Working Group Presentation

What cultural differences do we face, among and within countries and regions, that could impede a global consensus?

Ole Döring

FULL TEXT OF PRESENTATION

Some remarks about culture and bioethics

An assessment of cultural issues in bioethics is often phrased in such a way: „What cultural differences do we face, among and within countries and regions, that could impede a global consensus?“

The simple answer to such an enquiry would be “None!” However, this is a misleading question. Cultural diversity does not indicate dissension, because it is presupposed that there is already something we fundamentally share, namely the point of reference, that is, our capacity for “culture”. The question also confuses the starting point of consensus building with the strategic goal. Global consensus must integrate cultural diversity.

By acknowledging fundamental ethical intuitions, comprising all human beings, (as expressed in a variety of different moral and conceptual languages), we may be better prepared to prevent abuse of the global and regional disparities of material and intellectual powers. This provides a regulative normative frame for rejecting views that let humans regard one another as belonging to different moral species, in the name of cultural relativism, invented traditions and political manipulation of the people. If based on a concept of cultural or ethnic essentialism, recognition of the diversity of stakeholders deteriorates into paternalism.

Based on this regulative frame, which can be organised in the form of open and fair stakeholders’ discourse, cultural and other differences among humankind are encouraged and protected to articulate themselves. Normative claims that might impede global consensus have to be assessed in precise terms of (prescriptive) ethics, and not in a language of mystified culture.

From the perspective of a bottom-up-approach, culture hosts a wealth of resources for strategies and ends of conflict management. Culture sustains the living history of creative reason, the fabric of generating and re-drafting responses to what is “good” for humans, societies and the world we live in. Culture should be appreciated for her (self-) critical dimensions, which help to overcome her dogmatic tendencies. The true challenge of a global consensus in ethics lies not in cultural diversity, but in attempts to deny and reject a culture of humanity, in the name of mere personal or professional interests, or in terms of a deprived vision of the “good”. In this light, it is evident that we need more and better engagement in cultural studies in bioethics. (As in the pioneering work by Margaret Lock, Twin Death, California 2002).

We can not look at evolution without admiring the “wisdom of nature”, and therefor appreciate her, and be confident about nature’s resources to aid and heal. Nature helps us to understand how to deal with disease and how to improve our basic conditions so as to remain healthy.

We can not look at the history of humankind without admiring the wisdom of culture. Culture, in her plenitude of expressions in the cultures, must be appreciated as a resource for human values, moral experiences and conflict management. Culture offers us an understanding of our past and present, provides us with social context and identity and the vision of the never ending quest of humanity.

A pertinent example of culture’s richness comes from contemporary Germany. In relation to the heated debates about human embryo protection and the law to permit the importation of human embryonic stem cells from abroad (in 2002), Margot von Renesse has spoken about a “cultural divide” in Germany. This divide appears on the surface as a controversy about policy making and good laws, though it is more than a legal or political matter of interpreting the constitution. Our cultural crises is expressed, not only, in different ways of arguing “What kind of nation do we want to be?” but, more importantly, in the decision not to discuss bioethics in relation to this overall context in the first place. Not only the opinions about the lessons to be learned from Germany’s Nazi past, or from the big social debates in the 1960s, and others, count. The problem is much deeper, in that it puts into question whether policy making in a democracy can be reduced to a business for experts, politicians and administrators, or whether it involves society is a whole, including our place in history and the present and future world. Without such a larger scope, bioethics would in fact become the morally anaemic bureaucratic enterprise critics have labelled her already, that is, a true charade of everything ethics is about.

Why is it important to look at culture, rather than directly at cultural products, such as medicine, or ethics? Culture is a difficult concept to grasp in ethics and in medicine. Culture is not directly normative. An accurate definition of culture describes how it is (or has been), not how it should be.

However, many functions of culture, such as moral and social creativity, feed into the process of generating the fabric of moral life and ethical reflection. When we look at how culture and cultures generate moral claims, (e.g. in attempts to argue that “we should/should not apply the brain death criterion in organ procurement”), this is merely a description of a prescriptive assertion and the related processes of deliberation. It does not inform us in itself whether this assertion is tenable.

Moreover, culture is creative. Human activities in general change the factual world in ways that are sometimes normatively significant. Hence the second major pattern in the concept of culture is that it refers to something made by humans. We are particularly interested in the peculiar human creations that include prescriptive ideas.

Let us consider the following example. Qiu Renzong, the leading bioethicist in China has observed that, "Anatomy and surgery have never fully developed in traditional China, because dissection of a dead body and operation on a body will violate the principle of filial piety". (in Julia Tao, Cross-Cultural Perspectives on the (Im)Possibility of Global Bioethics, Kluwer 2002: 76).

This seems to express a common sense among the public and the educated people. However, what does it really tell us? It can not be inferred from Qiu’s statement whether the general historical assertion is valid (descriptive), nor whether he approves of it or not (prescriptive claim). In fact, it is evident from other writings that Qiu Renzong does not accept traditional Chinese culture as directly normative for contemporary China. He argues that medical sciences should include transplantation studies. This conclusion stands in no relation to the factual assumption above. In fact, Qiu argues for a modification of Chinese values, inasmuch as they are unsuitable for modern China.

Moreover, logically, there appears to be no foundation in xiao (filial piety), since one will not need to dissect a relative. In addition, historically, there have been anatomic dissections, which are reported through medical history. According to experts in the history of Medicine in China, such as Paul Unschuld, the description is historically flawed. Not at least, in an area of dynamic development, there is no common sense in modern cultures about newly emerging ethical puzzles. No culture has finished (or can be expected ever to stop) deliberating about them.

