Section 2: Approach to Consensus Development

1. Promoting Debate on Advanced Technology

As previously mentioned regarding the application of cloning technology, an interim report was submitted on June 15, 1998 by the Clone Subcommittee of the Bioethics Committee under the Council for Science and Technology. Another report was available on June 3, 1998 from Bioscience Group of the Subcommittee for Promotion of Special Fields under the Education Ministry's Academic Examination Committee. In addition, the Survey on Intellectuals regarding Cloning Technology was conducted in September 1998.

In response to these views, newspapers actively presented their opinions. The following summarizes their main ideas expressed in commentaries and editorials. These excerpts do not include all information provided. It should also be noted that they may not exactly convey what the papers meant, since they were compiled at the discretion of the authors of this report. The points of their comments are as follows:

<1> Some comments insist on considering legal regulations, while others assert that such considerations are too early.

<2> Some refer to regulations only on cloning technology, while others cover reproductive medical technology on the whole, as well as basic bioethics legislation.

<3> Diverse views are presented concerning how debate should be carried out (e.g., the necessity of public debate and preliminary assessments).

In view of high social credit given to newspapers in Japan, it would be necessary to pay considerable attention to their comments when considering regulations on cloning technology. (It is difficult to determine whether papers should belong to Category 2 for their "influence on society" or Category 3 for their "neutrality."

With regard to pros and cons on the introduction of legal restrictions described in <1> and the scope of restriction in <2> , legal and technological issues were examined in Chapter 1. Our discussion to follow will focus on the methods and procedures to be taken for debate on regulations mentioned in <3> . Methods for public debate have been examined in a number of studies and some have been applied to various administrative fields. Our discussion, therefore, will concentrate on the method for discussion over the application of life science and technology, especially cloning technology.

Discussion on life science and technology is, generally speaking, centered on the application of science and technology to society. In commenting on how science and technology, including cloning technology, should be applied, an increasing number of commentaries are referring to technology assessment (such as those in Asahi Shimbun on January 14, 1999 and Nihon Keizai Shimbun on November 7, 1999). It goes without saying that effects on society and other influences should require full scrutiny before the application of science and technology, such influences are extremely difficult to estimate. Under these circumstances, it is interesting to note that particular stress is made on technology assessment for the second time in Japanese history. As stated in the introduction of this report, it was technology assessment that was adopted first as part of realistic policies at a time when the importance of the relations of science and technology to humanity and society was recognized. There are some reasons for the failure of the technology assessment concept to settle in Japanese society. Thus, it does not suffice to apply technology assessment in just the same way as it was applied previously. Nonetheless, it would be useful in deepening our discussions to understand the background and limitations of technology assessment and recognize the fact that new movements for technology assessment are in progress in European countries (the Consensus Conference, which frequently comes up in conversation these days, is a variation of new technology assessment). We should also note that technology assessment will give us much to learn about consensus development methods (Europe's new technology assessment is drawing attention as a civil-oriented approach). On the other hand, Science Council of Japan has recently pointed out the importance of developing science and technology based on comprehensive, long-term perspectives. To realize such a goal, it is essential for researchers and scientists to cooperate with their counterparts in other fields, legislators and people in general, instead of confining themselves to their own domains, thus keeping themselves abreast of new trends in society. In this sense, problems and developments in technology assessment are worth keen attention.

Table: Summary of major paper editorials and commentaries on cloning technology.

<1> June 9 (Yomiuri Shimbun): Progress and ethics of reproductive technology
On in-vitro fertilization: It would not be right to deny the benefits of science and technology only from an ethical perspective; intellectuals and professionals should discuss this problem in relation to parental rights, inheritance rights and social standards; it is desired to examine the necessity of establishing guidelines and legal regulations and present them for public debate; the Ministry of Health and Welfare and the Japan Obstetrics and Gynecology Society should endeavor to build a system to cope with technological innovations.

