Reference 3 Materials on Consensus Conferences

The following provides supplementary materials related to our discussion in Section 2 of Part 2.

Consensus conferences have been held in a number of contries, as follows:

Reference 3-1 List of Consensus Conferences

Reference 3-2 Points in Consensus Conference

A variety of measures have been devised to facilitate the implementation of consensus conferences. The following provides several points for understanding consensus conferences:

• election of themes: It is essential to select themes that would allow smooth progress of debate. Many subjects concern new technologies, including biotechnology, partly because they offer open problems and also because interests are still to be established.
• election of panelists: To accurately represent the nation as a whole, it is important to make a well balanced selection in terms of age, sex, and educational background.
• Cooperation of experts: It is necessary to encourage the participation of a
• large number of experts in the subject.
• Briefing by experts: The lay panel is strongly influenced by the way expert
• briefings are carried out. Thus, such briefings must ensure impartial and sufficient quality and quantity of the coverage of the subject.

Function of consensus conferences

Even in Denmark, where consensus conferences are held frequently, the results of a consensus conference are not legally binding. Nonetheless, they exert strong influence on the public as they are covered widely by the press. Because of this, some congressmen show a keen interest in what is discussed in such conferences. In this manner, these results have indirect influence on policy formation.

Reference 3-3 Consensus Conference on Infertility

In 2) of Section 2 (2) of Part 2, we presented an outline of the consensus conference held in Denmark on infertility. The following presents the results, released by the Denmark Technology Committee on the opinions of the lay panel, of the 1993 conference on infertility. (This information was collected from the Internet.)

<1> Infertility and adoption

Regarding the presence of people suffering infertility, the panel discussed the way the adoption system and rules should be revised. The lay panel opted for a more lenient adoption system. Some panelists argued that infertile couples should be made aware that they may consider adoption instead of infertility treatment and that sufficient medical and mental support should be given to these couples.

<2> Identification of the cause of infertility and diffusion of knowledge

The panel discussed whether a higher priority should be given to research on causes of infertility. The lay panel asserted: In research, a higher priority should be given to identification of causes than to treatment; to promote causal research on infertility, it is recommended to construct a research plan that involves fundamental studies, environmental research and epidemiological survey; with anticipated degeneration of human sperm, efforts should stepped up in research on sperm; there is no organized sperm research system; a sperm research system should be established to accumulate experience and knowledge; businesses should endeavor to improve working environments.

<3> Prevention of infertility

In the discussion on infertility prevention, the lay panel argued: Infertility prevention should be promoted; regular inspection should be implemented on 15- to 25-year-old males and females for chlamydia, which is thought to cause infertility; although such inspection requires large amounts of money, benefits would exceed costs; it is essential to provide the young with official information about the disease; it is required to establish a more flexible maternity absence system for working mothers and improve the management of public health centers in order to counteract the declining conception rate as the result of more females receiving higher education; daily prevention measures are also important, including giving up smoking and drinking.

<4> Infertility treatment expenses

The discussion also covered the amount of public money to be spent on infertility treatment. Various opinions were presented: Infertility is not a disease; beneficiaries of infertility treatment should bear part of the medical costs; government subsidiaries should be provided for adoption, depending on the income level of adopters; in infertility research, the government should focus on the identification of causes as well as prevention of infertility.

<5> Provision of sperm and eggs

The panel discussed potential problems with the provision of sperm and eggs. The debate mainly centered on a contradiction between the desire of children to know their parents and the legal protection of anonymity of donors. The lay panel argued: To maintain the public health system and offer genetic treatment, recipients and donors of sperm and eggs should be identifiable; therefore, anonymity of donors should be abolished to allow children to know their genetic origin.

The lay panel further maintained: In receiving hormone treatment, egg donors should be warned of risks accompanying the treatment; sperm and eggs should be provided free of charge; compensation to sperm donors should be prohibited; recipients of sperm and eggs should be adults under 40; at least one of the parents should be a genetic parent of the child. The lay panel demanded the abolition of the current law, which permits the provision of eggs that have been used for research purposes, because the quality of such eggs is not guaranteed.

