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Amid rapid advances in science, we need wider debate on ethical issues involved

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South China Morning Post
Comment›Insight & Opinion
2014-11-24

Edgar Cheng

Edgar Cheng says new centre for bioethics will ensure Hong Kong becomes a platform for discussion

The word “bioethics” is not part of the common vocabulary in Hong Kong. When it comes up in conversation, my friends and colleagues often ask: “What does it mean? Why does it matter?”

The first question is relatively easy to answer. The second is more difficult, given the many different issues crowding for our attention in a hyperactive Hong Kong.

Bioethics is an ever-widening set of questions about the areas of life in which medicine and biotechnology affect human wellbeing.

It encompasses medical ethics, questions about the beginning and end of life, the impact of thrilling and frightening new technologies for human enhancement, and even climate change.

But most of all, it is a conversation across the generations and across cultures about the ways in which individuals and a society can make decisions about health that are ethically informed, responsible, uncoerced and non-coercive.

It is thinking laterally about issues of social justice in the health system, even given a public health system as inclusive and effective as Hong Kong’s. How can we make it better? How can we make sure that no one is left out?

Centrally, it is about respect for people, defined in the broadest manner possible.

We understand these things instinctively, and expect our doctors to do their jobs. Why take things another step? One reason is that Hong Kong has become a laggard in bioethics compared to its regional peers, such as South Korea and Singapore, both of which have advisers or councils on bioethics at the most senior levels of government.

The United States established its first presidential advisory commission on bioethics as early as 1974. In the US, the National Institutes of Health offers a free teaching guide on bioethics for secondary school teachers, aimed at getting students thinking about key concepts, such as fairness, minimising harm, maximising benefits, and respect for human beings and the natural world.

Whether or not Hong Kong needs to play catch-up in bioethics, the fact is that developments in medicine and biotechnology are advancing at a breakneck speed, well beyond the ability of even trained physicians to keep up with the literature, let alone our neighbours.

The first human genome was sequenced in 2003, at a cost of US$3 billion.

Today, the cost of sequencing an average human genome has dropped from US$10 million to under US$1,000 and is still falling, opening the door to mass genetic sequencing.

Genetic sequencing is making it possible to screen for diseases in embryos prior to implantation in the womb, or even sequence the entire embryonic genome. Other pre-implantation techniques, designed to block inherited diseases, introduce the DNA of unrelated individuals to eggs. The catch-all term for this phenomenon is “designer babies”.

And that represents just the beginning of technologies for human enhancement, from nano-medicine to “mind uploading”.

We need to put our resources together and develop a common platform to share ideas about how to deal with the technological future that is rushing at us.

At the Chinese University of Hong Kong, Vice-Chancellor Joseph Sung Jao-yiu is leading an effort that will put bioethics into the general education curriculum and make it an integrated requirement for all six years of medical training.

The new Centre for Bioethics, to be formally launched in January, will sponsor interdisciplinary research and collaboration, joining forces with the Hong Kong Bioethics Association and other universities in Hong Kong, mainland China, and the world to examine the profound ethical issues raised by technological change in the biomedical sciences.

Its launch conference will seek to begin a debate on how the new technologies will affect the future of our city.

These two steps together – educating our undergraduates in bioethics and inviting wide participation in the new Centre for Bioethics – will help to build bioethics capacity in Hong Kong.

Beyond these, however, there is a need to find ways to bring the community into the debate, not just health practitioners and students.

At its most basic, bioethics represents a way forward in developing the values that should inform our health systems, as they fall under new pressures from demographic change and science.

Bioethics is not a panacea, but it represents a moral compass in societies facing change, as we all are.

Edgar Cheng was educated as a medical doctor and is senior adviser to the Council of the Chinese University of Hong Kong. He is a board member of the Hastings Centre, the premier institution in the US for public policy and thinking on bioethics

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