Justice Michael Kirby (Rapporteur)
<http://eubios.info/UNESCO/ibc2002ip.pdf>
UNESCO International Bioethics Committee, Report of the IBC on Solidarity and
International Co-operation between Developed and Developing Countries concerning the
Human Genome (2001), Mehmet Öztürk (Rapporteur)
<http://eubios.info/UNESCO/ibc2001.pdf>
UNESCO International Bioethics Committee, Bioethics and Human Population Genetics
Research (1995), Chee Heng Leng, Laila El-Hamamsy, John Fleming, Norio Fujiki, Genoveva
Keyeux, Bartha Maria Knoppers and Darryl Macer
<http://eubios.info/UNESCO/ibc1995pg.pdf>
UNESCO International Bioethics Committee, Advice of the IBC on the Patentability of the
Human Genome, 2001.
<http://eubios.info/UNESCO/ibcpatent.pdf>
Chapter C7: Eugenics
Resources
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
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UNESCO International Bioethics Committee, Bioethics and Human Population Genetics
Research (1995), Chee Heng Leng, Laila El-Hamamsy, John Fleming, Norio Fujiki, Genoveva
Keyeux, Bartha Maria Knoppers and Darryl Macer
<http://eubios.info/UNESCO/ibc1995pg.pdf>
Chapter C8: Human Gene Therapy
Gene therapy was unusual as science because many ethical issues were discussed for years
before it was actually done. It has not led to a real therapy for most patients. There may be
some parallel to the way that stem cell therapy is being discussed with much hype as a miracle
cure nowadays, and the way gene therapy was discussed in the 1980s.
Online resources
See papers on the Eubios Ethics Institute website, including News in Bioethics and Biotechnology
< http://eubios.info/NBB.htm>
US NIH Guidelines for Research Involving Recombinant DNA Molecules
http://www4.od.nih.gov/oba/rac/guidelines/guidelines.html
ClinicalTrials.gov gives information about all US clinical trials of drugs and therapies
including the purpose of the trials, who may participate, locations, and phone numbers for
more details.
http://www.clinicaltrials.gov/
UNESCO International Bioethics Committee, Report of the IBC on Pre-implantation Genetic
Diagnosis and Germ-line Intervention (2003), Hans Galjaard (Rapporteur)
<http://eubios.info/UNESCO/ibc2003ip.pdf>
UNESCO International Bioethics Committee, Ethical Considerations Regarding Access to
Experimental Treatment and Experimentation on Human Subjects (1996), Harold Edgar and
Ricardo Cruz-Coke (Rapporteurs)
<http://eubios.info/UNESCO/ibc1996.pdf>
UNESCO International Bioethics Committee, Report on Human Gene Therapy (1994), Mr
Harold Edgar and Mr Thomas Tursz (Rapporteurs)
<http://eubios.info/UNESCO/ibc1994.pdf>
Chapter C9: Universal Declaration on the Human Genome and
Human Rights
Background
The declaration provides a summary of internationally accepted principles on these issues and
is available in multiple languages from the UNESCO websites. It can be interesting for debates.
Chapter C10: International Declaration on Human Genetic Data
Background
The declaration provides a summary of internationally accepted principles on these issues and
is available in multiple languages from the UNESCO websites. It can be interesting for debates.
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Section D. Medical Ethics
Chapter D1: Informed Consent and Informed Choice
Background
The issue of informed consent has been widely discussed in medical ethics, and can apply to
the visits that students make to health care professionals.
Resources
The internationally agreed declaration on bioethics is useful for background:
UNESCO Universal Declaration on Bioethics and Human Rights (19 October, 2005)
<http://eubios.info/udbhr.pdf>
UNESCO, Establishing Bioethics Committees, 2005 72pp.
<http://eubios.info/UNESCO/ebc.pdf>
Bergstrom, Philip, ed, Ethics in Asia-Pacific, 2004, 372pp.
<http://eubios.info/UNESCO/ethap.pdf>
UNESCO International Bioethics Committee, Report of the IBC on the Possibility of
Elaborating a Universal Instrument on Bioethics (2003), Giovanni Berlinguer and Leonardo De
Castro (Rapporteurs)
<http://eubios.info/UNESCO/ibc2003.pdf>
UNESCO International Bioethics Committee, Ethical Considerations Regarding Access to
Experimental Treatment and Experimentation on Human Subjects (1996), Harold Edgar and
Ricardo Cruz-Coke (Rapporteurs)
<http://eubios.info/UNESCO/ibc1996.pdf>
Chapter D2: Telling the Truth about Terminal Cancer
See also Chapter D3 “Euthanasia”. Usually there is information available from local hospitals
and oncology departments that may be useful for students.
The four contexts of dying awareness of life-threatening illness were described by Glaser &
Strauss (1965). The emotions of shock, denial, anger, bargaining and depression experienced
by Mr. G were first published by Kubler-Ross in her book On Death and Dying (1969).
In the case described in this chapter, Mr. G is protected from the shock of hearing about his
terminal condition. According to his background (age and generation), it is assumed that he
most probably would have had no intention to actively participate in his treatment. And that he
would have preferred to depend on his children and medical authorities to make appropriate
decisions on his behalf. Based on his culture, it is often presumed that keeping the cruel truth
of an impending death outweighs the benefits of knowing. However, based on studies done in
many countries, dying people become more devastated when they eventually learn that they
were deliberately prevented from knowing the truth about the seriousness of their illness. What
is the attitude in your country? A discussion on cultural differences could be a good way to get
students to become passionate about this topic. After all, in the end, all people die.
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References
The Eubios CD or website provides a news section on euthanasia, with a number of papers
discussing the topic.
Glaser and Strauss (1965) Awareness of Dying. Aldine, Chicago.
Kubler-Ross, E. On Death and Dying. (1969) The Macmillan Company, New York.
Seale, C., Addington-Hall, J. and McCarthy, M. (1997) "Awareness of Dying: Prevalence,
Causes and Consequences." Soc. Sci. Med. 45: 477-84.
Chapter D3: Euthanasia
Please see also the related Chapter D2 "Telling the Truth about Terminal Cancer", but note the
difference between hospice care and supporting people's choices to limit medical treatment at
the end of life (passive), and active euthanasia which is largely the topic of this chapter.
Many medical professionals today have taken the Hippocratic Oath (4th Century BC). The
Hippocratic Oath includes prohibitions against active euthanasia and deals with the duties of
the physician, such as confidentiality, resistance to injustice, and moral respect for each patient.
However, euthanasia has a very long history. In fact, in the Stoic tradition (ca. 300 BC), active
assistance with suicide of the physically or mentally impaired was allowed. The term
euthanasia here referred to the ideal of a quick, gentle and honourable death.
These Dutch guidelines are based on the criteria set out in court decisions relating to when a
doctor can successfully invoke the defence of necessity. This form of defence is valid when a
conflict of responsibilities occurs between preserving the patient's life on the one hand and
alleviating suffering on the other. The conflict must be resolved on the basis of the doctor's
responsible medical opinion measured by the prevailing standards of medical ethics.
The euthanasia law is intended to respect the wish of the patient, thereby recognising the need
for defining Patients' Rights. In 1994, 'Amendments under the Burial Act' incorporated the
definition of patient's rights, making the Netherlands the first country in Europe to pass a law
defining the responsibilities of doctors to their patients. Physicians must provide clear
information, written down if requested, before they obtain consent for any operation.
These developments are reflected in the court decisions made with regards to euthanasia since
the 19th century. According to the Supreme Court in 1891, respect for human life has to be
balanced against the loss of personal dignity, unbearable suffering and the impossibility to die
in a dignified manner. The appeal to force majeure in a euthanasia case, therefore, was and still
is recognised when a physician was confronted with a conflict of duties and acted in
accordance with the medical-ethical demands of careful practice. This general exception is laid
down virtually unchanged in the new law in a special justification for physicians.
Critics say that euthanasia and assisted suicide are not private acts, but involve one person
facilitating the death of another, and a human environment that shapes its conditions. In this
view, euthanasia is a matter of public concern since it can lead to abuse, exploitation and
erosion of care for the most vulnerable people in society. Respect for the person of the patient
and concern for the family requires the optimal personal and public use of resources in end-ofDarryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
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life decisions that promote the value of humane life. On a personal level, a dying patient needs
care. A patient is not merely a biological unit but a cultural being with a conscience, a social
existence and family ties. On a public level, legal measures are taken to protect the rights of
patients and physicians, and financial budgets are put together to provide the public with 'good
treatment'. Criticism of the euthanasia law expresses uncertainty about the ways in which this
'good treatment' takes shape in society, especially in the long-term.
One concrete step in the direction of dealing with the slippery-slope argument is the
clarification of the complex conceptual apparatus adopted in official legal and health care
institutions. According to the critics, a worrying entrance in the statistics is the category of
'intentional life-terminating acts without explicit request'. This entrance is regarded as a
separate category and constituted approximately 0,7 per cent of all death in the Netherlands in
1995. These cases concern mostly patients who no longer can express their will, and suffer the
last phase of a terminal disease such as cancer and neurological diseases. In the majority of
cases morphine is administered, not only to relieve the patient from pain, but also with the
purpose of hastening death. Though there is a relatively clear definition of euthanasia, there is
a lack of a clear legal framework for these other occurring cases in which the patient does not
have a clear say.
Discussion Suggestions



Does decriminalisation of euthanasia have the same effect in wealthy countries as in
poor countries?
How important are different cultural and religious notions of death to the definition of
euthanasia?
Are the arguments for decriminalising euthanasia the same in a democracy as under a
authoritarian regime?
Online Resources
See papers on the Eubios Ethics Institute website, including News in Bioethics and Biotechnology
http://eubios.info/NBB.htm
Dutch
Ministry
of
Foreign
http://www.minbuza.nl/english/homepage.asp.
Affairs
on
euthanasia:
For web sites that oppose the legalisation and decriminalisation of euthanasia and assisted
suicide, see: The Euthanasia Prevention Coalition: http://www.epc.bc.ca/
and a radical opponent of euthanasia at: http://www.prolifeinfo.org/euthanasia.html
Background literature on euthanasia and suicide in the Netherlands
Griffith, John & Alex Bood & Heleen Weyers (1998) Euthanasia & Law in the Netherlands,
Amsterdam: Amsterdam University Press.