<6> Problems arising from infertility treatment

The lay panel discussed social problems that would potentially arise as infertility treatment is practiced more widely. The panel questioned the low priority given to the review of the results of infertility treatment. It claimed: Infertility and its treatment are a cause of mental problems; wider practice of infertility treatment is causing stress on an increasing number of patients; sociological studies should be conducted before and after infertility treatment to determine how much mental assistance will be needed for infertility patients; the artificial reduction in the number of fetuses should be banned to avoid multiple birth, treatment techniques should be improved; in order to identify long-term effects of hormone treatment, infertility patients should be registered to facilitate descendant tracking; with opinions varying among specialists on the effects of hormone treatment, a higher priority should be given to research on such effects; infertility research and treatment should be concentrated in a limited number of centers.

<7> Effects of infertility treatment technology on human existence

The panel discussed whether there might be changes in the conventional way we view humans. A wide range of opinions were presented: Advancements in infertility technology should not lead to the belief that all humans have the right to have children; it should not be left to physicians to decide the extent to which abnormal conception should be permitted; the quality of our life, including the decision whether to have children or not, seems to be determined by infertility technology; infertility treatment might pose grave ethical problems; there is the danger that technological advancements will dissolve ethical standards.

The discussion covered cloning and genetic engineering: Genetic interference should be prohibited in infertility treatment; the ban on human egg cloning should be maintained.

<8> Advantages and disadvantages of private treatment of infertility

The panel discussed whether private hospitals should be authorized to conduct infertility treatment. Some panelist stressed the importance of guaranteeing treatment quality and follow-up survey on long-term effects of treatment: Regulations are required to ensure a minimum level of quality of infertility treatment; treatment should be conducted by physicians with sufficient knowledge and experience; those who offer infertility treatment should not compete only in terms of price; a transparent and homogeneous market should be guaranteed; the results of infertility treatment should be maintained at a central registration office; registration procedures should be controlled by the sanitation committee; registration data should include the frequency of treatment, method applied, number of eggs collected, treatment applied to eggs, results of treatment, conception frequency, number of children born, number of fetuses aborted, and delivery method; a registration system for infertility patients is desired for the sake of openness; the registration will allow the government to control private clinics and hospitals; under the registration system, treatment information will be centralized to make it easily available to infertile couples; registration is also necessary to prevent the application of treatment methods still under development.

Reference 3-4 Categorization of Technology Assessment

A wide variety of methods are available for technology assessment. It is difficult to precisely classify them. On the basis of different types of technology assessment practiced in Europe, it might be categorized as follows:

* Scope

In a narrow sense, technology assessment in businesses aims at only technological and economical potential of new technologies and products, although in a wider sense, it means a comprehensive system designed to analyze effects of new technologies on the internal and external environments of a business.

* Characteristics

According to Cronberg, the characteristics of technology assessment can be classified on the basis of the relation of the technology to society.

a. Technology Prediction: If it is assumed that society in the future will be defined by technology and that it is possible to foresee technologies, it is essential to endeavor to predict such technologies (Tarja Cronberg, Technology assessment in the Danish socio-political context, Technology Management, Vol. 11, No. 5/6)

b. Passive Technological Evaluation: Based on the assumption that we are capable of knowing the effects of technology on society, such effects are analyzed in a passive manner.

c. Positive Technological Evaluation: Technology assessment is organized also as part of learning new technologies. Under the assumption that we are capable of controlling technological changes, a wide array of methods are employed, such as conversations, scenario workshops and consensus conferences.

d. Society-based Technological Evaluation: On the assumption that technology in a society is determined by interested parties, efforts are made to solve problems through negotiation between those parties.

* For whom?

