Bioethical Viewpoints: East and West

I am now attending the 11th Asian Bioethics Conference in Singapore. This is a grueling conference where all the papers are presented one after another in one big room from 8:20 am to almost 8 pm. So let’s see what will happen. Four days before this conference there was a bigger one, the World Congress of Bioethics.

The themes of both conferences focused on cultural perspectives on bioethical issues. During the World Congress there was a panel of no fewer than eight panelists who came together to discuss whether issues in bioethics are universal and culturally relative. For example, there has been an ongoing debate whether issues in bioethics, such as conducting research on human subjects, do admit themselves of cultural variety. In other words, since bioethics is a normative discipline, there is the problem whether those norms transcend cultures or are they restricted to the specifics of cultures wherein the norms take place. In conducting research on human subjects, it is well known that the researchers need to obtain signed informed consent forms from the participants (or subjects). In most cases the consent from the concerned individual is enough. The consent is an agreement between the participant and the researcher only. But in some other cases that is not enough. The research needs also to obtain consent of the community leader in order for them to conduct research on individuals within the community. This happens when researchers go to a remote village and contact individuals there directly. This violates a norm of the village itself, which views itself as a close knit community where decisions needs to be made collectively or through the village leader. Hence the need to obtain consent from the leader in addition to that of the individual herself.

This has generated a lot of debates among bioethicists. Key to the debate is the question of what justifies the need for community consent and also what justifies the need for individual consent in the first place. This is where philosophy can be very useful. But what happens is that when philosophers deal with these issues of justification, they have found that different cultures look at the issue differently. One culture may look at the requirement of community consent to be superfluous, or they may even look at this as an encroachment upon the autonomy of the individuals themselves. If somebody can make a decision about your body on your behalf, then you do not have much of control of yourself to begin with. On the other hand, another culture may believe that the addition of the judgment and decision making by the village leader is necessary, because the individual herself is not an isolated entity existing apart from others. The community is a self-subsisting entity, of which the individual is a part. For an individual to make a decision, such as to allow the researcher to perform research on her body, would mean that the individual is somehow cut off from the community, since the decision comes from herself alone. Furthermore, in real settings the individual may feel that she needs to consult the leader, who speaks for the whole community because she defers to the leader’s wisdom on this kind of thing.

Bioethics have been debating this issue for quite some time. At issue, of course, is the question whether community consent is justified. According to some ethical system, this is not necessary because the individual should control her own destiny and for others to decide things for her would be to limit her freedom and autonomy. But according to another system, this is justified because the individual’s ontological status is different. Instead of being fully autonomous, the individual in this system is only part of her own community.

How can we resolve this issue? The debates surrounding cultural perspectives on bioethics are actually about whether judgments in bioethics are universal and culture-transcendent, or whether they are culture-specific. In addition, the debate is also about “Eastern” and “Western” perspectives. The two kinds of debate are not exactly the same (although many bioethics have always tended to conflate the two). Furthermore, the debate can also be between the East and the West. These need to be spelled out clearly. The first kind of debate is between those who believe that ethical norms are universal and those who do not believe that. The second kind is between those who believe that the Western perspective is universal, and all other perspectives outside of the West are wrong (this also includes those who believe that only the Eastern perspective is right — they may differ about who is right, but they agree that among the two views, at least one must be true). The third kind, moreover, is a straightforward debate between the two perspectives. Instead of talking about “East” or “West,” those who enter the third kind of debate focus their attention on the concrete issues at hand, such as how to obtain informed consent from participants, or the best policy for mother surrogacy, and so on. Representatives from the eastern and western cultures can enter the debate of the third kind without realizing that they come from different cultures.

If this is the case, then we need to be clear first at what level the debate about cultural perspectives on bioethics is. It seems to be that most debates are of the second kind. That is, debates as to which system is universal. Most of the World Congress panelists believed that their judgments are universal and should be accepted and enforced by all cultures. In fact we need to take this position, because if we did not–if we believed instead that validity of arguments depend on where you are from, then there is no point in having intercultural discussion at all. So the standard of good argument needs to transcend cultures.

I think what is lacking in these debates about cultural perspectives is a kind of argument aiming at showing that judgment stemming from a non-western culture is a universal one that should be accepted by all bioethicists. For example, the view that the individual is embedded within the web of social and cultural relations and actually depends on the web for her being should be accepted universally, because it will help solve a lot of problems that we are facing globally in bioethics. It will emphasize he importance of compassion and sympathy, for example, but unfortunately this was not mentioned much at all during these meetings.

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