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BIOETHICS IN CULTURALCONTEXTS
INTERNATIONALLIBRARYOFETHICS, LAW,
AND THE NEWMEDICINE
Founding Editors
DAVID C. THOMASMA†
DAVID N. WEISSTUB, Université de Montréal, Canada
THOMASINE KIMBROUGH KUSHNER, University of California, Berkeley, U.S.A.
Editor
DAVID N. WEISSTUB, Université de Montréal, Canada
Editorial Board
TERRYCARNEY, University of Sydney, Australia
MARCUS DÜWELL, Utrecht University, Utrecht, the Netherlands
SØREN HOLM, University of Cardiff, Wales,United Kingdom
GERRITK. KIMSMA, Vrije Universiteit, Amsterdam, the Netherlands
DAVID NOVAK, University of Toronto, Canada
EDMUND D. PELLEGRINO, Georgetown University, Washington D.C., U.S.A.
DOM RENZO PEGORARO, Fondazione Lanza and University of Padua, Italy
DANIELP. SULMASY, Saint Vincent Catholic Medical Centers, New York, U.S.A.
LAWRENCE TANCREDI, New York University, New York, U.S.A.
VOLUME 28
The titles published in this series are listed at the end of this volume.
Bioethics in Cultural Contexts
Reflections on Methods and Finitude
Edited by
CHRISTOPH REHMANN-SUTTER
University of Basel, Switzerland
MARCUS DÜWELL
University of Utrecht, The Netherlands
and
DIETMAR MIETH
University of Tübingen, Germany
AC.I.P. Catalogue record for this book is available from the Library of Congress.
ISBN-10 1-4020-4240-X (HB)
ISBN-13 978-1-4020-4240-9 (HB
ISBN-10 1-4020-4241-8 (e-book)
ISBN-13 978-1-4020-4241-6 (e-book)
Published by Springer,
P.O. Box 17, 3300 AADordrecht, The Netherlands.
www.springeronline.com
Printed on acid-free paper
All Rights Reserved
© 2006 Springer
No part of this work may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming, recording
or otherwise, without written permission from the Publisher, with the exception
of any material supplied specifically for the purpose of being entered
and executed on a computer system, for exclusive use by the purchaser of the work.
Printed in the Netherlands.
Contents
Introduction
Christoph Rehmann-Sutter, Switzerland; Marcus Düwell, the Netherlands
and Dietmar Mieth; Germany 1
I. Fundamental Aspects 11
1. History and Future of Bioethics
Albert R. Jonsen, USA 13
2. The Need for Ethical Evaluation in Biomedicine and Biopolitics
Dietmar Mieth, Germany 21
3. Finitude – a Neglected Perspective in Bioethics
Beat Sitter-Liver, Switzerland 45
4. Limits of Bioethics
Christoph Rehmann-Sutter, Switzerland 59
5. The Problem of Limits of Law in Bioethical Issues
Silvana Castignone, Italy 81
v
vi
II. Classical Approaches 91
6. One Moral Principle or Many?
Marcus Düwell, the Netherlands 93
7. Danger and Merits of Principlism: Meta-Theoretical Reflections on the
Beauchamp/Childress–Approach to Biomedical Ethics
Bettina Schöne-Seifert, Germany 109
8. The Journey from Ethics to Law: The Case of Euthanasia
Brigitte Feuillet le Mintier, France 121
9. Recognition and Respect for Persons: a Personalistic Interpretation of
Kant's Categorical Imperative
Roberto Mordacci, Italy 129
10. Rationality in Bioethics: Reasonable Adjudication in a Life and Death
Case of the Separation of Cojoined Twins
Deryck Beyleveld, UK 145
III. Culture and Society 163
11. The Public Role of Bioethics and the Role of the Public
Adela Cortina, Spain 165
12. Experts on Bioethics in Biopolitics
Sigrid Graumann, Germany 175
13. The Contribution of Medical History to Medical Ethics: The Case of
Brain Death
Claudia Wiesemann, Germany 187
14. Alternative Medicine: A Dispute on Truth, Power or Money?
Eva Krizova, Czechia 197
15. Dimensions of Cultural Diversity of Medical Ethics
Pavel Tishchenko, Russia 211
vii
IV. Body and Identity 229
16. Body, Perception and Identity
Jean-Pierre Wils, The Netherlands 231
17. Disabled Embodiment and an Ethic of Care
Jackie Leach Scully, Switzerland and UK 247
18. Coping with Limits: Two Strategies and Their Athropological and
Ethical Implications
Walter Lesch, Belgium 263
V. Innovative Modes of Analysis 275
19. What Can the Social Sciences Contribute to the Study of Ethics?
Theoretical, Empirical and Substantive Considerations
Erica Haimes, UK 277
20. Discourse Ethics: Apel, Habermas, and Beyond
Matthias Kettner, Germany 299
21. The Concept of Care Ethics in Biomedicine: The Case of Disability
Eva Feder Kittay, USA 319
22. The Thick Social Matrix for Bioethics: Anthropological Approaches
Rayna Rapp, USA 341
23. Narrative Bioethics
Hille Haker, USA and Germany 353
List of Contributors 377
INTRODUCTION
CHRISTOPH REHMANN-SUTTER, MARCUS DÜWELL,
DIETMAR MIETH
When we placed “finitude”, “limits of human existence” as a motto over
a round of discussion on biomedicine and bioethics (which led to this
collection of essays) we did not know how far this would lead us into
methodological quandaries. However, we felt intuitively that an
interdisciplinary approach including social and cultural sciences would
have an advantage over a solely disciplinary (philosophical or theological)
analysis. Bioethics, if it is to have adequate discriminatory power, should
include sensitivity to the cultural contexts of biomedicine, and also to the
cultural contexts of bioethics itself.
Context awareness, of course, is not foreign to philosophical or
theological bioethics, for the simple reason that the issues tackled in the
debates (as in other fields of ethics) could not be adequately understood
outside their contexts. Moral issues are always accompanied by contexts.
When we try to unpack them – which is necessary to make them accessible
to ethical discussion – we are regularly confronted with the fact that in
removing too much of the context we do not clarify an issue, but make it less
comprehensible. The context – at least some essential parts of it – is intrinsic
to the issue. Unpacking in ethics is therefore a different procedure. It does
not mean peeling the context off, but rather identifying which contextual
elements are essential for an understanding of the key moral aspects of the
issue, and explaining how they establish its particular character. Contexts,
we could claim, are not a kind of packaging at all; they are not something we
could reasonably try to get rid of without losing the substance of what we
want to clarify. This wisdom is as old as ethics itself, and it would be
surprising if it were not also applicable to bioethics.
In the current bioethical discourse, it is obvious that context dependency
characterises not only the moral significance of the issue, but also the
answers we produce. There are “cultural differences” in moral attitudes to
questions such as disclosure of terminal diagnoses, reproductive
technologies, stem cell research, therapeutic cloning, organ transplantation,
brain death, assisted suicide or euthanasia. “Comparative bioethics” started
1
C. Rehmann-Sutter et al. (eds.), Bioethics in Cultural Contexts, 1–10.
© 2006 Springer. Printed in the Netherlands.
2
in the mid 1990s, following the groundbreaking study by Renée Fox and
Judith Swazey (1984) comparing medical ethics in China and the United
States. Different countries, with their specific mix of cultures, have different
laws about these matters, and some of the official attitudes represented in a
1
country’s law might not find equal support in all sectors of society. As
Martha Nussbaum (2000: 49) observes, in the context of ideas of feminism,
democracy and egalitarian welfarism, which now pervade every society,
“the ideas of every culture turn up inside every other, through the internet
and the media.” The idea of homogeneous cultures apart from each other is
unrealistic. Instead of homogeneity, agreement or submission, in reality
there is diversity and contestation. Moral answers, as well as the methods
used to produce them, are rooted in cultural traditions that are themselves
diverse and dynamic. The predominant arguments have “local” histories
and reveal different debates about understanding the role of the human
subject in relation to life and to suffering. This holds true even for the choice
of questions discussed in healthcare ethics and politics. In a world in which
acute wealth differences mean that the single most important risk factor to
global health is in fact malnutrition (WHO 2003), but where in some places
the major risks are seen to be in the over-development of biomedical
technologies, it is clear that not all ethical questions appear equally
important everywhere. The choice of questions also reflects the contestation
of the power structures that are responsible for these striking inequalities in
the trans-cultural distribution of capabilities to live in good health.
This book is not about comparative bioethics and therefore does not
contribute much to these observations. It rather starts from the evidence and
opens a range of methodological questions. The chapters ask, for instance,
how the intrinsically important elements of cultural contexts can be
identified, and how they can be introduced adequately into bioethical
inquiries. Can bioethics be an enterprise that does not simply isolate but also
(re)contextualises? The various chapters also ask about the strengths and
weaknesses of traditional and innovative modes of ethical argumentation in
terms of this set of tasks. Which discipline (or method) would be capable of
doing which job? And how can different approaches and their contributions
be integrated without stepping into an “anthology trap” of just referring to a
variety of historically developed methods (from consequentialism to
deontology, virtue or discourse ethics, care or narrative approaches) one
after the other, leaving people simply faced with the different results and
thereby jettisoning the clarifying and guiding role of ethical investigation?
What are the main differences between and limits of these diverse
approaches to context? The overall question is this: if bioethics is to become
context sensitive, what must be taken into consideration and how should
this be done?
