Public appraisal of government efforts and participation intent in medico-ethical policymaking in Japan: a large scale national survey concerning brain death and organ transplant
Public satisfaction with policy process influences the legitimacy and acceptance of policies, and conditions the future political process, especially when contending ethical value judgments are involved. On the other hand, public involvement is required if effective policy is to be developed and accepted.
Using the data from a large-scale national opinion survey, this study evaluates public appraisal of past government efforts to legalize organ transplant from brain-dead bodies in Japan, and examines the public's intent to participate in future policy.
A relatively large percentage of people became aware of the issue when government actions were initiated, and many increasingly formed their own opinions on the policy in question. However, a significant number (43.3%) remained unaware of any legislative efforts, and only 26.3% of those who were aware provided positive appraisals of the policymaking process. Furthermore, a majority of respondents (61.8%) indicated unwillingness to participate in future policy discussions of bioethical issues. Multivariate analysis revealed the following factors are associated with positive appraisals of policy development: greater age; earlier opinion formation; and familiarity with donor cards. Factors associated with likelihood of future participation in policy discussion include younger age, earlier attention to the issue, and knowledge of past government efforts. Those unwilling to participate cited as their reasons that experts are more knowledgeable and that the issues are too complex.
Results of an opinion survey in Japan were presented, and a set of factors statistically associated with them were discussed. Further efforts to improve policy making process on bioethical issues are desirable.
- Feldman EA: Culture, conflict, and cost: Perspectives on brain death in Japan. International Journal of Technology Assessment in Health Care 1994,10(3):447–463. CrossRef
- Sass HM: Action driven consensus formation. Consensus formation in healthcare ethics (Edited by: ten Have HAMJ, Sass HM). London: Kluwer Academic Press 1998, 159–173.
- Jones CO: An Introduction to the Study of Public Policy Second Edition Boston: Duxbury 1978.
- Manin B: On legitimacy and political deliberation. Political Theory 1987,15(3):338–368. CrossRef
- Rowe G, Frewer LJ: Public participation methods: A framework for evaluation. Science, Technology and Human Values 2000,25(1):3–29. CrossRef
- Leroux T, Hirtle M, Fortin LN: An overview of public consultation mechanisms developed to address the ethical and social issues raised by biotechnology. Journal of Consumer Policy 1998, 2:445–481. CrossRef
- Akabayashi A: Report of the project "Strategies for Social Consensus Building on the Policies concerning Advanced Medical Technologies Tokyo: Fuji Research Institute Corporation 2003.
- King CS, Feltey KM, Susel BO: The question of participation: Toward authentic public participation in public administration. Public Administration Review 1998,58(4):317–326. CrossRef
- Brannigan MC: A chronicle of organ transplant progress in Japan. Transplant International 1995, 5:180–186. CrossRef
- Kimura R: Japan's dilemma with the definition of death. Kennedy Institute of Ethics Journal 1991, June:123–131.
- Kita Y, Aranami Y, Nomura Y, Johnson K, Wakabayashi T, Fukunishi I: Improving public awareness of organ transplantation in Japan. Progress in Transplantation 2000,10(1):56–59.
- Hardacre H: Response of buddhism and shinto to the issue of brain death and organ transplant. Cambridge Quarterly of Healthcare Ethics 1994, 3:585–601. CrossRef
- Ad-hoc Committee on Brain Death and Organ Transplantation: Interim Report (Important issues related to Brain Death and Organ Transplantation) Tokyo: Ad-hoc Committee on Brain Death and Organ Transplantation 1991.
- Hori M, Yamamoto K, Kodama K, Takashima S, Sato H, Koretsune Y, Kuzuya T: Successful launch of a cardiac transplantation in Japan. Japanese Circulation Journal 2000, 64:326–332. CrossRef
- Zaller JR: The nature and origins of mass opinion Cambridge: Cambridge University Press 1992.
- Pharr SJ: Losing face: Status politics in Japan Berkeley: University of California Press 2000.
- Joly PB, Assouline G: Assessing Public Debates and Participation in Technology Assessment in Europe: ADAPTA Project Final Report Grenoble: Unite de Grenoble, Departement d'Economie et Sociologie Rurales 2001.
- Akabayashi A, Slingby BT, Kai I: Perspectives on advance directives in Japanese society: A population-based questionnaire survey. BMC Medical Ethics 2003, 4:5. CrossRef
- Tourangeau R, Rasinski K, Bradburn N, D'Andrade R: Carryover effects in attitude surveys. Public Opinion Quarterly 1989, 53:495–524. CrossRef
- Cook-Deegan RM: Finding a voice for bioethics in public policy: Federal initiatives in the United States, 1974–1991. Consensus formation in healthcare ethics (Edited by: ten Have HAMJ, Sass HM). London: Kluwer Academic Press 1998, 107–140.