Technology assessment was originated with the aim of protecting those who are placed in a disadvantageous position as the result of scientific advancement. In the 1970s, particular stress was laid on the prediction of negative effects of technology and science, focusing on consumers and victims of environmental issues. In recent years, however, many experts maintain that, in order to predict negative effects it is essential to involve as many interested parties as possible, such as scientists, engineers, businessmen and government officials, who have a considerable influence on technological advancement (Rathenau Institute, Technology Assessment through Interaction).

* Methodology

A large number of methods have been developed for technology assessment, including brainstorming, checklist, field survey, cost benefit analysis, relevance tree, KJ method, multi-step assessment method, correlational loop diagram, scenario writing, impact matrix method, multi-step filter method, multivariate analysis, delphi technique, random sampling, and system dynamics (The Japan Industrial Technology Association, Survey on Conditions for Effective TA.). These methods are widely employed by experts. A variety of other methods have been invented and tried to encourage civil participation.

Reference 3-5 Environmental Assessment

Environmental assessment is a life-cycle assessment method, having much to share with technology assessment. An environmental assessment system was first established in the U.S. in 1969. In the U.S., environment assessment was conducted earlier than technology assessment. Technology assessment was presumably a result of environment assessment. If Japan conducts environment assessment, all 29 OECD members will have completed some form of legal system that provides general rules for environment assessment. Environment assessment involves preliminary survey, prediction and evaluation to determine effects on the surroundings of large-scale developments that would accompany a change in the natural environment. Previously, environmental assessment was carried out through voluntary cooperation of developers under administrative guidance. As discussed later, the legislation of environment assessment made it mandatory for developers. In Japan, environment assessment is conducted for each development project, while in the U.S. and Europe, attention is centered on the introduction of a more strategic assessment system based on a long-term perspective. This is intended to apply assessment to entire long-term plans of the government, with an understanding that assessment on individual development project is not sufficient to protect the local and national environments.

In Japan, cabinet agreement was made in 1972 on the Environmental Protection Measures for Public Works. Since then, laws, administrative guidance, and local ordinances have been instituted in accordance with the agreement. The Environmental Effect Assessment Law was drafted by the cabinet in 1981, but was rejected by the Congress. The bill was presented to the Congress for the second time and was passed in June 1997 to be enforced in 1999.

The Environmental Effect Assessment Law is applied to 14 categories of large projects implemented or authorized by the government which are expected to cause grave adverse effects on the environment. These projects include the construction of power stations, conventional railroads and forestry roads. The law is intended to facilitate environmental measures at an early stage of construction by having builders scope evaluation items though consultation with the community and local government before starting assessment. The builders are required to compile and publicize preliminary environmental assessment plans before implementation of their projects to collect opinions regarding environmental protection. Then, they prepare environmental assessment schedules. These schedules are adjusted through consultation with the authorities.

The Environmental Effect Assessment Law, however, simply permits the community and the local government to express their opinions, leaving the whole decision to the builders with respect to how much such opinions should be reflected in their projects.

Environmental assessment is different from technology assessment in that legislation is established for the former and that, in implementing it, local characteristics must be taken into consideration.

Reference 3-6 Life-cycle Assessment

Life-cycle assessment is a method of evaluating overall effects of a product on the environment by analyzing each of the life stages of a products, starting from manufacture to use to disposal or reuse of the product. The product is measured at each stage in terms of energy, material and the amount of carbon dioxide emitted. The life-cycle method is useful in devising countermeasures against environmental pollution.

In automobiles, the life-cycle method demonstrates that, through the processes of manufacture, use and disposal of vehicles, about 70% of carbon dioxide is produced when the product is being used. This indicates that focus must be drawn to fuel when designing automobiles. In housing, it is known by life-cycle analysis that, although insulation or air-tight work during construction generates a greater amount carbon dioxide, the disadvantage is compensated in one year, with a further decline in carbon dioxide emissions in later years.

In material engineering, it is noted that, in estimating the life of a product, it is essential not only to measure durability of materials but also to take into consideration the cost and effects of the product on the environment.

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