Hendin, H., C. Ruthenfrans, and Z. Zylics (1997) 'Physician-assisted suicide and euthanasia in
the Netherlands' Journal of the American Medical Association 277: 1720-22.
Keown, Damien (1995) 'Euthanasia in the Netherlands: sliding down the slippery slope?' in
Keown (ed.) Euthanasia Examined. Ethical, Clinical and Legal Perspectives.
Cambridge: Cambridge University Press.
Kimsma G, Leeuwen (1993) E. Dutch Euthanasia: Background, Practice, and Present
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Justifications. Cambridge Quarterly of Healthcare Ethics.
Shneidm, Edwin S. (1990) 'Preventing Suicide'. In John Donelly Suicide. Right or Wrong?
Buffelo, New York: Promotheus Books
Wijsbek, Henry (2001) Taking Lives Seriously. Philosophical Issues in the Dutch Euthanasia
Debate, Amsterdam: Dissertation Vrije Universiteit
Van der Maas, P.Jp., J.J.M. van Delden, L. Pijnenborg, C.W.N. Looman (1991) 'Euthanasia
and other medical decisions concerning the end of life', Lancet 1991 (338): 669-674.
Chapter D4: Brain Death
Materials on brain death are available in some countries from the organ donation networks, and
these may be a good source of teaching material. Certain countries, like Japan, have debated
the issue for many years and have abundant literature. There is confusion about the issue in
materials so use reliable sources.
There is background material below on brain death, and a technical description. Japanese
language notes are also available. Several pictures of the brain are available. You could white
out some areas and ask students to fill in the regions if you wish. The story continues in
Chapter D5 “Organ Donation”. There is a play script available as well, in Chapter D6 “Brain
Death and Organ Transplant Drama”. See also Chapter D3 “Euthanasia”.
What is brain death?
Brain death is defined as the irreversible loss of all functions of the brain. Although
diagnosis of this condition varies country to country in general it can be determined in several
ways. First - no electrical activity in the brain; this is determined by an EEG. Second - no blood
flow to the brain; this is determined by blood flow studies. Third - absence of function of all
parts of the brain - as determined by clinical assessment (no movement, no response to
stimulation, no breathing, no brain reflexes.)
The criteria may be legally applied in some conditions, with exclusions for persons who
are very young, in drug overdose, or whose bodies are very cold, because of the reliability of
the criteria. There are also other conditions, like locked in syndrome, persistent vegetative state
or coma, which are distinct from brain death, because the persons in those states are alive.
Sometimes writers and the media get confused.
A persons' heart can still be beating because of the ventilator and medications helping
to keep the blood pressure normal. In most countries of the world a person who is declared
brain dead is legally dead. Japan is one exception, and leaves the decision up to the person’s
prior expression on the organ donor card, with their family's agreement.
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Chapter D5: Organ Donation
Materials on organ transplants are available in some countries from the organ donation
networks, and these may be a good source of teaching material. The story continues from
Chapter D4 “Brain Death”. There is a play script available also in Chapter D6 “Brain Death
and Organ Transplant Drama”.
Online resources
Japan Organ Transplantation Network, available at http://www.jotnw.or.jp/news/news.html.
Management
Centre
for
Transplantation
and
Special
Diseases,
Iran,
http://www.Irantransplant.org
Philippines “Organ Donation Act of 1991”, Republic Act No. 7170,
http//:www.chanrobles.com/republicactno7170.htm
Saudi Organ Transplantation, Available at Saudi Center for Organ Transplantation:
http://www.scot.org.sa/eng-index.html
Singapore
Human
Organ
Transplant
Act,
(HOTA),
http://www.moh.gov.sg/corp/systems/organ/hota.do
Chapter D6: Brain Death and Organ Transplant Drama
Background
This chapter is a drama version of chapters D4 and D5, see references for those chapters.
Chapter D7: The Heart Transplant
Background
This chapter is a single page topic on organ transplants, see references for chapter D5.
Chapter D8: SARS (Severe Acute Respiratory Syndrome)
Background
This chapter introduces some of the ethical issues associated with a recent outbreak of an
infectious disease with the issues of quarantine and medical responsibility.
Chapter D9: AIDS and Ethics
This topic about AIDS is very straightforward on one hand, and very culture-oriented
and complex on another. In some countries it may be more difficult to discuss about sexual
behavior than in other countries. It is desirable therefore to acquire information according to
the needs of every country where the class is taught. There have been a number of films made
involving AIDS, for example "Philadelphia". In some countries patients can openly say they
have AIDS, or HIV carriers will talk about how they feel. In others it is a secret.
Online resources
Eubios AIDS news: http://eubios.info/NBB/NBBAIDS.html
UNAIDS: http://www.unaids.org/index.html
WHO health topics on HIV: http://www.who.int/health_topics/hiv_infections/en/
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[Japanese pages]
http://www.hokenkai.or.jp/
http://www.jfap.or.jp/ (AIDS prevention information network)
http://www.cai.presen.to/
http://www.page.sannet.ne.jp/uchida/
http://www.internetacademy.co.jp/~s1201102/ (Little Angel)
http://l-gff.gender.ne.jp/2001/qdp/aids.html
Chapter D10: Ethical Principles for Medical Research Involving
Human Subjects
Background
This chapter is the so-called Helsinki Declaration, which is a basic international standard for
guidance for experimental medical research. It is not without controversy.
Resources
UNESCO International Bioethics Committee, Ethical Considerations Regarding Access to
Experimental Treatment and Experimentation on Human Subjects (1996), Harold Edgar and
Ricardo Cruz-Coke (Rapporteurs)
<http://eubios.info/UNESCO/ibc1996.pdf>
Chapter D11: Bird flu
Background
This chapter introduces some of the ethical issues associated with a recent outbreak of an
infectious disease with the issues of quarantine and medical responsibility.
Chapter D12: Indigenous Medicines and Access to Health
Background
This chapter introduces some of the ethical issues associated with the choices made in the use
of medicines in health care systems. It would be interesting to see how many students and
families use traditional medicines.
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
Section E. Reproduction
Chapter E1: Lifestyle and Fertility
Chapters E1 and E2 are linked to each other in discussing fertility and assisted
reproductive technologies, intended to be taught over consecutive study periods. There are
many issues that could be discussed, so the chapters are long and you may want to split them
into more class times or selectively use specific sections. There are also photographs in the CD
or on the website that can be downloaded.
Chapters E1 and E2 have four specific aims:
1. To fully discuss the divide between fertility and infertility.
2. To outline the influences of lifestyle, environment and social development on
personal empowerment and reproductive health.
3. To describe the assisted reproductive technologies.
4. To highlight major bioscience-bioethical concerns.
By the end of chapter E1 students should be able to describe:
a) Fertility health indicators
b) The relationship of lifestyle factors to fertility
c) Major contributors to reproductive health across the course of the life cycle.
Summary
To achieve the goal of a healthy, live child it helps for parents to learn as much as
possible about the biology of fertility, pregnancy and childbirth and about the factors that
promote or compromise fertility and reproductive health of the mother and her fetus. This
lesson attempts to raise general awareness about ways social/lifestyle stresses during
conception and pregnancy may impair growth and development resulting in long-term, even
permanent, abnormalities in the child. Teacher to emphasize that when reproduction is
considered a privilege, not a right, the chances of a good outcome is elevated significantly.
Reproductive health care, education and support: general background analysis
People’s sense of right and wrong behavior comes from many sources – not least from
ethical instincts inherited from our evolutionary past. For the full development of reproductive
health, humans depend upon the satisfaction of basic needs such as contact, intimacy,
emotional expression, pleasure, tenderness and love. In order to maximally develop a person’s
genetic potential personal, interpersonal and societal wellbeing is significant. It follows that
since health is a fundamental human right, so must reproductive health be a basic right
extended into future generations.
When a couple plans to reproduce, they can take many practical steps to safeguard their
own fertility and reproductive capacity, thereby safeguarding their children’s health well before
conception and birth. These steps include seeking out prenatal care, ensuring good nutrition,
avoiding harmful substances and learning about exercise and sex during pregnancy. Numerous
studies have shown that prenatal care benefits almost every aspect of pregnancy as it decreases
the likelihood of early miscarriage, fetal or neonatal death, fetal prematurity and low birth
weight. Even before a woman becomes pregnant she can and be tested for her immunity to
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
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German measles (rubella). If she’s not immune to this disease and contracts it during
pregnancy, her fetus can suffer serious developmental defects; such as deafness and mental
disability. This is a good reason for a non-immune woman to be vaccinated when planning to
have a child. She can also be tested for HIV. This is another important reason since the virus
can infect the fetus during pregnancy or at birth, and antiretroviral therapy can diminish the
risk that this will happen.
Fathers also transmit debilitating effects to their offspring. Because sperm cells are
particularly vulnerable to genetic damage, birth defects in children appear to be more often
linked with paternal than with maternal DNA damage. Planning to have a baby entails unique
responsibilities from both parents and some understanding of biological systems is helpful in
reducing problem pregnancies. We all know that prevention is preferable to ‘cure’ and when
reproduction is considered a privilege, not a right, the chances of a good outcome is elevated
significantly.
The Box summarizes several possible approaches to the biological understanding of
human fertility.
Box: Approaches to the Understanding of Fertility
Physical and functional basis of fertility
The neural control mechanisms that mediate fertility and good reproductive potential
The genetics underlying the reproductive capacity and potentials of its maximization
The hormonal system that provides the capacity to nurture the fetus
The pathological and microbiological causes of infertility
The mental aspects governing fertility and how the brain generates mental states
The interpersonal relationships that maintain high quality fertility
References
Macer,
Darryl (editor) ‘UNESCO/IUBS/EUBIOS Living Dictionary of Bioethics’.
http://eubios.info/biodict.htm
Pollard, Irina (2002). ‘Life, Love and Children: A Practical Introduction to Bioscience Ethics
and Bioethics’. Kluwer Academic, Boston.
Pollard, Irina (1994). ‘A Guide to Reproduction Social Issues and Human Concerns’.
Cambridge University Press, Cambridge.
Chapter E2: Assisted Reproduction
Chapters E2 and E1 are linked to each other in discussing fertility and assisted
reproductive technologies. There are many issues that could be discussed, so the chapters are
long and you may want to split them into more class times, or selectively use specific sections.