- Taylor SE, Fiske S: Salience, attention, and attribution: Top of the head phenomena. Advances in social psychology (Edited by: Berkowitz L). New York: Academic Press 1978, 249–288.
- Hill S: Democratic values and technocratic choices Stanford: Stanford University Press 1992.
- Brunner RD, Lasswell HD, Lipset SM: The Encyclopedia of democracy Washington DC: Congressional Quarterly Press 1995, 3:723–725.
- CCNE (Comite Consultatif National d'Ethique): Les Chahiers du Comite Consultatif National d'Ethique pour les Sciences de la Vie et de la Sante, 33 Paris: CCNE 2002.
- DRZE (Deutches Referenzzentrum fur Ethik in den Biowissenschaften): Ethik-Diskussion in der Gesellschaft durch Informationen unterstutzen Bonn: DRZE 1999.
- Maynard A, Bloor K: Our certain fate: Rationing in health care London: Office of Health Economics 1998.
- Richardson A, Charny M, Hammer-Lloyd S: Public opinion and purchasing. British Medical Journal 1992, 304:680–682. CrossRef
- Abelson J, Forest PG, Eyles J, Smith P, Martin E, Gauvin FP: Deliberations about deliberative methods: Issues in the design and evaluation of public participation processes. Social Science and Medicine 2003, 57:239–251. CrossRef
- Renn O, Weber T, Wiedelmann P: Fairness and competence in citizen participation: Evaluating models for environmental discourse Boston: Kluwer Academic Press 1995.
- Neumann WR: The paradox of mass politics: Knowledge and opinion in the American electorate Cambridge: Harvard University Press 1986.
- Templeton F: Alienation and political participation. Public Opinion Quarterly 1996,30(2):249–261. CrossRef
- Arnstein S: A ladder of citizen participation. Journal of the American Institute of Planners 1969, 35:216–224. CrossRef
- Litva A, Coast J, Donovan J, Eyles J, Shepherd M, Tacchi J, Abelson J, Morgan K: The public is too subjective: Public involvement at different levels of health-care decision making. Social Science and Medicine 2002, 54:1825–1837. CrossRef
- Kathlene L, Martin JA: Enhancing citizen participation: Panel designs, perspectives, and policy formation. Journal of Policy Analysis and Management 1991,10(1):46–63. CrossRef
- Charles C, DeMaio S: Lay participation in health care decision making: A conceptual framework. Journal of Health Politics, Policy and Law 1993,18(4):881–904. CrossRef
- Splichal S: Public opinion: Developments and controversies in the Twentieth Century Lanham, Maryland: Rowman & Littlefield Publishers, Inc 1999, 1–52.
- Deutscher Bundestag: Schlussberichit der Enquete-Kommission "Recht und Ethik der modernen Medizin" Drucksache 14/9020 Bonn: Bundesanzeiger Verlagsgesellschaft mbH 2002.
- Abelson J, Forest PG, Eyles J, Smith P, Martin E, Gauvin FP: Obtaining public input for health systems decision making: Past experiences and future prospects. Canadian Public Administration 2002,45(1):70–97. CrossRef
- Einsiedel EF, Jelsoe E, Breck T: Publics at the technology table: the consensus conference in Denmark, Canada, and Australia. Public Understanding of Science 2001, 10:83–98. CrossRef
- Guston DH: Evaluating the first U.S. consensus conference: the impact of the citizens' panel on telecommunications and the future of democracy. Science, Technology, and Human Values 1999,24(4):451–482. CrossRef
- Joly C: Between consensus and citizens: Public participation in technology assessment in France. Science Studies 1999,12(2):3–32.
- Althaus SL: Information effects in collective preferences. American Political Science Review 1998,92(3):545–558. CrossRef
- McLeod J, Pan Z, Rucinski D: Level of analysis in public opinion research. Public opinion and the communication of consent (Edited by: Glasser T, Salmon C). New York: The Guilford Press 1995, 55–85.
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6939/6/1/prepub
- Public appraisal of government efforts and participation intent in medico-ethical policymaking in Japan: a large scale national survey concerning brain death and organ transplant
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
BMC Medical Ethics
- Online Date
- January 2005
- Online ISSN
- BioMed Central
- Additional Links
- Author Affiliations
- 1. Department of Public Health, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan
- 2. Department of Biomedical Ethics, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan
- 3. Department of Social Gerontology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan