Public Policy and the Future of Bioethics in Asia

A s i a n B i o e t h i c s R e v i e w D e c e m b e r 2 0 0 8 i n a u g u r a l e d i t i o n 24 Public Policy and the Future of Bioethics in Asia A L A S TA I R V. C A M P B E L L Introduction In 2005 I published an article questioning the relevance of bioethics to public policy debates.1 Then, two years later, Professor Akira Akabayashi of the Centre for Medical Ethics and Law at the University of Tokyo asked me to re-visit this question in a lecture to be given during a visit to his Centre, and to consider how the ideas in that paper might apply in an Asian context. This proved to be no easy task, especially for a bioethicist who had worked all of his life in westernised countries and had been in Asia a mere thirteen months! However, I was happy to try, in the hope of correction and mutual learning. This paper is a revised version of that lecture, following helpful discussion and debate with colleagues. What is the Use of Bioethics? It hardly needs saying that Bioethics has become a global phenomenon. As Biomedicine and Biotechnology catch the interests and investments of governments all over the world, the need for ethical scrutiny, policy advice and, possibly, new regulatory and governance structures is widely recognised. Many countries now have standing bioethics advisory committees (like the Bioethics Advisory Committee in Singapore), or have set up ad hoc committees to offer guidance in a specific area. But is the discipline of bioethics up to the task? Let me suggest a number of reasons why we need to worry about this: 1. Blessing the Battleships. The phrase comes, I believe, from criticism of Church of England bishops, who (so pacifist Christians would claim) lend an air of 24–30 Asian Bioethics Review December 2008 inaugural edition 25 P u b l i c P o l i c y a n d t h e F u t u r e o f B i o e t h i c s A l a s t a i r V. C a m p b e l l sanctity — but not a whiff of criticism — to their nation’s engagement in war. Applied to bioethics and public policy, it would suggest governments use bioethics advisory committees to sanction what, on economic and political grounds, they intend to do anyway. This criticism is in part related to what I have called the “inevitablist critique” of ethical reflection and advice. This critique claims that critical reflection, of the kind offered by bioethicists or bioethics advisory committees, is a waste of time, since sooner or later, some country will implement the new technique currently criticised, and once it happens in one country, others will quickly follow suit in order not to be left behind in the race for scientific prestige and commercial profit. Inevitablists turn to history to prove their point, often using new reproductive technologies as an example. In the past, they point out, procedures like donor insemination and IVF were widely condemned by some authorities, but now they are a virtually worldwide practice. The same, so the argument goes, will happen with techniques like cloning: first there will be cloned human embryos for research and stem cell therapy, then, once the technique is proved to be safe and effective, reproductive cloning will begin, will spread and soon will be regarded as acceptable. Why then waste time and money on bioethics advice, if, in the real world, technological advancement is inevitable? 2. The Problem of Expertise. A second difficulty comes from the nature of bioethics as a discipline. One could say that its strength is also its weakness. Bioethics is in essence a multidisciplinary endeavour, in which a range of subject areas have a say — Theology, Philosophy, Law and a wide range of Social Sciences. Moreover, there is no “knock down” theory in bioethics itself. Rather, like its parent discipline, Philosophy, it has a range...