How To Find Out What People Think About Bioethics In Japanese University

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1 SIGNIFICANCE OF BIOETHICS IN SCIENCE EDUCATION: OPINIONS OF JAPANESE UNIVERSITY STUDENTS ABOUT ISSUES OF BIOETHICS Junko Iwama 1, ShizuoMatsubara 2, Taro Hatogai 3 and Kunio Umeno 4 1 Kawasaki City College of Nursing, Japan 2 Toin University of Yokohama, Japan 3 Tokyo Metropolitan University, Japan 4 Japan University of Economics, Japan Abstract: In this study, we investigate Japanese university students opinions about the issues of bioethics by questionnaire, and consider significance of bioethics in science education. We investigated their opinions about genetic diagnosis, amniotic fluid examination, organ transplantation and brain death and preimplantation genetic diagnosis, as examples of bioethical issues which are important component of biology education, from February to December in The results of the study are as follows: Firstly, on genetic diagnosis, 76% of the students want to have genetic diagnosis. Secondly, on amniotic fluid examination, 71% of the students want to have this examination. Thirdly on organ transplantation and brain death, 79% of the students approved conditional promotion, or promotion. So the majority of students had positive opinion toward genetic diagnosis, amniotic fluid examination and organ transplantation. Finally, on preimplantation genetic diagnosis in order to treat the first child who is suffering from Fanconi anemia, 35% of the students approved conditional restriction, that is, We should not request the second young child who has no will to become the means of the treatment.. The number of students answering restriction or negation was 30%. Thus the majority of students (65%) had negative opinion. Japanese students who study about the issues of bioethics were only 15% in upper secondary school. Bioethics relates closely to the body and life of living things, so we would propose that issues of bioethics should be taught in lower and upper secondary school science. Key words: bioethics, genetic diagnosis, organ transplantation and brain death, preciousness of life, science education INTRODUCTION Bioethics relates to every aspect of life in nature and social environments. In recent years, the necessity of guidance about the preciousness of life has been proposed by many researchers for science education. However, our previous research has revealed that in Japan, implementation rate of bioethics education in lower secondary school was about 20%, and in elementary schools and upper secondary school, it was only about 10%. And Japanese students usually study about the issues of bioethics at classes such as Integrated studies, Contemporary society and Ethics and Science in upper secondary school (Iwama et al., 2012a).

2 In this study, we investigated Japanese university students opinions about the issues of bioethics by questionnaire. We investigated their opinions about genetic diagnosis, amniotic fluid examination, organ transplantation and brain death and preimplantation genetic diagnosis by questionnaire, as examples of bioethical issues which are important component of biology education. METHODS We investigated Japanese university students opinions by questionnaire (Table.1). The questionnaire is based on Umeno et al. (2012) and Iwama et al. (2012b). (1) Objects: Japanese university students Univ. A: Faculty of Culture and Sport Policy, Univ. B: Department of Nursing, Univ. C: Training of school teachers, Univ. D: Faculty of Economics. (2) Numbers of respondents Univ. A: 151 (111 males, 40 females), Univ. B: 63 (2 males, 61 females), Univ. C: 51 (34males, 17females), Univ. D: 151 (128males, 23females). Total: University A+B+C+D = 416 (275 males, 141 females). University A+B+C = 265 (147 males, 118 females) (3) Date: February to December 2012 (4) Themes of the investigation Theme 1: Learning experience about the issues of bioethics in the school education Theme 2: Comparison with past data about opinions on organ transplantation and brain death Theme 3: University students opinions on genetic diagnosis and amniotic fluid examination Theme 4: University students opinions on organ transplantation and brain death and preimplantation genetic diagnosis Theme 5: University students opinions about the issues of bioethics in general Table 1 Questions in the questionnaire about the issues of bioethics. Questions Q1) Have you ever learned about the issue of bioethics in the school education? Q2) Organ transplantation and brain death Organ transplantation and brain death are so disputed in Japan. How do you think about organ transplantation and brain death? Please choose one answer among these five alternatives. 1. I accept neither brain death nor organ transplantation. (Negation) 2. I do not accept the brain death. I accept only the transplant of such as kidneys irrelevant to the death of another person. (Restriction) 3. I do not accept brain death. I accept only transplant of such as kidneys irrelevant to the death of another person. I hope that artificial organ will be developed. (Conditional restriction) 4. I accept both organ transplantation and brain death. I hope that artificial organ will be developed. (Conditional promotion) 5. I accept brain death and the promotion of organ transplantation. (Promotion) Q3) Genetic diagnosis

3 Genetic diagnosis can inform us not only of our present physical condition but also the possibility of coming down with disease in the future. Would you want to have a genetic diagnosis, if this examination were available for any applicant? Please choose one answer among these four alternatives. 1. I strongly hope so. 2. I hope so. 3. I do not hope so. 4. I strongly do not hope so. Q4) Amniotic fluid examination We can easily check whether your fetus has any congenital disease such as Down s syndrome or not by the amniotic fluid examination. Would you want to have an amniotic fluid examination for yourself (or your spouse), when you (or your spouse) were pregnant? Please choose one answer among these four alternatives. 1. I strongly hope so. 2. I hope so. 3. I do not hope so. 4. I strongly do not hope so. Q5) Preimplantation genetic diagnosis In France, by a revision of laws on bioethics in 2004, the indication of the preimplantation diagnosis was extended. This means that, in order to treat the first child who is suffering from Fanconi anemia, giving birth to a second child who is HLA compatible with the first, with the aid of that diagnosis, is now permitted by law (Binet 2005). The donation of parts of the body for this treatment must be based on voluntary self-sacrifice in conformity with the principle of autonomy (Koide, 2009). What do you think about that the request to the second child become the means of treating the first child? Please choose one answer among these five alternatives. 1. I am against the delivery of the fitting second child of the HLA type using the preimplantation genetic diagnosis. (Negation) 2. We should not request the second child to become the means of the treatment. (Restriction) 3. We should not request the second young child who has no will to become the means of the treatment. (Conditional restriction) 4. The some sacrifice (collection of marrow and the blood) of the second child is unavoidable to save the life of the first child. (Conditional promotion) 5. The sacrifice (including the extraction of one kidney) of the second child is unavoidable to save the life of the first child. (Promotion) Q6) Please describe your opinion on the issues of bioethics. RESULTS Learning experience about the issues of bioethics in the school education Figure1 shows Learning experience about the issues of bioethics in the upper secondary school, as responses of the question Have you ever learned about the issue of bioethics in the school education? Only two students learned about the issues of bioethics at the lower secondary schools. At the upper secondary schools, the percentage was 15% (39 of 265). They had learned as subject at the upper secondary schools, Science was 17 students, Contemporary society and Ethics and Integrated studies were 8, and Health and physical education was 6. And the content that they had learned, Organ transplantation and brain death was 15 students, Life and Birth was 12, DNA, ips cell and Clone was 7 and Death with dignity and Terminal care is 2.

4 Science Contemporary society, Ethics, Integrated studies 226 Health and Physical Education Figure 1. Learning experience about the issues of bioethics in the upper secondary school (Subjects). Remarks: 265 students (male: 147, female: 118). Number: Number of respondents Organ transplantation and brain death Life, Birth DNA, ips cell, Clone Death with dignity, Terminal care Figure 2. Learning experience about the issues of bioethics in the upper secondary school (Contents). Remarks: Experienced students (39 of 265 students, 43 cases). Number: Number of respondents. Comparison with past data about opinions on organ transplantation and brain death Figure3 shows university students opinions on organ transplantation and brain death together with the data of previous studies of other researchers for upper secondary school students. Two graphs from the bottom on Figure3 are university students opinions. University students: Students who chose conditional promotion were 54% in 2011, and 58% in And promotion was 17% in 2011, and 18% in So the great majority accepted the promotion of organ transplantation. There is no significant difference between 2011 and 2012, according to a statistical test (Chi-square test). Upper secondary school students 3) : The number of promotion was 41% and conditional promo-

5 tion was 35% in 2006 (Saruta et al. 2007). There is a significant difference between 2006 and 2012, according to a statistical test S S S U U % 20% 40% 60% 80% 100% S:Upper secondary school students (11th grade) U:University students Number:Percentage Negation Restriction Conditional restriction Conditional promotion promotion Figure 3. Students opinions on organ transplantation and brain death. Remarks: 1995:2142 students, 2002:1967 students, 2006:1699 students (Saruta et al. 2007), 2011:226 Univ. students (Iwama et al. 2012a), 2012:416 Univ. students. Opinions on genetic diagnosis and amniotic fluid examination Figure4 shows university students opinions on genetic diagnosis and amniotic fluid examination. Firstly, on genetic diagnosis, the students who chose I hope so were 40% of the students (107 of 265), and I strongly hope so were 36% (95). I do not hope so was 17% (45) and I strongly do not hope so was 7% (18). So the majority of students had positive opinion toward genetic diagnosis. The examples of positive opinions are as follows: if we can know about disease, we can try to take preventive measures, and we are prepared for it, if we can know about disease. And the examples of negative opinions are as follow; A gene is the most personal information, and one can be discriminated against by the results of diagnostic genetic testing. Secondly, on amniotic fluid examination 38% of the students (101 of 265) chose I strongly hope so, and I hope so was 33% (87). I do not hope so was 19% (51) and I strongly do not hope so was 9% (24). So the majority of students had positive opinion toward amniotic fluid examination. The examples of positive opinions on amniotic fluid examination are as follows; I feel that we

