Keynote Speech 1
Medical Ethics in a Multicultural Society
Prof. Yasushi KOIDE
President of the Japanese Association for Philosophical and Ethical Researches in Medicine, Shibaura Institute of Technology
Today, because of the advance of globalization, we have more and more opportunities to come into contact with cultures other than our own. It is wonderful that globalization expands our world, broadens our horizons and lets us mix with people from other cultures. But there is sometimes friction or conflict between people of different cultures, because different cultures usually have different customs, religions and values.
It is a similar case in the field of biomedicine in which we medical ethics researchers are most interested. As science and technology are common to all the world, today the development of medical technologies has enabled us to receive a higher level of medical treatment in many parts of the world. But there are some medical treatments that cannot be permitted ethically, though they are possible technologically. As in different cultures the criteria of moral judgment may be different or the order of priorities may be different, even though they are similar, the medical treatments that cannot be permitted ethically can differ from culture to culture. In such cases the regulation of some medical treatments for ethical reasons in one country may gradually be eroded or rendered meaningless.
On the one hand, UNESCO, in its Universal Declaration on Cultural Diversity (2001) and its Universal Declaration on Bioethics and Human Rights (2005), asserted that the importance of cultural diversity and pluralism should be given due regard, for cultural diversity, which has been generated by the unique background of history and the natural and cultural climate, is “the common heritage of humanity” as “a source of exchange, innovation and creativity.”In reality, many peoples with different cultures and values must live together in the world. As such, we should try to understand, permit and respect different cultures and values in order to get along with them comfortably on a crowded earth.
On the other hand, as seen in the Universal Declaration on Human Rights (1948) and the like, a modern world accepts human dignity, human rights, fundamental freedoms and so on as universal and absolute values transcending values particular to a certain region. Article 12 of the Universal Declaration on Bioethics and Human Rights stipulates that considerations about cultural diversity are not to be invoked to infringe upon human dignity, human rights and fundamental freedoms, nor upon the principles set out in this Declaration, nor are they to limit their scope.
Consequently, how we should harmonize universal values with cultural diversity is a difficult problem in modern global society. We will have to respect both, not giving priority to either, and create a generous society. Where there is no conflict, there is no growth. Conflict is a force essential to future harmony. At a higher level, we modern humans are tasked with creating a third way that incorporates both of, yet is not an alternative to, the two conflicting paths of universalism and pluralism.
Keynote Speech 2
Community Medicine and Medical Ethics in the Global Era
－In the era after the Great East Japan Earthquake－
Prof. Takashi NAGASHIMA
President of the 2014 International Conference, Toyo University
Today, our Society will hold an international conference, indicating that the world is united. In the era of today’s so-called globalization, I focus on “Community medicine”. First I confirm that the specialist topic of “Community medicine” has been part of the WHO’s international agenda since its establishment, secondly, information that has been revealed in the era after 3.11, and lastly, I show clearly how “community medicine” is linked to medical ethics.
The first issue. The second paragraph of the WHO Charter has shown that “Community medicine” has been part of the WHO’s international agenda since its establishment. In the case of Japan, the challenge of “community medicine” is based on Article 25 of the Constitution. Our community has achieved an important goal in that a system has been constructed that enables all citizens to have access to health care. Japan also achieved a national health insurance system in 1961. Today, this system has a critical problem: an increase in self-payment is being contemplated. The frame of free medical care has been expanded to include “mixed medical care”. The logic of self-responsibility has shaken the underlying foundation of this system in Japan fundamentally.
The second issue. On the 11th March 2011, the Great East Japan Earthquake occurred. This disaster revealed a serious flaw in the health system in Japan. A situation emerged in which the network of welfare and medical care was disrupted. State impossible to make contact at all was lasted. A dangerously large gap between areas also emerged. Simultaneously with this, medical staff efforts were extensively increased in such a situation and the situation arose in which Japanese and foreigners actively united to handle the aftermath of the disaster. And as with the case of the Kobe earthquake, cooperation between Japanese and foreigners emerged during this period. This indicates the maturation of the Japanese and the problem of information acquisition.
The third issue. What is the meaning of “medical ethics” at this time? As a medical ethicist, I think that contribution to the expansion of community medicine of Japan is demanded. “Medical ethics” is aiming for universal from the very special. That is, the problem is making Japan into a place of dispatch and thus presenting the problem to the world. I think that experience of Japan in the meantime can say that generalizing medical treatment to the ground which cannot receive a medical benefit globally is asking us while It made the problem of Japan itself emerge.