<2> June 13 (Tokyo Shimbun): Full review necessary on medical technology
European countries which permit in-vitro fertilization also have related laws; before Japan faces the same problems as those in the U.S., it should discuss the necessity of setting up effective guidelines and laws; the important point is to develop public debate on a nation-wide basis, and not leave the initiative to the medical circle.

<3> June 16 (Yomiuri Shimbun): Rules should be established for reproductive technology
The first thing to do is to set up a national rule regarding reproductive technology as a whole, including cloning technology; the government is required to act promptly to work out a unified view and a control measure.

<4> June 21 (Mainichi Shimbun): Regulations are premature
Considering that guidelines were enough to deal with genetic treatment, there is no need to impose legal restriction on cloning technology.

<5> June 22 (Nikkan Shimbun): It is natural to curb cloning technology as
the application of cloning technology to humans will impair human dignity and cause safety problems. (The paper did not discuss the option between guidelines and laws.)

<6> July 7 (Asahi Shimbun): Reproductive technology, cows and man
Consistent rules should be provided for the entire range of reproductive technology, including guidelines and laws; the important thing is what discussions these regulations should be based on; it is essential that women and handicapped persons participate in discussion; all processes of discussion should be open to the public, but neither the Council for Health Sciences nor the Council for Science and Technology are yet to meet this requirement.

<7> July 8 (Nikkei Shimbun): What cloning technology means
The application of cloning technology to humans will not only cause ethical problems but also bring about many problems, including total destruction of cattle.

<8> July 10 (Tokyo Shimbun): Ethics tried by "cloning"
Cloning technology is not so difficult to apply; in light of this fact, self-imposed rules are not enough for the technology; legal regulations must be considered; it is essential to review restrictions on reproductive technology as a whole and establish well-balanced regulations.

<9> July 30 (Tokyo Shimbun): Never, human cloning
To establish effective restrictions, debate should be extended to involve the nation as a whole.

<10> December 18 (Sankei Shimbun): Establish basic bioethics legislation
Set up an extraordinary bioethics committee to enforce a comprehensive basic law.

<11> December 23 (Mainichi Shimbun): Conscience of scientists at stake
It is realistic to compile guidelines on condition that cloned embryos are forbidden at least for the time being.
[For reference] February 8, 1998 (Nikkei Shimbun): Fundamental discussion desired for bioethics
Bioethics legislation may be required; we should now start extensive debate to be ready for future developments related to this problem.

(1) Appearance and History of Technology Assessment

The term "technology assessment" was first used in a report submitted in 1966 at the Scientific Research and Development Subcommittee of the U.S. Congress. The concept of technology assessment was born as a countermeasure to deal with pollution and urban problems as well as criticism against advancing science. In this report, technology assessment was seen as an early warning system for dangers created by science and technology.

Technology assessment is regarded as part of policy science for science and technology ("Technology Assessment: Practice & Method," Reikichi Shirane). Policy science, said to have been started in the 1950s, is an interdisciplinary study of policy formation. Since engineering and information engineering were introduced into this field during the 1960s, policy science has evolved to be applied to the solution of policy issues. One of its major developments is a systematic budgeting method called PPBS (Planning Programming Budgeting System). In the course of its evolution, policy science produced the concept of technology assessment. Technology assessment is an attempt to make comprehensive assessments on human society as a whole in connection with science and technology. Technology assessment is not simply a method but also offers attitudes and ways of thinking in evaluating science and technology.

In 1969, the National Environmental Policy Act was enacted in the U.S. This led to the establishment of an organization for conducting technology assessment with extensive authority. The term "technology assessment" involved effects of science and technology not only on the environment but also on economy and society.

A technology assessment bill was submitted for discussion by Representative Daddario, followed in 1971 by a report, "A Technology Assessment Methodology: Some Basic Propositions," by Mitre Corporation at the request of the White House. The Office of Technology Assessment (OTA) was set up in 1972 under the Technology Assessment Act. Technology assessment was conducted by the office 20 to 30 times a year, producing a total of about 750 reports.

In the medical field, movements were made toward implementing technology assessment on its own, independently of OTA's technology assessment activities. Under its plan, several measures were put into practice, including the implementation by the National Institutes of Health (NIH) of a standardization program for medical treatment and examination and the establishment of a state-run medical technical center. There was a strong need for evaluation concerning the effectiveness of medical activities, because medicine was being practiced just by custom in those years without sufficient data on the effectiveness of medical practice. A surge in medical costs during the 1980s prompted the society to review the medical payment system, involving medical technology assessment deeply in policy making activities for cost reduction and more effective medical techniques. In recent years, medical technology assessment is shifting its attention from subjects directly related to medical professionals to the quality of life and ethical issues. The results of assessment reports are drawing more attention from the general public as well as physicians ("Technology for Genes, Thoughts on Genes," Yoshinori Hiroi).

Globally, on the other hand, OECD stressed the importance of technology assessment in the 1970s, as seen in the Brooks Report, which emphasized the role of technological assessment in April 1971 under the title, "Science, Growth and Society" at an OECD council. In 1973, a report, "Society and the Assessment of Technology," was released by Francois Hetman, an OECD technology assessment member. Further, in 1975, methodological guidelines (OECD, Methodological Guidelines for Social Assessment of Technology) were compiled regarding technological aspects of social assessment.

With respect to technology assessment conducted in by OTA of the U.S., the quality of its assessment reports was reviewed internally (OTA, Policy Analysis at OTA: A Staff Assessment). According to the review, these reports ranged widely in quality. Stressing that it is essential for reports to make themselves readable, analyze objectively and make congressional views clear, OTA admitted that the OTA reports as a whole failed to propose a sufficient number of practical policy options. External criticisms, most of which were from the Congress, included poor readability of the reports and too much Chapter in addition to too much time taken in compilation of the reports. It was also pointed out that some reports lacked objectivity.

Amid calls for cuts in the government budget, OTA went out of operation in 1995.

(2) Technology Assessment in Japan

Technology assessment was first introduced to Japan when a special study team on industrial projections visited the U.S. in 1969. This concept was incorporated as part of governmental policies n 1971, as the Council for Science and Technology stated in its 5th report that it is becoming increasingly important for us to introspect negative effects science and technology has on us and to predict their positive and negative influences based on human dignity. As early as 1971, the Science and Technology Agency conducted technology assessment research on pesticides, high-rise buildings and computer-based education. In the same year, similar research was carried out by the Ministry of International Trade and Industry on nuclear steel making. One survey implemented by the Science and Technology Agency involved 14 researchers, with five of them specializing in architecture, three in law and economics, three in psychology, two in medicine and one in welfare. The study was designed to clarify problems with an increasing number of skyscrapers and examine possible solutions. The results produced such proposals as the development of a network system against disasters, the establishment of flexible measures that incorporate changing elements, the importance of countermeasures against mass consumption and waste disposal problems, and the necessity to review effects on population and the human mind. In 1974, the Science and Technology Agency started a practical program based on technology assessment. In the same year, the Ministry of International Trade and Industry introduced technology assessment into its technological development program for new energy.

Years later, a number of methodological studies for the implementation of technology assessment were carried out, resulting in a variety of assessment methods. The number of technology assessment studies implemented by the government increased from five in 1971 to 10 in 1974. Since this year, research activities have been declining, with only one carried out in 1984.

The following tables present state-sponsored technology assessment surveys, with surveyors, year of implementation and themes.

Table 1 Technology Assessment by the Science and Technology Agency (STA)

Table 2 Technology Assessment by Ministry of International Commerce and Industry (MITI)

JEMA: Japan Electrical Manufacturers' Association. KEIC: Kansai Electronic Industry Center. JITA: Japan Industrial Technology Association. JII: Japan Industry Institute.

Source: JITA, Study on Conditions for Effective TA.

According to the "Survey Report on Actual State of Technology Assessment in Businesses," released by the Japan Industrial Technology Association, the most popular technology assessment methods employed in Japan are brain storming, the checklist, investigation of actual conditions, and the relevance tree.