6 cannot make our minds to face a child with a serious hereditary disease, without foreknowledge, and I do not want to make a child feel painful. And the examples of negative opinions are as follows; I think that we should bring up any given child tenderly, It seems that it can lead to screening of an embryo, and I admire diagnosis and medical treatment at a gene level, but I doubt whether we should intervene in such a level. There is a significant correlation between genetic diagnosis and amniotic fluid examination, according to a statistical test. Genetic Diagnosis Amniotic Fluid Examination % 20% 40% 60% 80% 100% I strongly don't hope so I hope so Number:Number of respondents I don't hope so I strongly hope so Figure 4. University students opinions on genetic diagnosis and amniotic fluid examination. Remark: 265 students (male: 147, female: 118) Opinions on organ transplantation and brain death and preimplantation genetic diagnosis Figure5 shows university students opinions on organ transplantation and brain death and preimplantation genetic diagnosis. Firstly, on organ transplantation and brain death, 60% of the students (158 of 265) approved conditional promotion, and promotion was 19% (51). So the majority of students (79%) had positive opinion toward organ transplantation and brain death. Preimplantation genetic diagnosis is argued in many countries such as U.S.A., Japan, European countries and so on (Bennett, 2005; Binet, 2005; Liu, 2007; Koide, 2009). On preimplantation genetic diagnosis in order to treat the first child who is suffering from Fanconi anemia, 35% of the students (92 of 265) approved conditional restriction, and restriction or negation was 30% (57+24). Thus the majority of students (65%) had negative opinion. There is no significant correlation between organ transplantation and brain death and preimplantation genetic diagnosis, according to a statistical test. For this test, it is thought that the opinions are different from organ transplantation and brain death and preimplantation genetic diagnosis on each personal viewpoints and situations.

7 Organ Transplantation and Brain Dearh Preimplantation Genetic Diagnosis % 20% 40% 60% 80% 100% Negation Conditional restriction promotion Number:Number of respondents Restriction Conditional promotion Figure 5. University students opinions on organ transplantation and brain death and preimplantation genetic diagnosis. Remark: 265 students (male: 147, female: 118) Free descriptions about the issues of bioethics From the free descriptions by students, we had many good opinions. The examples are as follows:, 1) I imagine that the second child may feel very sad, when he or she doubts whether his or her existence should be conceived as means of saving the first child. At the same time, I can acknowledge the parents desires to save the first child. We can think freely. I feel it is a very difficult problem. 2) My younger brother has weak kidneys. He will get one kidney from our father by organ transplantation three years later. As member of the family, I sincerely hope that the operation will save him. 3) The more people know about the issues of bioethics, the more they may be more tolerant. I think that the issues of bioethics should be learned at the lower and upper secondary schools. 4) The issues of bioethics should not be given a final answer. We can think freely. Therefore we should be tolerant of different points of view. I wish that medical progress will contribute to saving precious lives. CONCLUSIONS On genetic diagnosis, 76% of the students want to have genetic diagnosis, and on amniotic fluid examination, 71% of the students want to have this examination. And on organ transplantation and brain death, 79% of the students approved conditional promotion, or promotion. So the majority of students had positive opinion toward genetic diagnosis, amniotic fluid examination and organ transplantation. However, on preimplantation genetic diagnosis in order to treat the first child who is suffering from Fanconi anemia, 35% of the students approved conditional restriction, that is, We should not request the second young child who has no will to become the means of the treatment. The number of students answering restriction or negation was 30%. Thus the majority of students (65%) had negative opinion. Japanese students who study about the issues of bioethics were only 15% in upper secondary school. Bioethics relates closely to the body and life of living things, so we would propose that issues of bio-

8 ethics should be taught in lower and upper secondary school science. The students thought that it was important to learn about bioethics. And we thought this investigation was good opportunity for the university students think about bioethics. We hope the each student has interested in issues of bioethics and think about it carefully in future. REFERENCES Bennett, B. (2005). Symbiotic relationships: saviour siblings, family rights and biomedicine, Australian Journal of Family Law. 19(3), Binet, J. (2005). Le nouveau droit de la bioethique. LexisNexis SA. 79. Iwama, J., Kobayashi, T., Matsubara, S. and Hatogai, T. (2012a). Bioethics in Science Education. Japanese Journal of Biological Education. 52 (4) (in Japanese) Iwama, J., Matsubara, S. and Umeno, K., (2012b). Opinions of Japanese University Students about Issues of Bioethics: The Cases of Organ Transplantation and Brain Death and Gene Therapy, The 24th Biennial Conference of the AABE,Program and Abstracts,60. Koide, Y. (2009). Ethical problems concerning bébé medicament : Human dignity and utilization of human body in French bioethics, Journal of Japan Association for Bioethics, 19 (1), (in Japanese) Liu, C. K. (2007). Saviour Siblings? The Distinction between PGD with HLA Tissue Typing and Preimplantation HLA Tissue Typing. Journal of Bioethical Inquiry, 4, Saruta, Y. et al. (2007). Attitude for Science, Risu-chosa-houkokusho :Heisei 18nendo Risu-tsuisekichosa-shukeikekka [Research Report of Science and Mathematics: Longitudinal Study on Science and Mathematics in 2006], Grant-in-Aid for Scientific research (C), Project number: , (in Japanese) Umeno, K., Iwama, J. and Matsubara, S. (2012). Opinions of Japanese University Students about Issues of Bioethics: The Case of Genetic diagnosis and Amniotic Fluid Examination,The 24th Biennial Conference of the AABE,Program and Abstracts,61.