There are also photographs in the CD or on the website that can be downloaded. Photos
illustrating sperm forms, ICSI and cross-cultural family members are available.
Chapters E2 and E1 have four specific aims:
1. To fully discuss the divide between fertility and infertility.
2. To outline the influences of lifestyle, environment and social development on
personal empowerment and reproductive health.
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
3. To describe the assisted reproductive technologies.
4. To highlight major bioscience-bioethical concerns.
Further possible discussion questions:
1.
Clinicians have to be vigilant not to repeat the same mistakes and so, in order to
benefit their patients, have to learn from each other’s experiences. What are the major
spheres of knowledge central to our understanding of human fertility and reproductive
success?
2. A man was found to have around 12 million sperm per milliliter of semen. In all
probability will he be able to father children in the normal way?
3. During hysterectomy a woman has her uterus removed. What effect will this have on
her producing eggs?
4. If the technique of reproductive cloning were perfected and adopted, would that affect
people’s ethical views about reproductive behavior? Compare and contrast what in your
opinion is right or wrong in the reproduction domain.
5. Explain how your views have changed following this bioethics module.
6. For both sperm and oocyte donations, there is a market for donors who are perceived to
be genetically superior, and higher fees may be paid in such cases especially for oocytes.
Discuss the bioethical ramifications of this.
7. What in your mind are the ‘correctness’ issues raised in the case of a rich couple using
a poor woman’s body to surrogate their child?
8. Discuss the pros and cons of paying high prices for ‘genetically favored’ gametes. Will
the couple love their child as much or will they be resentful if their dream of a ‘superior’
child does not come true?
9. Scientific discoveries build on previous scientific discoveries and the outcome of
scientific experiments cannot be known in advance. Discuss.
10. What are the perceived, including culturally-specific, barriers to seeking and
utilizing ART assistance and other reproductive care services?
11. How can we, as potential parents, best benefit from the insights gained by scientists
since the birth of the first IVF baby in 1978?
12. Discover culturally-dependent fertility beliefs and practices.
Male infertility
Sperm fertilizability tests investigate sperm fertilizing capacity and have become a
valuable adjunct to the classical semen analysis. Sperm function tests may indicate whether
conventional methods of assisted reproduction should first be applied or whether the couple
should immediately be included into a micro-manipulation program such as ICSI (see section
on ICSI).
Various steps can be taken to achieve pregnancy in patients with poor sperm quality.
Intrauterine insemination is often successful because placing the prepared semen high up in the
uterus, allows sperm to bypass the cervix and its mucus that can contain anti-sperm antibodies.
Partner insemination is usually called artificial insemination by the husband (AIH) and has
been useful in cases of paraplegia (sperm is collected by electroejaculation), obstructed vas
deferens or epididymis (sperm is aspirated from the epididymis) and forced separation of
couples (prisoners on long-term sentences).
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Donor insemination may also be used in combination with other ART technologies,
including sperm separation for sex preselection and for other ‘designer’ characteristics. The
latter application raises serious concerns from the ethical, legal and biological points of view.
Male infertility treatment has advanced rapidly since the early 1990s. Men with sperm
abnormalities sufficient to prevent in vitro fertilization can now father children through the
techniques of sperm micromanipulation or assisted fertilization. It is easy to see that the
outcome of ICSI is not related to any of the normal biological sperm selection processes
described in the Teachers Notes for chapter 8.
Female infertility
A woman may stop menstruating (called secondary amenorrhea) or menstruate
irregularly (called oligomenorrhea) or just fail to ovulate but menstruate normally.
Many fertility problems can be reversed by lifestyle changes, psychotherapy (if the cause is
depression or an eating disorder, for example), or failing the above, by drug treatment such as
clomiphene or its generic versions. Clomiphene is an estrogen antagonist which by several
feedback mechanisms promotes the maturation of ovarian follicles restoring fertility;
sometimes too effectively as 5-10% of clomiphene-induced pregnancies are twins (compared
with about 1% of normal pregnancies).
IVF
In IVF only a small number of sperm are needed because no long-distance migration
is involved. Various IVF adaptions are discussed below. You may want to use these for class if
students are competent enough.
Gamete Intra-Fallopian Transfer (GIFT) Technology
In an alternative procedure, oocytes are harvested from the woman as for IVF, but they
are placed directly into her fallopian tubes, along with sperm from the partner. Fertilization
then takes place in the fallopian tubes. This procedure is called gamete intra-fallopian transfer
or GIFT and was developed to simulate the natural fertilization process more closely.
The Ovarian Hyperstimulation Syndrome
The ovarian hyperstimulation syndrome is a serious and potentially life-threatening
physiologic complication encountered in a small percentage of patients undergoing the
standard IVF hormone stimulation cycles in preparation for oocyte collection. Numerous
ovarian follicles develop which drastically elevate estradiol secretion which, in turn, causes
fluid shifts, nausea, vomiting and acute physiological distress. Serious health consequences
resulting from medical treatments or diagnostic procedures are referred to as iatrogenic.
Cytoplasmic Transfer Technology
A more recent technological breakthrough is transfer of cytoplasm from a younger
donor oocyte to a recipient oocyte belonging to an older woman facing the risk of repeated IVF
failure. By the ‘rejuvenation’ procedure the older woman is, in some instances, enabled to bear
her own genetic infant. Cytoplasmic donation widens the options (childlessness, adoption, or
donor oocyte programs) available to a growing population of couples who face a high risk of
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failure with traditional IVF. As with ICSI, the preference provided by cytoplasmic transfer is a
child genetically related to the mother. Early reports have shown, however, that cytoplasm
manipulation may heighten the risk of chromosomal abnormality (see Assisted Reproduction:
Risks and Uncertainties’).
Spare embryos donated to research are used to improve on existing technology or
advance the development of new treatments. For example, donated embryos are a source of
embryonic stem cells, which are believed to have many potential therapeutic uses.
Counseling
Most of us understand counseling to be a therapeutic technique providing advice and
guidance to a patient and significant others. Therefore, counseling is an important part of any
fertility treatment and applies both to the doctor, who maybe motivated by a too enthusiastic
desire to help the infertile couple, and the couple who maybe blinded to consider valid
alternatives by their desperate desire for a child. When it comes to infertility treatment
protocols, all known potential risks must be carefully explained and received. Accredited IVF
clinics require couples to sign a general consent form acknowledging that they have
understood and accepted the information provided. This information typically clarifies the
various assisted reproductive technologies planned, includes a warning that there may be
associated short, medium and long term health risks, that there is no guarantee of a successful
pregnancy and that they have been given fair opportunities to become better informed. The
advantages of this practice to the couple are immeasurable from the point of view of increased
understanding and in establishing mutual respect for each other and their unborn children.
Assisted reproduction: risks and uncertainties
Over the past few years, evidence has begun to emerge that suggests that babies born
as a result of IVF and related procedures have an increased risk of low birth weight, genetic
disorders, neurological abnormalities and maybe even cancer. In the meantime, fears about the
safety of reproductive technologies should be kept in perspective because in most cases the
studies done were based on small samples size, while other studies on children conceived by
assisted reproduction have found no evidence of any serious problems. Evidently more
research is needed to assess the risks and care should be taken to refine as much as possible
the ART techniques in order to reduce these risks. New technologies for treating male-mediated
infertility, for example, have been developing rapidly but their long-term effects on the
offspring are still uncertain. Some researches are now questioning the safety of ICSI and other
invasive techniques, claiming that they maybe linked to increased rates of birth defects and
rare genetic imprinting disorders.
An increasingly important biological and ethical issue concerns the application of
assisted reproduction in all cases of infertility regardless of etiology. About one-third of all
patients referred for fertility treatment have a significant history of drug exposure, reinforcing
the view that drug exposure is an important consideration in all at-risk groups (Part A is
devoted to the relationship of lifestyle and fertility). ART has certainly offered hope to those
whose fertility has been compromised by the excessive use of recreational drugs, although the
technology itself may, in some cases, further compromise the reproductive outcome. Poor IVF
prognosis in the offspring may well be a contributing factor in a sub-population suffering from
drug-induced infertility rather than the infertile population at large.
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References
Macer, Darryl (editor) ‘UNESCO/IUBS/EUBIOS Living Dictionary of Bioethics’.
http://eubios.info/biodict.htm
Pollard, Irina (2002). ‘Life, Love and Children: A Practical Introduction to Bioscience Ethics
and Bioethics’. Kluwer Academic, Boston.
Pollard, Irina (1994). ‘A Guide to Reproduction Social Issues and Human Concerns’.
Cambridge University Press, Cambridge.
UNESCO International Bioethics Committee, Report of the IBC on Pre-implantation Genetic
Diagnosis and Germ-line Intervention (2003), Hans Galjaard (Rapporteur)
<http://eubios.info/UNESCO/ibc2003ip.pdf>
UNESCO International Bioethics Committee, The Use of Embryonic Stem Cells in
Therapeutic Research (2001), Alexander McCall Smith and Michel Revel (Rapporteurs)
<http://eubios.info/UNESCO/ibc2001sc.pdf>
Chapter E3: Surrogacy
Surrogacy
If a woman cannot sustain pregnancy at all because, for example, her uterus is
malformed or absent, or because her general medical condition makes pregnancy inadvisable,
or she is unwilling to reproduce naturally because of inheritable genetic disease, an option is to
use a surrogate mother. In a further twist of gestational surrogacy, the oocytes used for IVF
may be taken from neither the woman nor the surrogate, but from a third woman whose genes
are considered preferable to those of the surrogate.
Adoption
Adoption is a low-tech but often very successful way for infertile couples, or couples
who have chosen against reproduction, to have children. A major problem with adoption from
the perspective of would-be parents living in societies such as the United States of America or
Australia, is the acute shortage of suitable adoptees; that is, healthy infants of the same
ethnicity as themselves. Older or ‘special-needs’ children; that is, children with disabilities or
other medical or psychological problems, are much more readily available and so are sets of
siblings who want to be adopted together. For this reason and for a variety of other personal
preferences, many couples nowadays choose to adopt infants from abroad even though this
involves 1-3 years waiting periods and considerable expense. Cross-cultural family
relationships have revealed them to be especially rewarding in that they generate wider
understanding and respect for difference and challenge conventional mores about family and
social conduct.
Chapter E4: Choosing Your Children’s Sex and Designer Children
Sex selection
For example, they may have one or more children of one sex and now want to balance
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the family with a child of the other sex, or perhaps think that it’s good for a brother to have a
sister, or vice versa. More troubling, however, is the general social preference for boys seen in
a variety of Asian and African cultures. Boys are preferred because traditionally they help with
the farm work, bring money into the family and their children will carry on the family name.
Girls are less favored because marrying them off requires heavy bridal payments and they
leave their birth family after marriage. A particular abhorrent practice of the past was
infanticide or abandoning newborn children of the unwanted sex. Nowadays, with
amniocentesis and chorionic villus sampling it is possible to determine the sex of a fetus before
birth. The introduction of obstetric ultrasonography has made it also possible to visualize a
fetus’s genitals and to determine its sex. This can be done with reasonable accuracy by 12-14
weeks post-conception. As a consequence, sex-selective abortion is now a realistic option.
Studies have exposed that the practice of aborting female fetuses is prevalent in India and
China where the sex ratio of newborn children has become noticeably skewed toward males. In
China, for example, about 119 male births are registered for every 100 female births, and in
some parts of India the ratio is 126:100. The natural sex ratio at birth is about 105:100, at least
for Western populations. Might not the present be an opportune time to reconsider abandoning
gender discriminatory practices and return to women their due value and proper recognition?
Considerable high-tech research has gone into developing techniques for selecting a
child’s sex before fertilization. Because the fetus’s sex is determined by whether the oocyte is
fertilized by an X-bearing or a Y-bearing sperm, researches have developed sperm separation
techniques by focusing on the sperm’s total DNA content (X-bearing sperm contain about 2.9%
more DNA that Y-bearing sperm). This difference is detected by a technique called flow
cytometry. X- or Y-enriched fractions of sperm may then be selected to inseminate women who
desire a girl or a boy, respectively. The researchers claim over 90% success with girls; results
with boys are only slightly better than chance.
A more complex, but more reliable method of selecting a child’s sex is by
preimplantation genetic screening where only embryos of the preferred sex are transferred for
implantation. Although this technique is mostly done to avoid sex-linked disease, some fertility
clinics are said to offer this service for the purpose of family planning.
Designer children
A market for ‘superior’ sperm has long existed but the demand seems to be geared to
donors with high intellectual attainment. For example, the Repository for Germinal Choice in
Escondido, California, is a nonprofit organization founded in 1980 by Robert Graham. It
distributed sperm from Nobel Prize winners, and other high achievers. The Repository has
since gone out of business, but another organization Heredity Choice continues to offer semen
from prominent scientists and others.
Resources
UNESCO International Bioethics Committee, Report on Human Gene Therapy (1994), Mr
Harold Edgar and Mr Thomas Tursz (Rapporteurs)
<http://eubios.info/UNESCO/ibc1994.pdf>
UNESCO International Bioethics Committee, Report of the IBC on Pre-implantation Genetic
Diagnosis and Germ-line Intervention (2003), Hans Galjaard (Rapporteur)
<http://eubios.info/UNESCO/ibc2003ip.pdf>
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Chapter E5: Prenatal diagnosis of genetic disease
Background
This chapter introduces a difficult moral issue that is hotly debated in countries that oppose
abortion. It is also linked to the eugenic issue, discussed in chapter C7, and genetic privacy
discussed in chapter C5. It is important to understand the different points of view in this issue.
Resources
UNESCO International Bioethics Committee, Report on Genetic Screening and Testing (1994),
Mr David Shapiro (Rapporteur)
<http://eubios.info/UNESCO/ibc1994gs.pdf>
UNESCO International Bioethics Committee, Report of the IBC on Pre-implantation Genetic
Diagnosis and Germ-line Intervention (2003), Hans Galjaard (Rapporteur)
<http://eubios.info/UNESCO/ibc2003ip.pdf>
UNESCO International Bioethics Committee, Genetic Counselling (1995), Michel Revel
(Rapporteur)
<http://eubios.info/UNESCO/ibc1995gc.pdf>
UNESCO International Bioethics Committee, Report of the IBC on Pre-implantation Genetic
Diagnosis and Germ-line Intervention (2003), Hans Galjaard (Rapporteur)
<http://eubios.info/UNESCO/ibc2003ip.pdf>
Chapter E6: Female Infanticide
Background
This chapter introduces a crime that still occurs in some parts of the world, and some of the
social issues behind it. It is related to chapter E4.
Chapter E7: Human cloning
Background
This chapter introduces a controversial topic that has been widely debated internationally.
Further documentation is provided in Chapters E8 and E9.
Resources
UNESCO Universal Declaration on the Human Genome And Human Rights (1997; Chapter
C9)
<http://eubios.info/unesco.htm>
UNESCO International Bioethics Committee, The Use of Embryonic Stem Cells in
Therapeutic Research (2001), Alexander McCall Smith and Michel Revel (Rapporteurs)
<http://eubios.info/UNESCO/ibc2001sc.pdf>
UNESCO International Bioethics Committee, Report on Confidentiality and Genetic Data
(2000), Working Group of the IBC on Confidentiality and Genetic Data
<http://eubios.info/UNESCO/ibc2000.pdf>
UNESCO International Bioethics Committee, Ethical Considerations Regarding Access to
Experimental Treatment and Experimentation on Human Subjects (1996), Harold Edgar and
Ricardo Cruz-Coke (Rapporteurs)
<http://eubios.info/UNESCO/ibc1996.pdf>
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Chapter E8: United Nations Declaration on Human Cloning
Background
This provides the text of a United Nations Declaration, and allows students to see where their
countries voted in this debate.
Chapter E9: Human Genome Organization Declaration on Stem Cell
Research
Background
This is an example of a statement from a professional scientific association on a key issue of
popular debate.
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Section F. Neurosciences
Chapters F1, F2 and F3 are linked to each other as they communicate progressive
topics in neuroscience and neuroethics. The present chapter is introductory and describes basic
principles together with interesting applications taken from modern neuroscience and
neuroethics (see ‘Summary’ below). Chapter F2 focuses on the fundamentals of learning and
memory. The final chapter of this trilogy explains the neuroscience of addiction. Lifestyle
factors and socially relevant examples are provided throughout.
Summary
The brain has always fascinated psychologists and with the advent of new technologies,
it has become possible to investigate the brain more methodically. Neuroscience includes the
study of brain development, sensation and perception, learning and memory, movement, sleep,
stress, aging as well as neurological and psychiatric disorders. It also investigates the
molecules, genes and cells responsible for nervous system functioning. Neurons are the
elements responsible for information-processing and information-transmitting within the
nervous system and throughout the whole bodily system. Since the nervous system consists of
all the essential functioning processes bridging cell anatomy and cell activity, it is also the
basis of all human behavior. Its cellular organization leads to the complexity of neural
networks that, in turn, are responsible for sensory functions such as sight, smell, touch and
hearing. Modern neuroscience research has enabled scientists to describe human brain function
fundamental in driving human consciousness and behavior. Present and future research has/is
developing ways to cure, or prevent, neurological and psychiatric disorders.
The present chapter aims to provide the preliminary tools to provoke student reflection
and debate about modern insights into neuroscience and neuroethics. For instance, the module
selects Parkinson’s disease in order to introduce intra-cerebral grafting of fetal tissue, which
may provide a cure but is also the subject of vigorous debate. I am hoping that discussion of
the above procedure together with its relevant ethics, will lead the way to more discussion
about medical research in general. Students need to be included in ethical debates involving
medical research in order to gain an understanding of the difficulties of forming ethical
guidelines in a society with different social and cultural values.
Resources
UNESCO International Bioethics Committee, Ethics and Neurosciences (1995), Mr JeanDidier Vincent (Rapporteur)
<http://eubios.info/UNESCO/ibc1995ns.pdf>
Chapter F1: Advances in Neuroscience and Neuroethics
Body or Mind – Where is the Difference? (Question 1)
Ethical codes have evolved over hundreds of thousand of years through the interplay of
biology and culture. Through neuroscience, we have now discovered that human emotions and
the ability to make rational decisions can be attributed to different parts of the brain. Ethical
choice depends on the capacity to foresee the results of actions and includes the acceptance of
individual responsibility – the ability to recognize and weigh decisions. The human brain – the
cortex in particular – is more than an instrument for shaping the environment. In addition to
receiving and linking heard, seen, smelled and felt sensations, parts of the cortex’s frontal lobe
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interpret what is received incorporating it into the development of judgment, volition and
consciousness of self and others. It is possible to connect the evolution of ethics with the
evolution of these various parts of the brain. Over time the development of the frontal lobes
allowed for more creativity and ability to make rational decisions. The ability to communicate
with others increased the complexities of social relationships improving the human’s
perception of self and others. At that point in evolution, humans began to understand the moral
and ethical consequences of their actions by recognizing the effects their actions had on the
behavior of others. This offered the opportunity for the development of a collective awareness,
or ethics. Ethical behaviors have survival value where humans acting in the interest of others
are favored in the struggle for existence and are more likely to survive.
Neuroethics (Questions 2 – 7)
Judicial systems around the world punish criminals who are responsible for committing an
unlawful act. But how could one be convicted of committing a crime if he/she could not
control themselves as a result of brain malfunction? To determine if a person is insane, the
court of law applies a series of tests, which differ between countries. The basic principles of all
such tests are to examine cognition: whether the offender had the ability to understand wrong
from right during the criminal act and volition or choice of whether or not the offender was
able to control themselves when they committed the criminal act. The insanity defense states
that a person cannot be guilty of committing a criminal act if they are unable to acknowledge
that the act was wrong or could not control their actions because of a mental illness.
Neuroscience research has examined the cause of behavior that permits people to commit
criminal acts. It suggests that some criminal actions are due to damage or related
illnesses/diseases to the prefrontal cortex region. Interestingly, when the prefrontal cortexes of
rats are damaged they regularly make the more impulsive choices, suggesting that the
prefrontal cortex regulates impulsive behavior.
Modern brain imaging began in the 1970s with computed axial tomography (CAT)
scans and many advances have since been made. In the earlier days of neuroimaging, studies
focused on structure-function relationships in the brain and now organization of the primary
sensors and motor regions of the brain is particularly well understood. Today studies probe at
our deepest thoughts, define our complex cognitive behaviors and judge our rational decisionmaking and consciousness. Neuroimaging reveals the structure of the living brain through
technologies such as computer-assisted tomography (CAT) scans or magnetic resonance
imaging (MRI). Brain function is revealed through positron emission tomography (PET) scans,
single photon emission tomography (SPECT) scans, or functional magnetic resonance imaging
(fMRI). Future developments in functional brain imaging may provide sufficient information
to potentially breach the privacy of a person’s own thoughts. Privacy is therefore high on the
list of ethical issues raised by the new brain scanning technologies. Despite apprehension on
expert ability to measure mental or neural processing meaningfully, there is an aura around
‘high tech’ visual images which may lead judges and juries to put more weight on evidence
from functional neuroimaging than is warranted. A better public understanding of the
limitations of imaging is necessary to prevent an over-reliance on this source of information.
Since modern neuroimaging faces the common bioethical considerations of privacy,
confidentiality and the misuse of this information, the ethical considerations are very similar to
those associated with the human genome debate. That is, the social implications of the
availability of personal information, particularly relating to future behaviour, to the wider
community. Neuroimaging can currently interpret personality, desires and may even ‘see’ a
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state of mind (e.g. racial attitude) of which one is unaware. The implications this would hold
for our health, legal, employment, immigration, education and not to mention insurance
systems are phenomenal. It isn’t always in the person’s best interest to have that information
available to others. Radiologists, using predictive testing, are faced with long-standing ethical
issues, particularly those relating to psychopathology.
In summary: Before brain fingerprinting becomes established as a forensic tool, its
accuracy needs to be assessed. Brain fingerprinting techniques are being rated that can reveal
an individuals’ knowledge of an event. If a truly accurate lie detector could be developed
current privacy guarantees might not provide enough protection against scanning requests from
courts, the government, the military or employers. Physiological measures, especially brainbased measures, possess illusory accuracy and objectivity as perceived by the general public.
Finger Printing – Can Machines Read Your Mind? (Questions 8, 9)
Advances in neuroscience may well improve our ability to make predictions about an
individual’s future. This seems particularly likely through neuroimaging, as patterns of brain
images taken under varying circumstances, are correlated with different future behaviors or
conditions. Neuroscience might predict, or reveal, mental illness, behavioral traits, or cognitive
abilities, among other things. For example, neuroimages might lead to predictions, with greater
or lesser accuracy, of a variety of neurodegenerative diseases. As identified above, this raises
some rather serious concerns that the technology could be abused. Further, such imaging tests
may be inaccurate, may present information patients find difficult to evaluate, and may provide
information of dubious value and some harm. Society may wish to regulate such tests along the
lines proposed for genetic tests where establishing guidelines for the testing procedure would
involve the following:
● Establishing the accuracy of the test for detecting a particular condition.
● Assessment of the competency of those performing the test.
● Ensure informed consent has been obtained to ensure the individual being tested is fully
aware of the possible outcomes and limitations of the test.
● Post-test counseling to ensure that the tested individual understands fully the
consequences of the results.
Another important policy question would be whether such tests should be regulated
through government action or by professional self-regulation.
Intra-cerebral Grafting of Fetal Stem cells for Parkinson’s Disease (Questions 10, 11)
The ethical debate surrounding stem cell research is centered on the use of embryonic stem
cells. Specifically, on the deliberate production and destruction of human life. The embryo,
which is manipulated technologically in an artificial environment, will never reach the uterus
where nature intended it to be.
Religion can be considered the most influential aspect driving the stem cell debate. But
there is diversity of thought as not all religions are categorically against all stem cell research.
For example, Buddhism believes in rebirth and the transformation of the deceased karma into
the embryo; thus, life is ‘ensouled’ at conception. However, Buddhism also teaches the virtues
of knowledge and compassion and has a long tradition of practicing medicines, which promote
the alleviation of suffering. Based on this reasoning, Buddhism accepts adult and embryonic
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stem cell research to an extent. This sentiment equally applies to other religious groups.
Contemporary life has profoundly modified Christianity even in the official circles of the
Church, including the Roman Church, where there are many scholars who find no difficulty in
maintaining communion while accepting the modern scientific view of the world. And so it is
with the stem cell debate which covers a wide variety of perspectives from qualified
acceptance to total disclaimer.
References
Check, E. (2005). Brain Scan Ethics Come Under the Spotlight. Nature 433:185.
DeCamp, M. and Sugarman, J. (2004). Ethics in Behavioral Genetics Research. Accountability
in Research 11:24-47.
Farah, M. and Wolpe, P. (2004). Monitoring and Manipulating Brain Function: New
Neuroscience Technologies and their Ethical Implications. Hastings Center Report
43:35-45.
Goodenough, O. (2004). Responsibility and Punishment: Whose Mind? A Response.
Philosophical Transactions for the Royal Society of London B 359:1805-1809.
Lovegren, S. (2005). Thought-Controlled Machines May Be One Step Closer. National
Geographic News, April 2005. http://news.nationalgeographic.com/news
Sapolsky, R. (2004). The Frontal Cortex and the Criminal Justice System. Philosophical
Transactions for the Royal Society of London B 359:1787-96.
Van de Klundert, M. (2005). Parkinson’s Disease: Recent Insights in the Disease Mechanism
and a Proposal for a New Line of Drug Development. Nature Neuroscience 3:537-544.
Chapter F2:
Learning to Remember: The Biological Basis of
Memory
Learning to Remember (Question 1)
Memories of an event can be modified to include information that never actually
occurred. Such memories are known as ‘false memories’. False memories become modified
through external suggestions or through the process of imagination, and this can occur so that a
person’s memory of an event supports a belief that they hold, or fits with information that
others later provide. As the person then relives a memory in their mind, they can
unintentionally alter its contents so that it is more meaningful to them. In experimental
conditions, some brain areas, for example the posterior medial temporal lobe, respond
differently to true memories and false memories and this can be visualized using brain-imaging
techniques. Functional magnetic resonance imaging (fMRI) measures brain blood flow while a
person is partaking in some activity, say recalling a memory, and can be used to detect which
areas of the brain are being activated.
When an eyewitness is called to testify in a criminal case it is important that their
recollection of the event is supported by other evidence to ensure that it is a true memory. Such
evidence can be provided by forensic tests, such as fingerprint or DNA evidence, or through
the support of other witnesses. In situations where a memory recalled by an eyewitness is
critical to the case, fMRI evidence could be utilised to support its validity. It is important to
remember however, that such fMRI evidence can only support, but not prove, the validity of
the memory, in the same way that a lie detector test supports a person's statement, but does not
prove its truthfulness.
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Learning to Remember (Question 2)
Since imagination is a proven modifier of memories it is a technique that should be
used with the utmost caution in therapeutic settings. Surveys of clinical psychologists,
psychiatrists and other therapists reveal that imagination is often utilised as a therapeutic tool
as patients are advised to imagine an event in the hope that it will stimulate buried or repressed
memories. This is particularly dangerous if used in treating cases of trauma, such as sexual
abuse, where imagining the abuse could enhance and exaggerate the memory in the patients
mind and increases their confidence that it occurred. “Imagination inflation" is an established
psychological phenomenon, whereby the act of imagination makes the event seem more
familiar and that familiarity in turn, can mistakenly be attributed to childhood memories rather
than to the act of imagination. Such confusion, when a person does not remember the source of
information, can be especially acute for the distant experiences of childhood and the potential
negative consequence of this technique for both the patient and their families is of significant
ethical concern.
Making Memories (Question 3)
The experimental animals that were genetically engineered to perform well on memory
tasks have helped neuroscientists understand the brain mechanisms involved in learning and
memory, but the use of this information to design individuals with 'super memories' poses
many ethical concerns. Not only do we need to consider the potential health consequences, but
also our right (or lack thereof) to design a person's characteristics based on our personal values.
While learning and memory are undoubtedly valuable traits, the ability to retain information,
as opposed to constructively evaluating it, is perhaps overemphasized due to the social value
placed on intellectual performance and the ability to recall facts.
The ability to remember information and recall it in academic settings, i.e. during
school exams, does not necessarily make an individual successful in life. Such traits must be
balanced with other abilities, including emotional qualities such as compassion and empathy,
mental skills such as creativity, and physical skills such as co-ordination, to name but a few.
Flexibility in both thinking and behaviour are the cornerstones of survival as animals
(including humans) must constantly adapt to an ever changing environment. The ability to
retain information that is associated with intelligence does not necessarily breed successful or
happy individuals, instead emotional intelligence is proving to be a more important
characteristic. Qualities associated with emotional intelligence include self-awareness, impulse
control, empathy and social dexterity, and it is these traits that are associated with success in
life, rather than the ability to store and recall information. With the incidence of emotional
disorders such as depression occurring at increasing rates throughout the globe, it is important
that we remain mindful of the balance that must be maintained between intellectual and
emotional abilities.
Fading Memory: Alzheimer's Disease (Question 4)
Those suffering from neurodegenerative disorders such as Alzheimer's disease require
full time care and often their needs are above and beyond what family members can meet.
Therefore, it is imperative that adequate treatment facilities be established within communities
to accommodate the growing need for caring for those who are physically healthy, but whose
mental capacities are deteriorating. Governments need to devote adequate funding to the
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treatment of such diseases, in both establishing adequate facilities and properly training
professional staff and caregivers. It is imperative with an aging population that sufficient
facilities are established in time to meet the growing demand that will be placed on them.
Without such facilities significant burden will be placed on the family members of those who
are suffering from Alzheimer's. Children will be forced to care for physically healthy, but
demented parents who are no longer able to care for themselves. Often Alzheimer's patients
require around the clock attention, forcing adult children to forfeit their own lives in order to
provide full-time care for their elderly parents. In addition to this, governments need to invest
in research investigating neurodegenerative disease prevention and cure, to ultimately relieve
this form of human suffering and the burden that it places on health care systems and families.
Fading Memory: Alzheimer's Disease (Question 5)
Genetic tests can provide valuable information about a person's susceptibility to a
particular disease. Such testing, however, must be supported by informative briefings, with
individuals providing their informed consent to participate in the procedure, to ensure that they
are fully aware of all the facts and options available to them. Parents who utilize prenatal
screening procedures for a degenerative disorder such as Alzheimer's disease have the right to
be advised of the potential to treat the disease in the future, particularly given the fast paced
nature of medical developments in today's world. While parents' choices of whether to
continue with a pregnancy or not are highly personal and influenced by many factors including
their faith or religious beliefs, their economic circumstances or their own health concerns, it is
important that they are fully informed about the current research in the area and provided with
supportive counsel to discuss each of their concerns in a respectful atmosphere.
Genetic testing can be particularly beneficial in circumstances where preventative
medicine is available, or under development, because it provides individuals with an
opportunity to treat the disease before it develops. Individuals informed that they are at risk of
developing a degenerative disease are also more motivated to partake in healthy habits that are
likely to enhance their outcome, such as eating a diet high in antioxidants, known to have
preventative medicinal properties for diseases such as Alzheimer's or Parkinson's disease, or
can avoid unhealthy habits that can accelerate the onset of each disease.
Fading Memory: Alzheimer's Disease (Question 6)
Issues surrounding privacy of information are particularly important in circumstances
where genetic screening is utilised to identify disease risk. Individuals have a right to protect
their information, however insurance companies also argue that they have a right to be fully
informed of the health status of their clients, including any knowledge they may have of their
risk for future disease if this has been confirmed through genetic testing. Positive genetic test
results for a degenerative disease that would occur sometime in the future would likely result
in the insurance company charging higher premiums to that individual today in order to cover
their expenses in the future. This could in turn, discourage people from partaking in potentially
beneficial screening programs for the fear that it will incur greater cost to them if they do not
have the right to protect their information.
Memory Enhancement Therapies (Question 7)
The majority of our memories are ‘negative memories’ whereby our nervous system
actively filters out unimportant information and inhibits the formation of memory traces in the
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brain. A pill that acts to enhance the consolidation of memories may be of benefit to an
individual in some circumstances, for example, while studying for an exam, but is likely to
incur significant side effects if taken while a person's brain is still developing, or if taken over a
long period of time. It is unlikely that a ‘memory enhancing pill’ could allow a person to
selectively store memories of their choosing (such as class notes), without also storing
unrelated or insignificant information, or perhaps even modifying memories more easily. The
excess storage of information could, in turn, put unnecessary pressure on the storage and
retrieval systems of the brain over time, which may incur negative consequences that are as yet
unknown.
Social pressure to succeed in school and business will likely provide the motivational
drive for individuals to consume memory enhancing drugs, to the point where the negative side
effects may not be of significant interest to them. Yet the developing mind is particularly
fragile, and we must proceed with caution when administering drugs to young individuals,
when the effects on neuronal systems are not well established. In addition to this, long-term
consumption may have disastrous consequences on established neuronal systems, given the
neuronal mechanisms involved in memory storage, if pushed to the extreme, may lead to the
destruction of neuronal cells.
Social pressure to succeed in either school or business can place undue pressure on
individuals to modify their mental abilities with a memory-enhancing drug. The development
and availability of such drugs will inevitably provide unfair advantage for those who consume
them in learning and memory tasks and will place pressure on those who do not take the drug
to consume it also. This advantage is likely to be associated with higher socioeconomic status,
that is, those who can afford the treatment will potentially benefit from enhanced memory,
while those who cannot, may be disadvantaged. In a competitive school or work environment,
this advantage may be likened to chemicals such as anabolic steroids that enhance physical
performance in sporting activities, and regulations to prevent unfair advantage may need to be
introduced.
References
Farah M.J., Illes J, Cook-Deegan R, Gardner H, Kandel E, King P, Parens E, Sahakian B,
Wolpe PR. (2004). Neurocognitive enhancement: what can we do and what should we
do? Nat Rev Neuroscience 5:421-425.
Goleman, D. (2003). Destructive emotions and how we can overcome them a dialogue with the
Dalai Lama, Mind and Life Institute, Great Britain
Kalat, J.W. (2001). Biological psychology 7th Ed., Wadsworth Thomson Learning, USA
Loftus E.F. (2005). Searching for the neurobiology of the misinformation effect, Learning and
Memory 12:1-2.
Chapter F3: The Neuroscience of Pleasure, Reward and Addiction
What is Addiction? (Question 1)
This question can readily be adapted to suit a class activity where some students portray
the point of view of the rat while others trace their thoughts and feelings in human terms. For
example, does drug addiction surrender the right of personal freedom of thought and
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behaviour? Does providing the state with powers to order addiction rehabilitation violate or
defend the right of freedom of choice?
Dopamine: The Courier of Addiction (Question 2)
There has been a long-standing debate between the medical and the moral models of
addiction. The moral interpretation deems addiction as a voluntary behaviour, whereby an
individual chooses at free will to engage in using an abusive drug without assuming
responsibility for his or her actions. The medical interpretation differs from the moral one and
states that an individual forms an addiction based on brain processes. As described in the text,
recent research has provided increased understanding of the biological-behavioural features of
addiction. These differing interpretations have fuelled fiery controversy; not least because the
medical model describes drug abuse as a form of brain disease resulting from chronic
behavioural abuse by the individual. In the final analysis, however, it’s probably wise to
assume that the truth lies somewhere in between the two models of addiction.
Dopamine: The Courier of Addiction (Question 3)
One of the reasons neuroscientists study drugs is to better understand how synapses and
neurons function within the brain in order to more fully understand the ways the brain operates,
channels thinking and modulates behaviour. Some neuroscientists are particularly interested in
how and why people become addicted to drugs of abuse because understanding this will allow
physicians to better treat addiction and prevent/ameliorate the traumatic cravings in those who
have become addicted. Moreover compassionate understanding of physiological systems has
the added quality of accelerating community pressure for reform in areas of social injustice
which underlie and perpetuate drug consumption risking addiction (see notes for question 6).
Research effort is also directed at developing drugs that inhibit the drive to consume the
drug of abuse by blocking key receptor sites in the dopamine reward circuit. Research efforts
are also directed at developing better medications for the treatment of disorders such as anxiety,
depression or schizophrenia, or for the treatment of degenerative diseases such as multiple
sclerosis, Parkinson's disease or Alzheimer's disease. Finally, another related area of research is
directed at the development of drugs that enhance normal brain functions such as cognition and
memory (see notes for question 7 and Chapter F2, section 4).
Dopamine: The Courier of Addiction (Question 4)
The primary difference between 'good drugs' and 'bad drugs' relates to the amount taken
and the motivation for taking it. If we think for a moment we will soon realize that many drugs
that we consider dangerous; including cocaine, morphine and amphetamines, have useful
medical applications. The reason that drugs of abuse are labeled as 'bad' is because the
individual who consumes them in excess may become addicted to the point where the
motivation to consume said drug overwhelms almost, if not all, aspects of their life. In extreme
cases, life’s normal pleasures and motivations such as eating, socializing, thinking and working
are completely inhibited. There is also the risk that addicted individuals, especially those who
have become sensitized to their drug (i.e., require higher doses to receive a previously
satisfying 'high') may misjudge a 'safe' dose level risking hospitalization or death. In the
absence of quality controls, keeping track of ‘safe’ dose levels of black market substances,
especially of narcotics such as heroin, is made extremely complicated and wide fluctuations in
purity and strength become the norm rather than the exception.
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Alternatively, a drug is considered 'good' if it helps to restore a malfunctioning
physiological system to its original, or adequate, level of performance. ‘Good’ drug
consumption must be controlled in order to minimize the risk of addiction and this is where
informed consent by the patient is crucially important.
The Biology of Drug Addiction (Question 5)
Our brain has evolved a mechanism whereby it encourages us to repeat behaviours that
are conducive to our own survival, as well the survival of the species as a whole. The
mesolimbic dopamine system is critically involved in mediating incentive-motivation laden
behaviours such as eating, drinking or sexual activity. Each of these activities lead to the
activation of dopamine cells in the ventral tegmental area which release dopamine in the
nucleus accumbens. This neuronal signal is referred to as a reward signal and serves to
reinforce these behaviours, motivating an animal to repeat them in the future. In this way, we
(and other animals) will naturally repeat behaviours that are conducive to our own survival
(eating and drinking) and the propagation of the species (reproduction). Animals with these
survival enhancing mechanisms are in turn, more likely to pass on their genes to future
generations, and in turn propagate the species. Unfortunately these basic mechanisms which, in
the natural setting, are beneficial to survival are ‘hijacked’ by chemical mechanisms upon
exposure to drugs of abuse such that the maladaptive drug consumption is reinforced as a
behaviour.
Lifestyle, Stress and Addiction (Question 6)
Modern functional imaging technology has generated a dramatic increase in our
understanding of the neural mechanisms underlying cognition, behaviour and moods. Mood is
the consistent extension of emotion in time, while emotion is typically transient and responsive
to the thoughts, activities, and social situations of the day. It is our mood – the state of our
emotional balance – that powerfully influences the way we perceive the world and interact
within our environment.
Emotion corresponds to an ancient signalling system that evolved millions of years ago
in all mammalian species living in social groups. From the very first the newborn makes use of
emotional signals of joy, sadness, anger and disgust in order to stimulate the parents to protect
its basic needs. The free expression of these primary emotions, and their recognition, interact
to shape the quality of the bonds that develop between family members and is fundamental to
the brain’s further development. Later, as the infant’s brain develops, personalized
configurations of brain connections expand to construct the mind – the individual’s unique
personality. Pure emotion becomes tempered with individual memories, experiences and
cultural/private meanings. Significantly, attachment and emotional expression between parent
and offspring go hand in hand with the development of the emotional self. The development of
the secondary emotions; such as shame, pride, guilt, rely upon the ability to make intelligent
judgments against an acquired set of ethical standards. As mature adults the secondary
emotions dominate our social behaviour, the stability of our relationships and our personal
ethical consciousness.
Insufficient emotional stimulation and/or an excessive amount of negative simulation in
the early stages of life is likely to result in a higher risk of mental health troubles down the
track. On the positive side, however, the brain remains functionally plastic throughout the
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prenatal-neonatal periods and infancy, allowing it to adjust neuro-physiologically and
psychologically and, increasingly, to adapt to the prevailing environment. For example, the
outcome of children raised in dysfunctional families is not completely negative. Recent studies
have indicated that such children are much more resilient than supposed. Importantly, for the
child suffering extreme deprivation the chances for recovery in an improved environment are
far better than previously predicted.
Nevertheless, in circumstances of heightened, prolonged stress and weakened means of
defense, the sufferer may seek the escape that mind-altering, psychoactive substances can
provide. Simply expressed, those who become dependent on alcohol or drugs may be using
these substances as a medication to calm feelings of anxiety, anger or depression. It is
important to note, however, that the self-medication theory of stress alleviation may not follow
a direct relationship in every case. That is, the harmful effects from recreational drugs are
invisible and cumulative and those participating in casual drug consumption for recreational
purposes may risk compensatory deregulation of key neurochemical pathways that in turn can
result in states of anxiety or depression in formerly healthy individuals with no other inherent
risk factors. For example, there is increasing evidence that regular cannabis (marijuana) use
and depression are associated. There are varying reasons why cannabis use and depression
might be associated – cannabis use may precipitate depression or depressed individuals may
seek cannabis to improve their mood. From the perspective of the individual addict, however,
this may not be very helpful as it calls to mind the fruitless chicken-and-egg argument.
We may wonder then why the majority of young people are able to experiment with
drugs and alcohol without becoming addicted; while others become dependent almost from the
start. It should be kept in mind that poverty itself delivers emotional blows to children: poorer
children at age 5 are already more fearful, anxious and sad than their better-off peers. The
stress of poverty corrodes family life resulting in fewer expressions of parental warmth, more
depression in mothers (who are often single and jobless) and a greater reliance on harsh
punishments, perpetuating social inequalities in health and wellbeing. Scientist can only draw
attention to the biological needs that have to be satisfied and possible pathological
consequences if they are not – society has to take responsibility. A commitment to the right of
humans to express their full genetic potential free from preventable harm is fundamental to the
mature society and this is where bioscience-bioethics can assist.
Lifestyle, Stress and Addiction (Question 7)
As described in section F2.4, another emerging ethical issue in neuroscience concerns
the use of drugs that enhance normal function including mood enhancement and focus
enhancement. Drugs used to treat conditions such as depression and attention deficit
hyperactive disorder (ADHD), for example, are readily available as more people with less
severe symptoms are being prescribed these medications. One reason for this is that doctors are
not trained neuroscientists or psychologists and misdiagnosis cannot be ruled out. If healthy
people are prescribed anti-depressants there is a reduction of negative emotions and they
become less fearful, hostile and do better in social situations. Equally, if healthy people take
Ritalin, a drug used to treat ADHD, this improves their vigilance, problem solving and
planning abilities. So what is the problem with healthy people receiving beneficial effects from
these drugs?
Possible discussion points may incorporate the following:
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● Parents who may press pediatricians for Ritalin in order to give their
child an extra edge at school.
● School and university students using Ritalin (bought of individuals
prescribed the medication) during their exam period.
● Can illegally bought drugs be taken unsafely risking the potential for
overdosing?
● Is it right to risk addiction or other changes in neuronal functioning?
● Is it right to be cheerful and focused only because of drugs? Could the
long-term health and social effects be serious?
● If mood enhancement were to become accepted and widespread, would
it be evenly distributed? Would people from low socio-economic
backgrounds, or those who didn’t use enhancement drugs, be
disadvantaged?
● May parents be indirectly coerced to put their children on Ritalin
because they cannot perform as well as the drug-enhanced children?
● If widespread enhancement raises the standard of normalcy, are we
overriding important biological imperatives?
Drugs can also be used to treat people who have committed a serious sex-offense or
violent crime. At the moment treatment and rehabilitation through the use of drugs, which alter
body chemistry and nervous system function, is voluntary. But what if the court requires
offenders to undergo compulsory treatment rather than relying on the more traditional
methods; such as anger management classes? Is compulsory treatment a human rights issue?
Note that traditional treatment keeps intact a person’s natural thought processes, while drug
treatment causes changed cognitive patterns.
Other important issues may include the technology itself. How safe are the technologies? Who
should decide whether they are safe or not? When promising new treatments are discovered,
who should receive them? Is a rich person more deserving than a poor one or a young person
more deserving than an old one?
References
Anderson, K., Anderson, L. and Glanze, W. Editors (1998). Mosby’s Medical, Nursing & Allied
Health Dictionary 5th Ed. St. Louis, Missouri: Mosby.
Bioscience-Bioethics Friendship Co-operative at www.bioscience-bioethics.org
Castle, D. and Murray, R (2004). Marijuana and Madness: Psychiatry and Neurobiology.
Cambridge UK: Cambridge University Press.
Kalat, J.W. (2001). Biological Psychology 7th Ed. Wadsworth Thomson Learning, USA.
Pollard, Irina (2005). Bioscience-Bioethics and Life Factors Affecting Reproduction with
Special Reference to the Indigenous Australian Population: Review. Reproduction
129:391-402.
Pollard, Irina (2004). Meditation and Brain Function: A Review. Eubios Journal of Asian and
International Bioethics 14:28-33.
Pollard, Irina (2003). From Happiness to Depression. Today’s Life Science 15:22-26.
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Section G. Social Ethics
Chapter G1: Revisiting the Body
Background
The topic of obesity, dieting and body shape is very relevant for teenagers, and this chapter
makes students think about assumptions that they make. It challenges the media preoccupation
with body shape.
References
1. Chris Shilling, The Body and Social Theory, Sage Publications, London/Newbury Park/New
Delhi, 2003.
2. Charles Taylor, The Ethics of Authenticity, Harvard University Press, Cambridge,
Massachussetts, 1991.
3. Thomas Mautner ed., The Penguin Dictionary of Philosophy, Penguin Books Ltd., England,
2000.
4. Erik Parens, “Authenticity and Ambivalence: Toward Understanding the Enhancement
Debate,” Hastings Center Report 35, no.3, 2005, pp. 34-41.
5. Richard Titmuss, The Gift Relationship: From Altruism to Commerce, Pantheon, New York,
1971.
6. US House of Representatives, HCON 124 1H, 109th congress, 6 April 2005.
7. Donna Dickenson, “Commodification of Human Tissue: Implications for Feminist and
Development Ethics” Developing World Bioethics, 2 (1), 2002, pp. 55-63.
8. Moore vs. The Regents of the University of California, 51 Cal.3d 120, 1990.
9. The President’s Council on Bioethics, Staff Background Paper - Organ Transplantation:
Ethical Dilemmas and Policy Choices, Washington D.C., January 2003.
10. Leonardo de Castro, “Commodification and Exploitation: Arguments in Favour of
Compensated Organ Donation” Journal of Medical Ethics, 29, 2003, pp. 142-46.
11. D. Dickenson, Commodification, pp.55-63.
12. Carol Gilligan cited in “Whose Body Is This? Feminism, Medicine, and the
Conceptualization of Eating Disorders” pp.45-70, Susan Bordo, Unbearable Weight:
Feminism, Western Culture, and the Body, 10th Anniversary edition, University of
California Press, Berkeley and Los Angeles, 2003.
13. S. Bordo, Unbearable Weight, p. 67.
14. Ibid, p.68.
15. Elizabeth Frazer, Jennifer Hornsby, and Sabina Lovibond, eds., Ethics: A Feminist Reader,
Blackwell Publications, England, 1992.
16. Susan Bordo, “Are Mothers Persons: Reproductive Rights and the Politics of Subjectivity”, pp.71-98, Unbearable Weight : Feminism, Western Culture, and the Body, 10th
anniversary edition, University of California
Press, Berkeley and Los Angeles, 2003.
17. Ibid, p. 76.
18. Ibid, p. 77.
19. Ibid, p. 95.
20. Arthur Greil, “ Infertile Bodies: Medicalization, Metaphor, and Agency” in Marcia C.
Inhorn and Frank Van Balen eds., Infertility Around the Globe: New Thinking on
Childlessness, Gender, and Reproductive Technologies, University of California Press,
Berkeley and Los Angeles, 2002, pp.101-118.
21. Ibid, p.106.
22. Ibid, p.110.
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23. American Society of Plastic Surgeons website
24.
25. Erik Parens, “Is Better Always Good? The Enhancement Project,” in Erik Parens ed,
Enhancing Human Traits: Ethical and Social Implications, Georgetown University
Press, Washington D.C., 1998, pp. 1-28.
26. “Dermatologists Bend Ethical Standards to Sell their wares”, Boston Globe, 23 August
2005.
27. Norman Daniels “The Genome Project, Individual Differences, and Just Health Care,” in
Justice and the Human Genome Project, ed. Timoty F. Murphy and Marc A. Lappe,
University of California Press, Berkeley, 1994 pp.110-32, at 122, cited in E. Parens Is
Better Always Good? p.3.
28. James E. Sabin and Norman Daniels, “Determining ‘Medical Necessity’ in Mental Health
Practice,” Hastings Center Report 24, no.6 (1994): 5-13, at 5 cited in E. Parens, Is
Better Always Good? p.3.
29. Eric T. Juengst, “What Does Enhancement Mean?” in Erik Parens ed, Enhancing Human
Traits: Ethical and Social Implications, Georgetown University Press, Washington D.C.,
1998, pp. 29-49.
Chapter G3: Peace and Peacekeeping
Background
Peace is one of the objectives of ethical dialogue and this chapter introduces topics which may
be interesting for class debates of senior high school students.
Further reading
Adams, James (1998) The Next World War. Arrow Books, London, and Random House, Sydney. 438pp.
Air Force Science and Technology Board (2002) Implications of Emerging Micro and Nanotechnology.
National Academies Press.
Ananthaswamy, Anil (2003) March of the Motes. New Scientist 23 August 2003: 26-31
Barker, Jonathan (no date) The No-Nonsense Guide to Terrorism. New Internationalist Publications,
Oxford, and Verso, London. 144pp.
Barnaby, Frank ed.(1988) The Gaia Peace Atlas: Survival Into the Third Millennium. Gaia Books, Pan,
London 271pp.
Baylis, John and Smith, Steve (2001) The Globalization of World Politics: An Introduction to
International Relations. Oxford University Press, Oxford. 690pp.
Board of Army Science and Technology (2001) Opportunities in Biotechnology for Future Army
Applications. National Academies Press.
Boutwell, Jeffrey and Klare, Michael (2000) A Scourge of Small Arms. Scientific American June 2000:
30-35
Bremer, Stuart and Cusack, Thomas, eds. (1995) The Process of War: Advancing the Scientific Study of
War. Gordon & Breach Scientific Publishers, Amsterdam.
Brogan, Patrick (1998) World Conflicts. Bloomsbury, London. 682pp. first edition 1989.
Burton, John W. (1996) Conflict Resolution: Its Language and Processes. The Scarecrow Press,
London. 87pp.
Carroll, John (2002) Terror: A Meditation on the Meaning of September 11. Scribe Publications, Carlton
North, Victoria. 105pp.
Chomsky, Noam (1989) Necessary Illusions: Thought Control in Democratic Societies. Pluto Press,
London. 422pp.
Chomsky, Noam (2001) September 11. Seven Stories Press & Allen & Unwin. 137pp.
Chomsky, Noam (2003) Hegemony or Survival: America’s Quest for Global Dominance. Allen &
Unwin, Crows Nest, NSW. 279pp.
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Chua, Amy (2003) World on Fire: How Exporting Free-market Democracy Breeds Ethnic Hatred and
Global Instability. Random House, Sydney, and William Heinemann, London.
Clements, Kevin and Ward, Robin, eds. (1994) Building International Community: Cooperating for
Peace Studies. Peace Research Centre, Canberra and Allen & Unwin, St Leonards NSW. 354pp.
Drexler, K. Eric (1986) Engines of Creation: The Coming Era of Nanotechnology. Anchor Books,
Doubleday, NY/London/Toronto/Sydney/Auckland. 299pp.
Dyson, Freeman J. (1984) Weapons and Hope. Harper Colophon, New York. 341pp.
Evans, Gareth (1993) Cooperating for Peace. Allen & Unwin, St. Leonards, NSW. 224pp
Feynman, Richard P. (1960) There’s Plenty of Room at the Bottom. Engineering and Science Vol. 23
No.5
Gaubatz, Kurt Taylor (1991) Election Cycles and War. Journal of Conflict Resolution 35: 212-224
Geller, D.S. and Singer, J.D. (1998) Nations at War: A Scientific Study of International Conflict.
Cambridge University Press, Cambridge. 242pp.
Genest, Marc A. ed. (1996) Conflict and Cooperation: Evolving Theories of International Relations.
Harcourt Brace College Publ., Fort Worth. 583pp.
Gladwell, Malcolm (2000) The Tipping Point: How Little Things can make a Big Difference. Abacus,
London. 279pp.
Goleman, Daniel (1996) Emotional Intelligence: Why it can matter more than I.Q. Bloomsbury Publ.,
London. 352pp.
Grayling, A.C. (2003) What is Good? The Search for the Best Way to Live. Phoenix, Orion Books,
London. 274pp.
Guevara, Ernesto ‘Che’, anthology edited by Deutschmann, David (1997) Che Guevara Reader:
Writings on Guerilla Strategy, Politics and Revolution. Ocean Press, Melbourne & New York.
400pp.
Hall, Lavinia ed. (1993) Negotiation: Strategies for Mutual Gain. The Basic Seminar of the Program on
Negotiation at Harvard Law School. Sage Publications, Newbury Park, London & New Delhi.
212pp.
Haller, Stephen (2002) Apocalypse Soon? Wagering on Warnings of Global Catastrophe. McGill
Queens University Press, Montreal.185pp.
Hartung, William O. (2003) How Much are you Making from the War, Daddy? Bantam Books, Sydney,
and Nation Books, Avalon Publishing Group, New York
Hunt, Scott (2002) The Future of Peace – On the Front Lines with the World’s Great Peacemakers.
HarperCollins, San Francisco, 372pp.
Huntington, Samuel (1996) The Clash of Civilisations and the Remaking of World Order. Touchstone
Books, Simon & Schuster, London & New York. 368pp.
Joy, Bill (2000) Why the Future Doesn’t Need Us. Wired 8.04: 238-263 and see online:
www.wired.com/wired/archive/8.04/joy.html
Kelly, Kevin (1994) Out of Control: The New Biology of Machines. Fourth Estate, London and Addison
Wesley, USA. 666ppp
Kirk, Andrew (2004) Words that Changed the World: Civil Disobedience. Ivy Press, East Sussex. 128pp.
Kuhn, Thomas (1970) The Structure of Scientific Revolutions. Second edition. University of
Chicago Press, Chicago. (First edition published 1962).
Leaman, Oliver, ed. (2000) Eastern Philosophy: Key Readings. Routledge Key Guides, London & New
York, 305pp.
Macer, Darryl (1998) Bioethics is Love of Life: An Alternative Textbook. Eubios Ethics Institute,
Christchurch and Tsukuba. 160pp.
Milburn, Gerard (1996) Quantum Technology. Frontiers of Science Series, Allen & Unwin, St Leonards,
NSW. 188pp.
Morris, Julian ed. (2000) Rethinking Risk and The Precautionary Principle. Butterworth Heinemann,
Oxford. 294pp.
Murty, Danuse (2003) Buddhist Studies for Secondary Students. Buddhist Council of NSW, Sydney, and
Buddha Educational Foundation, Taipei. 119pp.
National Academy of Sciences (2004) Emerging Technologies and Ethical Issues in Engineering:
Papers from a Workshop, October 14-15, 2003. National Academies Press.
National Academy of Sciences (2004) Biotechnology Research in an Age of Terrorism: Confronting the
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‘Dual Use’ Dilemma. National Academies Press.
National Academy of Engineering (2004) The Engineer of 2020: Visions of Engineering in the New
Century. National Academies Press.
National Academy of Engineering (2005) Tenth Annual Symposium on Frontiers of Engineering. Rob
Phillips, ed., National Academies Press.
National Research Council (1996) Linking Science and Technology to Society’s Environmental Goals:
National Forum on Science and Technology Goals. National Research Council Policy Division,
Washington DC. 520pp.
Naval Studies Board (2003) An Assessment of Non-Lethal Weapons Science and Technology. National
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Chapter G4: Human Rights and Responsibilities
Background
Human rights are already included in many curricula. This chapter introduces some issues
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Teaching Resources and Notes: A Cross-Cultural Introduction to Bioethics
which may be interesting for class debates of high school students.
Further reading
Gorlin, Rena A., ed. (1999) Codes of Professional Responsibility: Ethics Standards in Business, Health
and Law. Fourth Edition. Bureau of National Affairs, Washington DC. 1149pp.
Grayling, A.C. (2003) What is Good? The Search for the Best Way to Live. Phoenix, Orion Books,
London. 274pp.
Laszlo, Ervin, ed. (1997) Third Millennium: The Challenge and the Vision. The Club of
Budapest Report on Creative Paths of Human Evolution. Gaia Books Ltd,
London.156pp.
Levin, Leah (1998) Human Rights: Questions and Answers. ‘Human Rights in Perspective’
Series, UNESCO, Paris.
Macer, Darryl (1994) Bioethics for the People by the People. Eubios Ethics Institute, Christchurch and
Tsukuba. 458pp.
Macer, Darryl (1998) Bioethics is Love of Life: An Alternative Textbook. Eubios Ethics Institute,
Christchurch and Tsukuba. 160pp.
Makinson, David and Symonides, Janusz, eds. (1998) Human Rights: 50th Anniversary of the
Universal Declaration. International Social Science Journal December 1998. p.465-590
Martin, Hans-Peter and Schumann, Harald (1997) The Global Trap: Globalization and the
Assault on Democracy and Prosperity. Pluto Press, Annandale, NSW. 269pp.
(originally published 1996 in German).
Monbiot, George (2003) The Age of Consent: A Manifesto for a New World Order. Flamingo,
and Harper Perennial, London. 274pp
Muntarbhorn, Vitit (2002) Dimensions of Human Rights in the Asia Pacific Region. Office of
the National Human Rights Commission of Thailand, Bangkok. 327pp.
Rawls, John (1971) A Theory of Justice. Harvard University Press, Cambridge, Mass.
Robertson, Geoffrey (1999) Crimes Against Humanity: The Struggle for Global Justice. Penguin Books
(2000), Ringwood, VIC. 554pp.
Sachs, Jeffrey, with foreword by Bono (2005) The End of Poverty: How We Can Make it
Happen in Our Lifetime. Penguin Books, London. 397pp.
Singer, Peter (2002) One World: The Ethics of Globalisation. Yale University Press, US, &
Text Publishing Company, Melbourne. 255pp.
Symonides, Janusz and Volodin, Vladimir, eds. (1999) UNESCO and Human Rights: StandardSetting Instruments, Major Meetings, Publications. Second Edition. UNESCO, Paris.
537pp.
Theis, Joachim (2004) Promoting Rights-Based Approaches: Experiences and Ideas from Asia
and the Pacific. Save the Children, Sweden. 147pp.
United Nations Educational, Scientific and Cultural Organisation (1998) World Directory of
Human Rights Research and Training Institutions. Fourth Edition. UNESCO, Paris.
285pp.
United Nations Educational, Scientific and Cultural Organisation (1999) Birth of the Universal
Declaration on the Human Genome and Human Rights. Division of the Ethics of
Science and Technology of UNESCO. 166pp.
United Nations Educational, Scientific and Cultural Organisation (2003) Human Rights in the
Constitutions of UNESCO’s Member States in the Asia and Pacific Region. UNESCO
Regional Unit for Social and Human Sciences in Asia and the Pacific, Bangkok. 420pp.
United Nations High Commissioner for Refugees (2000) The Status of the World’s Refugees:
Fifty years of Humanitarian Action. UNHCR and Oxford University Press, Oxford.
United Nations (1948) Universal Declaration of Human Rights.
United Nations (1993) World Conference on Human Rights: The Vienna Declaration and
Programme of Action, June 1993. United Nations, New York.
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United Nations High Commissioner for Human Rights, and Centre for Human Rights (1997)
Human Rights and Law Enforcement: A Manual on Human Rights Training for the
Police. Professional Training Series No. 5. United Nations, Geneva. 211pp.
Unger, Peter (1996) Living High and Letting Die. Oxford University Press, Oxford & New
York
Venturelli, Shalini, ed. (1998) Human Rights (special double issue) Journal of International
Communication Vol. 5: No’s 1 & 2.
Weiss, Thomas G., Forsythe, David P. and Coate, Roger A. (2001) The United Nations and
Changing World Politics. Third Edition. Westview Press, Perseus Books Group,
Boulder (US) and Oxford (UK). 362pp.
Darryl Macer, ed., Teaching Resources and Notes for A Cross-Cultural Introduction to Bioethics © Eubios Ethics Institute
2006 < http://www.unescobkk.org/index.php?id=2508>