Can Political Science Contribute to Human Life and Death and Biomedicine Issues?

Yukio Sakurai
yukio1887@gmail.com


Physician-Assisted Suicide Laws

In recent years, the legislation of physician-assisted suicide has been progressing slowly but steadily in developed countries and states. Euthanasia was legislated by some countries and states in the 1990s and 2000s and was seen as an exception. Since 2016, however, there has been a growing movement for some countries and states to legislate physician-assisted suicide. For example, Australia enacted physician-assisted suicide legislation in all six states in five years, triggered by the enactment of the Voluntary Assisted Dying Act 2017 (Vic) in the State of Victoria. Why does this happen?

Yukio Sakurai, Doctor of Laws (Yokohama National University, Japan) is a member of the Japan Association of Social Security Law, the Elder Law Society Japan, and the Japan Institute of Comparative Guardianship Law who researches social security law, elder law, comparative guardianship law in the field of Japan and Australia, and global governance studies. ORCID ID:  0000-0003-1273-9227

The population in the world is generally ageing except for Africa, and more people tend to spend their terminal lives in hospital beds, and some of them may suffer from incurable diseases. It may be speculated that other elements have been added to this situation. First, the influence of religion, such as the Catholic Church’s prohibition against suicide, has weakened. Second, in the background of legislation, the activities of NGOs appear to run “right to die” campaigns based on the dignity and autonomy principles of the patients.

Physician-assisted suicide is discussed as a theme in interdisciplinary studies, such as medicine, nursing, bioethics, law, public policy studies, and philosophy, but as legislation spreads to various countries and states, it may well become an issue to be discussed in political science as well. This essay discusses whether political science can contribute to academic research not only on euthanasia but also issues related to human life and death and biomedicine and how to do it.

Diverse Responses by Country or State

Responses to physician-assisted suicide by country or state are diverse, as indicated below (SWI 2022).

  • Singapore regulates suicide or assisted suicide as a crime (Article 308 of the Penal Code 1871, up to 10 years imprisonment and fine), and Germany prohibits assisted suicide as a business (amendment to Article 217 of the Penal Code 2016).
  • Countries that have not enacted laws, like Japan, account for the majority, which has terminal care guidelines for the elderly for medical professionals by governments or medical societies or enacted living wills and/or medical advance directives. In Asia, Taiwan legislated the Patient Right to Autonomy Act 2018/2021 for medical advance directives.
  • Countries and states that enacted physician-assisted suicide laws, such as the U.S. States including Oregon in 1996, the Netherlands in 2001, Belgium in 2002, Luxembourg in 2009, the Provinces of Canada in 2016, Victoria (Aust.) in 2017, Queensland (Aust.) in 2018, NZ and Western Australia in 2019, South Australia in 2021, Tasmania (Aust.), Spain, and NSW (Aust.) in 2022. The countries and states that have enacted physician-assisted suicide laws clearly state the requirements for certification, such as unbearable pain and terminal symptoms due to illness, and the patient concerned has the legal capacity, and impose a strict duty of care on the multiple medical doctors responsible for the certification. The legislative intent prohibits voluntary assisted suicide that does not meet legal requirements by enforcing strict requirements and establishing a system of strict supervision by the national and state governments.
  • Switzerland allows “unselfish assisted suicide” as an exception in 2019 case law, and the Swiss medical academy established guidelines for operation. Medical doctors of NGOs perform assistance for the patients (Shibasaki 2010).
  • Countries where Constitutional Courts decided to allow physician-assisted suicide with certain terms and conditions in Italy in 2019, Austria in 2020, and Colombia in 2022.
  • Although the 2021 assisted suicide bill passed in the parliament, it was abolished after the president refused to sign it in Portugal, and there are moves in South Korea where the lawmakers deliberate on the assisted suicide bill, in addition to the 2016 legislation on palliative care and discontinuation of life-sustaining treatment.

At this stage, it is a challenge to evaluate the implications of physician-assisted suicide laws, case law, and decisions of the Constitutional Courts without verifying the results in detail of how each country or state operates law, case law, and decisions. Some Swiss NGOs assist foreigners, including Japanese, to participate in the physician-assisted suicide program. If euthanasia tourism becomes widespread, other countries may newly consider legislation or, on the contrary, reconsider amending their legislation or the case law for stricter operation.

In Japan, a TV documentary film titled “She Has Chosen Euthanasia” was aired in 2019, focusing on a Japanese woman who had a physician-assisted suicide in Switzerland with the assistance of the Swiss NPO. However, it does not appear that the discussion of euthanasia has taken place. It is understood that there is a silent majority voice in Japan that says that it should not be enacted into law without a national consensus. Even if euthanasia is strictly regulated by law, it might be possible that operational conditions could be relaxed like a slippery slope over time (Herring 2022).

Roles and Limitations of Bioethics

In academic society, bioethics has deliberated human life and death issues, including euthanasia, for years. Bioethics emerged in the United States in the 1960s to participate in the policymaking of the US national policy on biomedical sciences. Therefore, the cultural traditions and values behind the U.S. national policy influence the selection and evaluation of bioethics research subjects (Fox 1990). In fact, bioethics emphasizes the principles of individual rights, autonomy, and self-determination.

Bioethics was then imported to Japan in the 1980s and developed further, where social values are sometimes prioritized over individual rights. It is meaningful to consider unique Japanese bioethics, based on more relational autonomy rather than individual autonomy, taking the influence of relatives, professionals, and society into consideration.

Nowadays, bioethics has developed research for issues that are closely related to modern biomedicine, particularly those posed by sophisticated scientific and technological advances. Those include organ transplants, biotechnology such as embryonic stem (ES) cells and induced pluripotent stem (iPS) cells, genetic manipulation, and reproductive technology. Issues of bioethics, therefore, become more complicated than before since these involve exceedingly advanced biotechnology and the mixture of values in an international science arena.