A number of evaluation reports are available concerning the technology assessment activities during the 1970s. The Technology Assessment Concurrent Session working for the General Meeting of the Science and Technology Council summarizes in its 1975 report "Basic Concept and Promotion Policy for the Introduction of Technology Assessment": Technology assessment is not adopted in society as extensively as initially expected; factors in this slow proliferation include unfulfilled establishment of refined predication and evaluation methods required for technology assessment, difficulty with collection of widely ranging information, unfinished establishment of a reliable assessment base, and incomplete understanding by the society of the concept of technology assessment. With respect to the implementation of technology assessment, the report stressed the necessity of voluntary implementation in each stage of the assessment process and the need for sponsors, who are largely developers of the technology to be assessed, to take an impartial stance in the implementation of technology assessment. According to the report, social values play an essential role in the evaluation of the results of technology assessment, while such values are rapidly diversifying nowadays, making it extremely difficult to identify common values of the population. This means that the key to success in technology assessment is to accurately identify trends in changing values. Admitting the presence of barriers to the implementation of technology assessment and at the same time encouraging its promotion, the report cited, as requirements for successful technology assessment, the recognition by the society of technologies, the development of methods and personnel necessary for implementation of technology assessment, and the establishment of social systems, such as a society evaluation system, technology monitoring system and the insurance system.

Later, in 1979, a survey was conducted using a questionnaire aimed at large businesses ("Survey on Actual State of Technology Assessment in Japan," conducted by the Future Engineering Institute under the sponsorship of the Science and Technology Agency). The results of the survey showed that most businesses recognized the significance of technology assessment but that little effort had been made to implement it, indicating that they were just on the verge of the implementation stage. The survey pointed out that, in practical application of technology assessment, they were faced with the necessity to clarify basic goals for technology assessment activities, in addition to cost problems and incomplete implementation systems. The report also said that the real objectives of technology assessment are not fully understood by businesses, stressing the importance of clarifying such objectives and educating business people. According a report in 1980 related to technology assessment outside Japan ("Survey on Actual State of Technology Assessment in Foreign Countries," by the Future Engineering Institute), governmental organizations in the U.S., such as OTA and NSF, were conducting large-scale technology assessment activities, while they were faced with several problems, including the shortage of information, the shortage of professionals well versed in multiple areas of study, and too much time taken in an activity. Revealing that most respondents were not satisfied with the level of the technology assessment methods employed, the survey concluded that Japan was not lagging behind foreign countries in technology assessment efforts and urged the country to clarify the goals of technology assessment and improve its methods.

The point common to these surveys was that it was not so easy to comprehend the concept of technology assessment and that the implementation of the technique will face such problems as acquisition and disclosure of technical information, implementation methods, and manpower.

The aforementioned 1979 survey pointed out the fact that technology assessment in Japan drew keen attention because it was introduced at a time when pollution problems were growing into social issues. Although the original purpose of technology assessment is to identify real technical needs, the government and public found hope in technology assessment as a means of predicting negative effects of science and technology. As Japan's economic growth slowed after the oil crisis, however, the country expected technology assessment to be applied to technology development. At the same time, the report said that, interest in technology assessment lost momentum as more environmental measures were taken by the government. Some businesses had the wrong impression that technology assessment is intended to curb technological development. A 1977 research by the Policy Science Institute maintained that it was wrong to regard technology assessment as a hindrance to technology. Instead it asserted that technology assessment should be considered as a method for forming a consensus on the way we see technology and build a society which would find new values through involvement of the government, businesses, social groups and public ("Survey on Technology Assessment Methodology," sponsored by MITI and conducted by the Policy Science Institute"). The government was making efforts to promote technology assessment in those years. Later developments, however, demonstrate that its efforts bore little fruit.

2. New Trends in Technology Assessment

(1) New Technology Assessment in Europe

In the 1970s, heated political debate in European countries over the construction of nuclear plants and other industrial facilities gave rise to popular movements, involving general citizens in scientific and technological issues (Nelkin, Technological Decisions and Democracy). In 1979, OECD compiled a report concerning decision making on science and technology through public participation (OECD, Technology On Trial). Almost at the same time, the Battel Research Institute of the U.S. proposed a new technology assessment method called "Social Learning," which embodied citizen-based processes (Future Engineering Institute, 1980).

Globally, the 1970s saw intensifying technology assessment activities, which declined in the 1980s (Rathenau Institute, Technology Assessment through Interaction).

By comparison, no conspicuous development was seen in technology assessment across Europe. It was during the 1980s that technology assessment activities gained momentum.

Technology assessment was based on "reactive" movements in the 1970s, during which a focus was directed to predicting potential dangers in science and technology. During the 1980s, on the other hand, attention was drawn to the "proactive" side of it.

Looking at this issue by country, OPECST (Office Oarlementaire d'Evaluation des Choix Scientifiques et Technologique) was set up in France in 1983. In Germany, the parliament established the Technology Assessment Bureau to be dedicated to conducting technical evaluations; in this country as a whole, which is characterized by decentralized policy making, scientific autonomy and growing environmental groups, a wide variety of technology assessment activities have been carried out.

In the Netherlands, NOTA (National Organization of Technology Assessment) was established (later renamed Rathenau Institute).

In the case of Denmark, technology assessment was conducted in 1980 on a trial basis for various interested parties to participate in debate. In 1986, the Technology Council was founded under the Danish Parliament to perform technical evaluation as well as offering the public opportunities to join discussion. Its activities include a consensus conference to promote democratic debate over science and technology.

During the 1980s and 1990s, evaluation systems were created for science and technology in Belgium, Austria, Greece, Finland and Italy. With EU support, alliances are being formed to discuss common technology assessment problems for Europe as a whole. The EU itself offers a program called TSER (Targeted Socio Economic Research), which aims at incorporating opinions of end users.

(2) New Attempt at Technology Assessment for Consensus Development

Technology assessment activities have so far involved only a small number of intellectuals consisting mainly of technological professionals on the relevant subject and experts in cultural sciences who specialize in the subject. In technology assessment, the participation of scientific professionals is essential because of their deep understanding of the nature of science and technology required. Technology assessment also needs experts in assessment methodology as more complex methods are required. These participants are represented in the previous paragraphs by "researchers" under "directly interested parties" (Category 1) and "peripheral researchers," who are neutral (Category 3).

As mentioned previously, in the evaluation of technology assessment, it was pointed out that no values of the society have been clearly identified. It is impossible to know what is valued by the public, if discussions are carried out only by professionals. In Europe, there are some cases in which scientific and technological problems grew into political issues, as reported by OECD in 1976. Since then, many countries have attempted to incorporate popular opinion in technology assessment. In other words, the participation of "indirectly interested parties" (Category 2), such as ordinary citizens and those expressing specific views on society, will have to be sought. At the same time, more importance will have to be placed on journalists and intermediary experts. (There were cases in which debate was shared by recipients and subjects, who fall under Category 1, and administrative organs.) The paragraphs to follow will focus on consensus conferences, which aim at involving such new participants in debate to reach a consensus. In consensus conferences, ordinary citizens take the initiative in conducting an exchange of opinions through direct or indirect contact with concerned professionals. Debate at consensus conferences involves a wide range of participants. Nonetheless, they do not include all parties. Opportunities for participation of those in the next generations and the socially disadvantaged are extremely limited. How to reflect opinions of these parties remains an open problem.

(i) Consensus conference

One new feature of technology assessment is the consensus conference. The consensus conference is defined, for example, by Grundahl as "a method for technology assessment, which is organized in the form of a meeting between a professional panel and a lay panel where the latter evaluates the development of a technology considered to potentially give rise to social controversy." In a consensus conference, a scientific or technological theme is selected first. Those citizens who have no interests in the problem are asked to join the conference. More than ten citizens are chosen from applicants and grouped as the "lay panel." For the "professional panel," more than ten experts capable of handling questions from the lay panel are selected, including university professors, company officials, public servants and private group leaders. The professional panel explains about the state of the technology in question in terms understandable to the citizens, and answers questions asked by the lay panel. Next, the citizens hold discussions among themselves within their panels until they reach a conclusion concerning the technology. Their final agreement is called a "consensus." The opinions of the lay panel are disclosed to the public and publicized in papers and by other media. The report on the civil discussion is circulated among administrative organs for reference. In this way, these opinions are utilized to form public opinions and governmental policies. Such opinions impose no legal restrictions.

Consensus conferences are required to be neutral with regard to the problem in question. To ensure this requirement, fully deliberate arrangements are made, including the selection of a conference theme and participants.

The consensus conference is said to have derived from the medical technology evaluation system of the U.S. Under the U.S. system, it was professionals that conducted technological evaluations. By contrast, the technological evaluation system in Denmark was quite different from the U.S. system in that assessments were carried out by citizens. The first consensus conference in history was held in Denmark in 1987 to discuss genetic engineering as a subject. Since then, such conferences have been implemented once or twice a year in the country. In the Netherlands, the first consensus conference was held in 1993 with genetic engineering as a theme, followed by Britain in 1994, which organized a similar conference on the application of biotechnology to plants. Such conferences have been organized on a trial basis in New Zealand, Norway, the U.S. and Switzerland. Besides, in France, similar conferences were held under the name "the parliament of citizens." In Korea, a conference was held to discuss genetically modified crops in 1998. This type of discussion is gaining momentum in recent years, including one in Britain, where one was held in 1999 to discuss nuclear waste problems.

(ii) Consensus conference in Denmark on infertility

In Denmark, more than ten consensus conferences have been organized. Our study which follows concerns infertility, which is closely associated with life science. (As shown in the list of consensus conferences in Reference 3, few of them focus on reproductive technology, suggesting a limitation of the consensus conference.)

Advancements in reproductive science and technology have changed the nature of "infertility." To be more specific, in the past if one was unable to create a baby, there was no other way than give up the hope to have one; nowadays, an option is available to allow one to receive artificial fertilization. This changed the way people see infertility. At the same time, there are concerns about artificial fertilization because of the fact that the artificial fertilization technique is still incomplete, without satisfactory studies available on the technology. Thus, society is faced with the problems of what is required by people and what social system should be built to handle these problems. It was under these circumstances that the Danish consensus conference was held. The application of cloning technology was not discussed in the conference at that time, since the technology was still at the initial developmental stage. The significance of this conference should not be overlooked amid growing development in recent years of reproductive technology. Our summary is based on the material available from the Danish Board of Technology (www.tekno.dk). The material contains descriptions of key questions and responses to them exchanged at the conference.

The Danish consensus conference was conducted at the parliament building in Copenhagen, in October and November 1993 with the lay panel consisting of 13 citizens and the professional panel of 15 experts. The professional panel comprised physicians, infertility patients, public officers (lawyers), medical ethicists, Christian clergymen, clinical psychologists, social physicians, social medical researchers, jurists, Adoption Society members, and state health committee members.

A wide range of views were exchanged at the discussion. Along with opinions on science and research for infertility patients, proposals were made in connection with a social system for solving the problem. These proposals included the promotion of checkup services and knowledge for precautions against infertility, while an opinion expressed ethical concerns about the progress of the fertility techniques (reproductive technology).

The following eight key problems were presented. These were responded to with varying views (Reference 3) from professionals.

<1> Infertility and adoption.

<2> Identification of the cause of infertility and promotion of knowledge of infertility.

<3> Prevention of infertility.

<4> Costs of infertility treatment.

<5> Provision of eggs and sperm.

<6> Problems resulting from infertility treatment.

<7> Effects of new fertilization techniques on humans.

<8> Advantages and disadvantages of authorizing private infertility treatment.

At this conference, it was pointed out that the progress of fertility technology will cause ethical issues. The topics covered cloning technology and genetic engineering, with an opinion asserting that interference in genes should be banned and that the ban on cloning of human eggs should be maintained.

Although this Danish conference did not reach a consensus, a wide diversity of opinions were made clear as regards technical, institutional, social, ethical and legal problems with infertility treatment. Life science involves diverse problems to solve, such as conventional human perspective, doctor-patient relationships, future influences and genetic inheritance. The organizers of this conference concluded that many of these problems would require judgement on the part of citizens.

(iii) Attempt of Consensus Conference in Japan

Japan's first consensus conference was organized by a study group on civil participation in science and technology, which was led by Tokyo Denki University professor Masao Wakamatsu. Under the name "The Conference of Citizens on Genetic Treatment, " this conference met three times in three months, starting in January 1998, with the study group serving as the bureau. The results were released at an open symposium on March 21. The professional panel consisted of nine experts ? five physicians specializing in genetic treatment at medical colleges, two ethics experts, a medical economics researcher and a journalist. A total of 19 citizens were chosen for the lay panel from the Kansai district by publicizing the project and through personal connections. No special limitations were imposed on the scope of citizens.

Both the lay panel and the professional panel ardently participated in briefings and exchange of questions and answers. At the end of the conference, the lay panel submitted its opinions, which included minority views. The lay panel was characterized by orientation toward public interests as well as by the assumption that they stood by patients receiving genetic treatment. In its conclusion, the panel stressed the necessity to disclose the results of general treatment and establish a third-party organization which would check the safety of such treatment. The report also pointed out the need to systematically consolidate the current guidelines to curb excessive development of technology that would lead to unrestrained manipulation of reproductive cells. One participant expressed the fear of genetic treatment technologies being monopolized by the U.S. Some lay panelists were concerned about informed consent, which involves genetically treated patients: Informed-consent forms use too much technical jargon, frequently confusing and misleading patients; heavy emotional pressure would be placed on patients in critical condition if they were made aware that genetic treatment was given as the final option; for this reason, options should be widened to include hospice and death in dignity.

At the conference, one opinion argued that to reach a better consensus, the conference should comprise interested parties as well as ordinary citizens. Another comment pointed out that the conference was different in style from those in Europe in that it was carried out by the initiative of the conference bureau. Discussion was also made over the effect of consensus conferences on governmental policies and the types of themes that match the style of such conferences.

3. Points in Development of Consensus Development Methods

Technology assessment was employed in Japan on a trial basis in the 1970s. It failed, however, to gain wide social support, due to the ambiguity of its concept, the limited amount of information available, the incomplete development of methodology and the shortage of experts. The situation is changing in recent years as information disclosure systems are constructed, accompanied by remarkable developments in information infrastructures. At the same time, civil-based technology assessment is drawing more attention in Europe and the U.S. Domestically, a stronger voice is being raised for the participation of the general public in the governmental decision making process concerning complex problems like science and technology. In response to such public demand, new attempts are being made, including a round-table conference on nuclear policies and the use of the Internet and other means to collect opinions from wide layers of the population. In implementing technology assessment, it is essential to carefully keep up with these changing trends.

The consensus conference is one of such attempts to involve citizens as the major players in carrying out technology assessment in an effective manner. Nonetheless, it is extremely difficult to encompass all parties with interests in science and technology. In this respect, technology assessment methodology requires further improvements. One proposal for extending the range of opinions is to divide the opinion collection process into several phases for the three groups of interested parties, professionals and citizens (Renn et alternative, Public Participation in Decision Making: A Three-Step Procedure, Policy Sciences, Vol. 26). This approach is highly similar to the one discussed in Section 1 of this Chapter. To be more specific, interested parties will be asked to present opinions on their interest in science and technology; professionals will provide technical knowledge and suggest a number of solutions; citizens will express their values based on common sense and knowledge. This process appears to require a large amount of complex labor. Nevertheless, the approach is considered a measure to make the best use of the strengths of each group.

A number of methods and concepts have been proposed for consensus development. The majority of them, however, are new and untested for their feasibility. Our discussion so far has been focusing on technology assessment, which, actively undertaken by the government, is a typical consensus development method already corroborated with a sufficient amount of test data and evaluation results. To build a new consensus development method, it is desired to more deliberately analyze technology assessment policies implemented in the past.

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