A Kansai Joint Regular Meeting, organized this year by the JCLU Kyoto, was held at the Kyoto Rakuyo Kyokai on November 2, 1995. The topic of the meeting was a book entitled The External Genitals of Japanese Women. The reporters were Mr. Kinoe Inoue and Ms. Keiko Okada, representatives of a group organized to protest the book's publication.
Misgivings over the book, published by the Free Press Service, were first raised when the book was advertized on the front page of the Asahi Shimbun in September 1995. Shortly afterward, the book was also introduced in various weekly magazines, such as Shukan Bunshun.
Concerned citizens started a protest against the author -- Mr. Hiroshi Kasai, Assistant Professor of Gynecology at Shiga University of Medical Science -- and the publisher. They also requested an investigation by the Hygiene Department of the Shiga Prefecture, the Ministry of Health and Welfare, and the Ministry of Education. In addition, claims have been filed with the Public Prosecutor's Office, the Ministry of Justice, and other relevant bodies for the alleged obscenity of the book.
Shiga University of Medical Science has formed its own investigative committee regarding the allegations. The University seems, however, to have put forth only a token effort. At the moment, the University has admitted that in the past, the author has indeed taken pictures and measurements of his patients' genitals and printed this material in his other books without patient consent. However, the University is denying responsibility by maintaining, "The pictures included in this specific book were, according to the author, taken outside of the University hospital and with the consent of his patients. As the author says that he has destroyed pictures taken inside the University hospital, we no longer have authority to investigate this matter."
The author is said to have collected pictures of 8,330 cases. Since he has worked at Shiga University of Medical Science for fifteen years, most of these pictures were, in all probability, taken from patients he had treated while at the University. Furthermore, several facts indicate that his practice of unconsented documentation has long been known inside the University. Despite its significant role in the matter, the University has simply disposed of the case by issuing a written warning against the author and accepting his voluntary retirement at the end of March 1996.
Both the author and publisher insist that The External Genitals of Japanese Women is a scholarly book. Such an assertion, however, does not seem to be supported by the fact that the book has been sold to the general public and has enjoyed such rare popularity that three additional printings have been produced.
In addition to the above facts reported by the protest group, an element of sexual harassment has been introduced by a participant who claims to have been misdiagnosed by Dr. Kasai, the author. She has expressed that the newly revealed allegations regarding the publication of the book and invasion of patients' privacy have multiplied her original pain and anger, to the extent that she feels raped.
This case involves, on one hand, a human rights violation within the context of medical practice and, on the other, the issue of obscenity. The two elements converge on the issue of sexual harassment. At the moment, however, it would be more effective to approach this problem within the context of the former two elements: medical ethics and obscenity.
With regard to medical ethics, it is evident that the author, Dr. Kasai, violated the contract of treatment (unauthorized measurement and picture-taking which were irrelevant to treatment). It is also evident that he violated the patients' privacy by publishing the pictures without consent.
The author and the publisher maintain that the book was solely a scholastic endeavor. However, as stated in the Declaration of Helsinki, adopted by the World Medical Association, studies irrelevant to treatment should not be permitted. A mere assertion of "scholarly work" cannot justify such a book. The External Genitals of Japanese Women must indeed be scrutinized under this internationally recognized standard.
The book ostensibly maintains the appearance of a scholarly work. When closely examined, however, the displays of the photos and descriptions in the book cannot avoid suspicion of pornographic intention. Foremost, the book is openly available to the general public, while most academic works have restricted access. These facts substantiate the suspicion that the book's primary nature is obscene, rather than scholarly.
Other books and publications by Dr. Kasai suggest that his work contains elements that are not purely scholarly. Before this controversial work, he had published such books as Science of Excellent Genital Organs, Introductory Skills to Please a Woman in Bed, and Fitness of Women. These books, as well as his regular columns in a weekly magazine written after he had retired from the University, seem indicative of his non-scholarly intentions.
There is the potential that this case will be trivialized into a sexual scandal involving just another gynecologist, soon be forgotten. In order to avoid such irresponsible "yellow journalism," this case must be approached in a deliberate, strategic manner. It is important, at the outset, to focus on the issue of the patients' human rights violations, then to question the responsibilities of the author, Shiga University of Medical Science, the publisher, and other concerned parties.
It is evident that this is a case which has been caused and condoned by medical practices in Japan, where the rights of medical patients are hardly considered.
Editors' note: Prior to the above joint meeting in Kyoto, the JCLU held a meeting in Tokyo in July 1996 on the same issue, and invited members of a group protesting the book. Additional information concerning the above article -- provided by Ms. Machi Nishizawa and Ms. Keiko Tada, both from Niigata prefecture, and Ms. Keiko Okada from Shiga prefecture -- is as follows:
The group was formed two months after the book's publication under the claim that the work is a product of medical malpractice. The book contains seven hundred pictures of female external genitals.
The publisher insists that access to the book is limited only to those in the medical field. However, the book is in fact available to the general public at bookstores without any restrictions.
The group sent a protest letter to the author, the publisher, and Shiga University of Medical Science requesting the retrieval of the book from bookstores, the curtailment of any additional sales, and a meeting with the author.
Shiga University of Medical Science established an inquiry commission in November 1995. In January 1996, it submitted a report to the Shiga prefecture. The report admits that the author had taken pictures of patients' external genitals without consent during his stay at the University Hospital. The report also asserts that the author and University exchanged a correspondence confirming the following points: 1) the submission of all the pictures taken and their negatives to the professor of gynecology at the University; 2) the abstainment from future publication of the pictures taken without consent; and 3) a request to the publisher to limit future sales to scholars of gynecology only.
The group has also taken legal measures. In April 1996, it filed a request with the Japan Federation of Bar Associations that the human rights violation be remedied. On June 3, 1996 it also submitted a request for the indictment of both the author and the publisher with the Otsu District Prosecutors' Office, where the request was received for consideration.
The group has examined the possibility of filing a civil lawsuit as well. However, one substantial obstacle is the difficulty in identifying the victims. In addition, even if the victims could be identified, it would be still more difficult to persuade them to come forward as plaintiffs.
After the protest group's report, several suggestions were made by participants on possible future approaches. A civil suit might be feasible, but it would require elaborate and specific goals in order to be successful. In addition, the academic society and medical associations could be other targets against which to file a claim. Lastly, responsibility of Shiga University of Medical Science should also be questioned for the institution's inaction over the author's malpractice.
un, July 25, 1996, No. 301]