Literary works and films on biomedical themes have been published and are the subject of public interest. For example, the film “GATTACA” (1997) and the novel “Never Let Me Go” written by Kazuo Ishiguro (2005) and its film (2010) are typically seen. Ishiguro was awarded the 2017 Nobel Prize in Literature. These films visibly illustrate serious bioethics issues concerning genetic manipulation and organ transplantation and imply alerts.

If research results and recommendations of bioethics have a direct or indirect impact on people’s views on human life and death, bioethics must guide governments and the people in an appropriate direction. Can bioethics meet those expectations and find a big ethical narrative story? To meet these expectations, bioethics is strictly required to understand the various interests of governments and the people and find feasible and most appropriate solutions for each issue, including euthanasia.

Three questions are raised on bioethics. First, it is said that there are American traditional cultures and values behind bioethics. Is there no confusion in bioethics under the current American political situation where 50 states are divided into two and unable to form a unified value as a federal state? In fact, the issue of abortion is a serious agenda by state law. The second is the criteria of judgement and value in finding a feasible and most appropriate solution. Are there universal criteria of judgement and value that are common to countries and states in the world, even with different social and cultural backgrounds? Or, as an alternative, should they share the foundations of bioethics and allow flexibility to, in part, accept independent criteria of judgement and value that reflect the characteristics of the countries or states concerned? Third, under capitalism, biomedicine and human life and death issues are inevitably influenced by commercialism. Will bioethics play a role in promoting social adjustment between commercialism and an ideal ethical standard?

Assuming these difficulties, bioethics has certain limitations and does not solve all issues in biomedicine and biotechnology. This is because bioethics does not find a big ethical narrative story applicable to people worldwide. Whilst bioethics has hitherto been loosely related to the social sciences (Fox 1990). If it is so, can the social sciences contribute to bioethics to make up for their limitations and enhance academic research?

Can Political Science Contribute to Bioethics?

Euthanasia is multifaceted. In other words, it is a problem of ethics and philosophy in the sense that it is related to human life and death, it is a problem of medicine and nursing due to the involvement of medical doctors and nurses, and a problem of jurisprudence and public policy studies due to the involvement in law, guidelines, and policy. In addition to these, it will be an issue for political science as it concerns inter-state influence and dialogue by governments and NGOs and domestic relationships between governments and civil society, including hospitals and biomedicine research institutes.

Human life and death issues, including euthanasia, are placed in basic human rights, but not limited to. They are also based on important values and principles such as life, ecology, environment, and sustainability, which are mostly covered by Sustainable Development Goals (SDGs) in the United Nations. Therefore, involvement in the UN affiliates (i.e., UNESCO: Universal Declaration on Bioethics and Human Rights 2006) and the Council of Europe (i.e., Convention on Human Rights and Biomedicine 1999) is conceivable. These are possible agenda items to be discussed in political science under a microscope. Political science may lead research for topics such as “the consensus-making process within a country on physician-assisted suicide legislation and roles of NGOs” in a microscope.

Moreover, during the COVID-19 pandemic, public health and epidemic policy by governments and the WHO has been focused on and discussed in political science. Some researcher reminds us of the concept of biopolitics outlined by Michel Foucault (Lorenzini 2021). Foucault’s concept of biopolitics drew attention to the inner power mechanism of humans in response to the fact that people who originally disliked governmental regulation eventually demanded governmental regulation during the COVID-19 pandemic. This is an agenda to be discussed in political science on how governments can control citizens who voluntarily demand governmental regulation.

It is assumed meaningful for the social sciences, including political science, to participate in discussions on the issues of human life and death and biomedicine and to make up for the limitations of bioethics. It does not concern how to politicize bioethics but concerns how political science will be able to contribute to academic research on bioethics issues. It would be significant for political science to participate in research for bioethics issues such that people can expect not only analysis from a political science perspective but also a wider option available in the social science theatre (Brown 2009). In other words, the discussion will be explored in an open and well-organized manner if political science participates in research for bioethics issues.

Conclusion

It is significant for political science to participate in research for issues of human life and death and biomedicine from the discipline of political science perspective. The point of discussion is not whether this view is right or wrong but to consider how political science can contribute to bioethics issues.


References

Brown, M. B. (2009) Three Ways to Politicize Bioethics. The American Journal of Bioethics 9(2): 43-54.

Fox, Renée C. (1990) The Evolution of American Bioethics: A Sociological Perspective. Social Science Perspectives on Medical Ethics (Springer, Dordrecht, 1990) 201-217.

Herring, J. Medical Law and the Ethics (Oxford University, 9th ed. 2022) 591-616.

Lorenzini, D. (2021) Biopolitics in the Time of Coronavirus. Critical Inquiry 47(S2): S40-S45. https://www.journals.uchicago.edu/doi/full/10.1086/711432.

Shibasaki, M. (2010) Practice and Principle of Organized Assisted Suicide in Switzerland. OIU journal of international studies 24(1): 51-64 [in Japanese]  https://cir.nii.ac.jp/crid/1050282813399889152?lang=en.

SWI, Swissinfo.ch (2022) Where Is Euthanasia Allowed? (31 July 2022) https://www.swissinfo.ch/ger/gesellschaft/sterbehilfe-assistierter-suizid-schweiz-laender-wo-erlaubt/47716128.


Previous post The Politics of the Emirati Long Weekend: Between Modernity and Islam
Next post The Quad and ASEAN: Challenges and Prospects for Cooperation

Leave a Reply

Your email address will not be published. Required fields are marked *