From the Viewpoint of Bioethics
Aoyama Gakuin University
My name is Sakamoto and I have been given the theme of thinking about the population problem from the viewpoint of bioethics. I launched the first Bioethics Society in Japan about 15 years ago. I visited China 5 or 6 years after that and founded the Asian Bioethics Society in Beijing. I have been studying and promoting bioethics in Japan and in Asia as a whole through the activities of these two societies. Today, I would like to introduce one of the ways for approaching the population problem that I have obtained through these activities.
I have always regarded the population problems as an extremely important subject when thinking about bioethics. Surprisingly, population problem is rarely discussed within the bioethics society. However, I personally think that this is a major issue that has bearings on the fundamental character of bioethics.
I would therefore like to begin by talking about what "bioethics" is all about. In a word, one can define bioethics as ethics that has been applied to life phenomena or life activities that various living beings, including humans, are involved on this Earth.
Being a part of ethics, bioethics must think about what is right and what is wrong by following the convention of ethics. Dr. Matsui who gave today's first talk has said that population problem is not a problem of right and wrong. I disagree slightly with this view and think that population problem can be analysed from the viewpoint of reflecting on right and wrong.
Then an issue arises as to what bioethics should do in connection with the right and wrong of life activities. There is one ethics-related superstition in connection to this; it says that ethics generally has some big and absolute ethical value to which one can appeal and deduce in a top-down manner all kinds of ethical phenomena, i.e. what's right and wrong. In fact, there is a history of having considered ethics in such manner.
For example, Kant, who is regarded as the greatest authority on ethics, has formulated a theory in his book entitled "Critique of Practical Reason" in which he presented a major fundamental and abstract ethical principle and tried to derive all concrete ethical criteria from that principle. Frankly speaking. however, I think that one of the conclusions regarding the phenomena of ethics is that this kind of approach has lost its validity through the transition from modern era to present-day.
In short, you see a diversification of values; there are people with varying range of values in this world which make it nearly impossible, if not extremely impractical, to deduce ethical criteria that can be applied to all societies from one big absolute value. The greatest cause is the trend of diversifying values in the present. This, of course, includes discovery and entry of Asian values which are quite different from their Western counterparts. I think it is not possible to come up with an exclusive and absolute system of ethical values that encompass the entire world after including such new values.
However, an approach that brings forward several principles and attempts to interpret all ethical phenomena through these principles still exists today. For example, in the field of bioethics, there is a research institute named Kennedy Institute of Bioethics at Georgetown University. A group at that institute talks about the four principles of bioethics. They have presented the four principles of bioethics and appear to think that all criteria for bioethics can be derived by looking at life activities, life phenomena and life science in the light of those four principles.
Included in these four principles is "justice". In other words, they believe that universally correct criteria that is in line with the principles of bioethics
However, "justice" is probably a concept that is more diversely interpreted by varying values than any other term existing today. For instance, as can be seen from the current issue over Afghanistan, justice for people on one side is injustice for people on the other side. That is why insistence on justice by two parties inevitably results in war. I see the recent war in Afghanistan as a perfect example of this.
As can be seen from these examples, I think it is no longer possible to interpret bioethics by bringing up a basic principle or some golden rule.
Then what should we do? My idea is that we should follow ideas and norms that are functioning in reality and are concrete and easy to understand for everyone and take a bottom-up approach from there, instead of following the conventional ethics approach of formulating a certain principle and deductively amplifying it. That way, we should be able to obtain ethical principles and ethical norms that can be applied worldwide. I also think that population problem should be approached from such point of view.
I believe that the value notion that can obtain greatest social acceptance today is "fundamental human rights". Although we may not be sure of its grounds or its essence, fundamental human rights can be unanimously accepted in the sense that it is something people consistently feel that they have to defend and that it should not be infringed.
In short, I think the most proper and effective way would be to build the criteria for right and wrong of bioethics starting from concrete standards such as "not infringing on fundamental human rights", "carrying out life activities without infringing on fundamental human rights", or "applying life science to real world without infringing on fundamental human rights". Therefore, according to the definition I just gave, the most effective way to formulate the actual ethical criteria in bioethics would be to seek ethical integration without allowing new phenomena and situations related to human life activities such as population problem or intervention of science and technology to infringe on fundamental human rights.
However, a very serious problem arises when you look at population problem from such perspective. It is the fact that most population problems are based on infringement of basic human rights that becomes clear when we try to formulate policies to solve the problem.
In brief, population problem boils down to the issue of how to go about controlling the population. However, this concept of controlling population becomes an infringement of fundamental human rights from a certain perspective. People are alive and they also given life to this world. Since giving birth to as many children as a couple wants when they want them is one of the most fundamental human rights, placing restrictions on this right can be seen as one of the greatest infringement of fundamental human rights for humanity.
The most effective way to control population, which has actually been practiced throughout history, is to kill people. Nazi actually reduced population through this means. War also achieves this goal. Wars of grand scale have been occurring frequently in the recent years. Historians say that large wars have been occurring every 100 years in the modern age. These large wars reduce population. The famous Thirty Years' War is said to have reduced the population of Germany to one-third. These things have been occurring every 100 years. It is the most effective method for reducing and controlling population.
However, we can no longer do this, and, according to some predictions, outbreak of large wars is becoming less and less likely. We therefore cannot resort to such method to reduce population. To begin with, homicide is the greatest infringement of human rights.
Another factor that came up many times today is epidemic. In the past, epidemic occurred whenever population density became high and brought about large reduction of population. In Europe, it was the black plague. Black plague became prevalent regularly and reduced the population by a large margin. However, we cannot rely on this in the future either because of the rapid advancement of medicine and the much talked about improvement of health conditions. These things will probably not occur again.
Thus the only option that is left to us is to rely on the fertility side. That is, we need to prevent excessive number of babies from being born in order to control population. However, bearing children is one of the most important rights among fundamental human rights. The so-called feminist groups are particularly keen on this. They argue that the choice of whether or not to bring life into the world and to give birth to the desired number of children at a certain point in time is the greatest fundamental human right, particularly the right of women.
What should we do then? If we cannot check population growth without infringing on human rights, we have to conclude that human rights infringement and population control contradict are totally incompatible. Population problem in bioethics has to start from this very fragile ground.
Actually, United Nations and UNESCO have been the active proponents of fundamental human rights. The foremost assertion of the U.N. has been stated in the form of principles for realising fundamental human rights in this world. This means that we cannot control population under the principles of the U.N. They are helpless when it comes to the population problem.
The desperate but ingenious measure that the U.N. appears to have set forth under the pressure of necessity in these circumstances was the concept of reproductive health/rights that started to become popular around the time of Cairo Declaration. Now, the meaning of the slash you see between "health" and "rights" is rather difficult to understand. In theory, "reproductive rights" and "reproductive health" are in complete contradiction with each other because "health", in reality, cannot be attained solely through assertion of individual rights and freedom. Health is a social product. Society as a whole will have to reach a certain level to guarantee the health of individuals. On the other hand, health of society as a whole requires improvement of social medical technology and full equipment of medical system. Under a democratic system, this would also require fair distribution of medical resources, which means that freedom and rights of certain individuals will have to be controlled in some instances.
Therefore, the concept of reproductive health/rights that has been put forward by the U.N. and started to become popular around the time of Cairo Declaration and Action Plan was, in my view, an expression of a measure for watering down the idea of fundamental human rights and discussing it by striking a balance with health issues. In other words, it was a political wisdom for approaching the population problem after slightly narrowing the scope of fundamental human rights.
In sum, assertion of individual rights concerning birth at a time when entire society or entire humanity is working out various policies for their survival, particularly in connection with population problem, would not work. More likely, we will not be able to address the population problem of the 21st Century unless we take the approach of restraining individual rights and give higher priority to total − I allow myself to go ahead and use this term "total" − welfare from a more social and community-oriented viewpoint.
Reproductive health/rights is a way of thinking which asserts that population increase will be controlled by increasing the options and decision-making power of women by securing the health and rights of women, particularly those related to reproduction, in a well-balanced manner. However, when you take the nature of the problem into consideration, the nature of reproductive health/rights was never a kind of problem that the U.N. has asserted it to be. "Rights" is an individual issue while "health" is a social one − you might say it is an environment that society as a whole presents to individuals. Introduction of "health" in addition to "rights" will consequently internalise social constraints in individuals in the form of self-restraint. An ingenious approach of internalising this social constraint within the realm of rights was taken here, I think.
Reproductive health/rights must have been the concept that emerged out of awareness among population experts that mere assertion of rights as approved by the U.N. cannot solve the problem. The concept of "health" is just as important as the concept of "rights". Health is clearly a social product. I think that the population conference has indicated a very ingenious policy by announcing a direction for solving the population problem from the standpoint of improving the overall balance by incorporating such concept to control its counterpart, i.e. the right to give birth.
I just used the word "total". This "total" also refers to "total economy". As have been mentioned in the presentations by various lecturers today, economic condition is bearing down heavily on the rights. At least, it is becoming a hindrance to health. In short, it is unbalance of economy. In a sense, the world economy has attained enormous development in the process of globalisation. But there is a fact that there is an economic development in one developed country means that its prosperity is giving rise to poverty in most destitute countries. There are various empirical evidences regarding this matter.
In other words, uneven distribution of wealth is creating huge poverty and sapping the health of such poverty-stricken people as a result. For this reason, this is not simply a population problem but seems to be related to a problem of economic nature.
It is also accompanied by environmental problems because health can only be maintained in good environment. I am not referring to the health of individuals here. A good environment is clearly needed when one thinks about overall health − health of the entire society, entire community, entire country and entire humanity. And I think that good environment, in a way, is supported by affluent economy and impartial economic development.
In this sense, the term "sustainable development" has been widely used since the Agenda 21 and Rio Declaration in the Rio de Janeiro Summit in 1992. And I think that this slogan of "sustainable development" offers a very good viewpoint for looking at the population problem. One of the aspects that need to be "sustained" is economy − the global economy. You also need to sustain the global environment − the ecosystem. I feel that there is a need for viewpoint that carries out economic progress and environmental development while sustaining these aspects.