On the other hand, many people in China now are extremely reluctant to donate body parts, even after death. The reasons need to be clarified. I do not see how exploring the past would be the most prominent strategy to achieve such clarification. (There are rumours that many people’s attitudes favour "keeping the body intact after death" in Asian countries. Still a huge role is certainly played (also) by the fear about the medical system, and personal rather than collective sentiments.) We simply can not draw any generalising conclusions from the past culture to the driving motives of the present.

Again, from a cultural argument on the descriptive level there follows no value judgement or ethical determination. This may remind us that there is a different and more meaningful way in ethics to discuss culture. We should avoid mystification of “culture” due to the ambiguity of this concept. The only conclusion that can be drawn from a “cultural argument” in terms of ethics, is to enquire, “so what?”

Cultural reflection provides a perspective frame (Perspektivität) for humanity as a general condition. It manifests the ways we understand and aspire for a “Good Life”, as it is signified, e.g., in the works of literature, in institutions and processes of social life, or in expressions of science and technology. Medicine defines a scientific approach to understand, help and heal people, offering means to improve their present condition. Ethics in particular attempts to reflect upon the meaning of a good life and how our lives might be improved in general terms, under conditions of moral and anthropological plurality.

After the collapse of great ideologies and owing to the critical turn of metaphysics, in secular societies, culture denotes a (problematic) resort for our intellectual endeavour to define the human being as more than a sum of parts and functions. Culture delineates the horizon for critical speculations about the meaning of humanity in terms of (post-) modernity, a point of relation for our drafts to explore and answer the questions of humankind.

How can cultural difference be respected and become a resource for building global consensus in bioethics? At present, diversity of ethical regulations, biopolicies and laws in different countries, (note that these are not the same as cultures!), discrepancies in their implementation (education, enforcement and monitoring) indicate the need for common standards in a narrower sense. Bioethics should actively avoid creating opportunities for entrepreneurs in the life sciences who seek to profit from an insufficiently developed state of law, or from shortcomings in the implementation of existing regulations.

The challenge, on the applied level of ethics, comes from the encounter of different standards, which manifest themselves in double standards, protecting only those who enjoy the most rigorous state of regulation. This situation contradicts basic intuitions of a culture of humanity. Moreover, it represents a poor level of bioethics. It is common sense that, in inter-national research projects involving human subjects, a twofold standard has to be applied. It demands that, in cases of doubts, the stricter protocol should be observed, even when it is not formally required according to the respective country’s laws. For example, whether or not “informed consent” is functioning as a procedure to safeguard the subject against undue invasion of integrity and respect her or his will, including the will not to be informed may serve as a test case for cultural diversity and individual human’s dignity.

An organised attempt to enhance cultural studies in bioethics is the recently installed interdisciplinary research group “Culture-Transcending Bioethics” (based in Bochum university), entitled „Culture-transcending Bioethics. Conditions, Prospects, and Challenges“. Out of a total of eight individual projects, five are based at Bochum’s Ruhr University, two in Bonn and one in Goettingen. An associated project is located in Munich. The German Research Foundation (DFG) has granted funding for two years.

While it will contribute to comparative bioethics, the researchers’ interest also reaches out for systematic features, highlighting the foundations of international, intercultural and interdisciplinary understanding in bioethics. Among other things, it aims to provide more evidence for the relevance of a cultural perspective on bioethics for humanity. It addresses diverse issues raised by the global activities of biomedical technology and the world-wide disparity in bioethical regulations. It scrutinises issues of global and regional health-related justice, which are fuelled, e.g., by cultural and ethnic re-configurations in the aftermath of migration, and gender-related issues. Special attention will be paid to the empirical and conceptual impact of intra-cultural diversity, for example, within the „West“, on policy-making and decision-making. Thus, the myth of cultures as monoliths shall be confronted with reality. In general, the purpose is to probe into the fabric and dynamics of cultural issues on many levels in applied ethics.

In assessing the discourse, different project parts discuss the possibilities and problems of a common frame of questions. Identification of stakeholders is crucial. Who are the participants in the discourse? What are the main issues? Which are the leading opinions and tendencies? How are certain concepts, such as „personhood“, the „human being“, or „community“ evaluated? Whose interests matter? What are the determining political, social, demographic, or economic factors, and how are they reflected within the discourse? These and other questions guide the projects on the individual level, and help them to combine, compare and analyse the findings as a group.

On this basis the main lines of conflict and agreement between cultures in bioethics are assessed. Under discussion are potential normative clues and procedures for maintaining differences under conditions of mutual respect, learning, and understanding. Given the contemporary dominance of „Western“ styles and concepts, this project tries to find out how bioethics could benefit from integrating cultural perspectives and ethical concepts from different cultures. This investigation is expected to reinforce a general model of ethics that transcends mere utilitarian and pragmatic tendencies. The tension between cultural relativism and universalism will be treated with particular attention. (cf.

This is an invitation to learn more about related initiatives and to encourage network building in this fascinating area of bioethics. Greater attention to culture and ethics, and understanding their delicate interplay beyond utilitarian or political reasoning, is necessary and rewarding in view of a humane “global civil society”.

(Note that this author‘s paper about Eugenics in China, presented at the same conference, can be accessed via“ )