Bioethics and Moral Content: National Traditions of Health Care Morality: Papers dedicated in tribute to Kazumasa Hoshino PDF
Preview Bioethics and Moral Content: National Traditions of Health Care Morality: Papers dedicated in tribute to Kazumasa Hoshino
BIOETHICS AND MORAL CONTENT: NATIONAL TRADITIONS OF HEALTH CARE MORALITY Philosophy and Medicine VOLUME74 Founding Co-Editor Stuart F. Spieker Editor H. Tristram Engelhardt, Jr., Department of Philosophy, Rice University, and Baylor College of Medicine, Houston, Texas Associate Editor Kevin Wm. Wildes, S.J., Department of Philosophy and Kennedy Institute of Ethics, Georgetown University, Washington, D.C. ASIAN STUDIES IN BIOETHICS AND THE PHILOSOPHY OF MEDICINE 3 Series Editor Ruiping Fan, Department of Public & Social Administration, City University of Hong Kong, Hong Kong Editorial Advisory Board Kazumasa Hoshino, Kyoto Women's University, Kyoto, Japan Shui Chuen Lee, National Central University, Chung-li, Taiwan Ping-cheung Lo, Hong Kong Baptist University, Hong Kong Ren-Zong Qiu, Chinese Academy of Social Sciences, Beijing, China The titles published in this series are listed at the end of this volume. BIOETHICS AND MORAL CONTENT: NATIONAL TRADITIONS OF HEALTH CARE MORALITY Papers dedicated in tribute to Kazumasa Hoshino Edited by H. TRISTRAM ENGELHARDT, JR. Department of Philosophy, Rice University and Baylor College rif Medicine, Houston, USA and LISA M. RASMUSSEN Department of Philosophy, Rice University, Houston, USA SPRINGER-SCIENCE+BUSINESS MEDIA, B.V. Library of Congress Cataloging-in-Publication Data is available. ISBN 978-90-481-5658-0 ISBN 978-94-017-0902-6 (eBook) DOI 10.1007/978-94-017-0902-6 Printed on acid-free paper AII Rights Reserved © 2002 Springer Science+Business Media Dordrecht Origina11y pub1ished by Kluwer Academic Pub1ishers in 2002 Softcover reprint of the hardcover 1s t edition 2002 No part of this publication may be reproduced or utilized in any form or by any means, electronic, mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the copyright owner. TABLE OF CONTENTS H. TRISTRAM ENGELHARDT, JR. AND LISA M. RASMUSSEN I Bioethics in the Plural: An Introduction to taking Global Moral Diversity Seriously 1 PART I I PHYSICIAN VIRTUE AND NATIONAL TRADITIONS ROBERT M. VEATCH I The Physician: Professional or Entrepreneur 17 TANGJIA WANG I The Physician-Patient Relationship and Individualization of Treatment from the View of Traditional Chinese Medical Practice 35 PART II I MEDICAL TECHNOLOGIES AND NATIONAL BIOETHICS HANS-MARTIN SASS I Medical Technologies and Universal Ethics in Transcultural Perspective 49 KURT BAY ERTZ AND KURT W. SCHMIDT I Brain Death, Pregnancy and Cultural Reluctance toward Scientific Rationalism 77 MAURIZIO MORI I Bioethics in Italy up to 2002: An Overview 97 FABRICE JOTTERAND I Development and Identity of Swiss Bioethics 121 PART III I DEATH, CULTURE, AND MORAL DIFFERENCE MICHAEL D. FETTERS AND MARION DANIS I Death with Dignity: Cardiopulmonary Resuscitation in the United States and Japan 145 HO MUN CHAN I Euthanasia, Individual Choice and the Family: A Hong Kong Perspective 165 CORINNA DELKESKAMP-HAY ES I Dissensus in the Face of a Passion for Consensus: How the Japanese and the Germans Could Still Understand One Another 191 v vi TABLE OF CONTENTS PART IV I GLOBAL BIOETHICS AND ITS CRITICS LISA M. RASMUSSEN I Moral Diversity and Bioethics Consultation 205 DAVID C. THOMASMAt I The Challenge of Doing International Bioethics 215 JONATHAN CHAN I Taking Moral Diversity Seriously: A Discussion of the Foundations of Global Bioethics 235 MARKJ. CHERRY I Coveting an International Bioethics: Universal Aspirations and False Promises 251 RUIPING FAN I Reconstructionist Confucianism and Bioethics: A Note on Moral Difference 281 NOTES ON CONTRffiUTORS 289 INDEX 291 H. TRISTRAM ENGELHARDT, JR. AND LISA M. RASMUSSEN BIOETHICS IN THE PLURAL: AN INTRODUCTION TO TAKING GLOBAL MORAL DIVERSITY SERIOUSLY I. DIALOGUES ON DIFFERENCE On August 15, 1979, the first author of this article presented a paper concerning the philosophy of medicine at Sophia University in Tokyo. In the audience were philosophers, theologians, and physicians - they were politely puzzled concerning the claims made about the new field of bioethics. During that trip to Tokyo, the first author also visited in passing at Kitasato University's hospital in Tokyo. In all of these meetings, it was clear that the Americans, Texans, and Japanese saw issues of bioethics from radically different perspectives. Yet, the Americans claimed that the differences were superficial. In fact, they held that all sides should come to recognize that they shared a common understanding of ethics, which was to ground the new field of bioethics. This visit was followed by a series of meetings, again in August, this time in 1986, at Kitasato University School of Medicine in Sagamihara City. Once again, the audience was politely puzzled, although a number of the physicians voiced the view that the medical ethics of Japan was radically different from that of the United States. The response on the part of most of the American bioethicists was again to assure their Japanese hosts that the bioethics they (the Americans) were expounding reflected the common morality of mankind, whether or not the Japanese recognized this to be the case. The Americans were of the view that the critical reflective character of Western philosophy had brought them to understand the conceptual assumptions at the root of proper moral deportment. They were convinced that, with analysis and reflection, the considered judgments of Japanese philosophers and physicians would come to accord with that of American bioethics. This was the year in which the first author of this introduction published the first edition of The Foundations of Bioethics (Engelhardt, 1986). This author was, needless to say, skeptical of the position taken by his American colleagues, although he with his libertarian arguments appeared nevertheless strange to his Japanese hosts. He recognized, among other things, that American and Japanese bioethicists were attempting H. T. Engelhardt. Jr. and L.M. Rasmussen (eds.), Bioethics and Moral Content: National Traditions of Health Care Morality, 1-14. © 2002 Kluwer Academic Publishers. 2 H. TRISTRAM ENGELHARDT, JR. AND LISA M. RASMUSSEN somewhat similar but still essentially different undertakings under the rubric of bioethics. These encounters have been followed by a number of important meetings with Japanese scholars over the years. One of the most significant was the meeting with Kazumasa Hoshino and his colleagues. Through him and the Liaison Society of Ethics Committees of Medical Schools in Japan, the first author came to recognize both how similar and how different ethics committees and ethics consultations functioned in Japan versus the United States. Over the years, through numerous interchanges, this became even clearer. This encounter with the differences between Japanese and American approaches took further shape over the years at various conferences, including the very significant conference the proceedings of which appeared as Japanese and Western Bioethics: Studies in Moral Diversity, edited by Kazumasa Hoshino (Hoshino, 1997). Japanese bioethics distinguished itself from American bioethics by the former's focus on deeply developed senses of moral virtue and character, which were understood to guide the harmonious interaction of physicians, patients, and their families, and by the latter's focus on individuals, their autonomy, and their good. This peculiarly fragmented American approach has obvious roots in the ways in which religious and moral pluralism have structured the American experience. Physicians, patients, and their families cannot presume a common understanding of human virtue, character, and flourishing. Indeed, the American experience has involved creating space for the peaceable expression of moral difference. The differences among moral perspectives and their implications for the practice of bioethics became clear to the authors of this introduction as they explored the nature of practical bioethics. At the bedside, physicians, patients, and their families often possess radically different expectations regarding the role and functions of bioethicists. Even within the same culture, at least within the same Texan and American culture, there is a significant range of expectations from bioethicists. II. DIFFERENCES IN BIOETHICS: A CRITICAL ASSESSMENT The authors of the essays in this volume honor the work of Kazumasa Hoshino in many different ways. Robert Veatch, David Thomasma, Lisa Rasmussen, and Michael Fetters and Marion Danis focus on differences BIOETHICS IN THE PLURAL: INTRODUCTION 3 between Western bioethics and Japanese bioethics, illustrating both similarities and differences between the two cultures. Tangjia Wang, Fabrice Jotterand, Ho Mun Chan, Mark Cherry, Ruiping Fan and Kurt Bayertz and Kurt Schmidt give accounts of disagreement between cultures regarding bioethics, impressing upon us the importance of Hoshino's insights concerning the implications of cultural diversity for bioethics. Finally, Hans-Martin Sass, Jonathan Chan, and Corinna Delkeskamp-Hayes tackle the possibility of a global ethics directly, and Ruiping Fan offers a defense of bioethics grounded in a Reconstructionist Confucian account of moral probity. A. Section One: Physician Virtue and National Traditions Section One addresses the question of the role of the physician. Robert Veatch begins by taking us on a conceptual tour in "The Physician: Professional or Entrepreneur?" Western bioethics is confronted with these two views of physicians, and Veatch points out the problems with each. Viewing doctors as belonging to a noble profession with its own special requirements (such as making house calls, providing free service for the poor, and behaving as a pillar of the community) is appealing in many ways, not least because it is how they have been seen historically. However, such a view is at odds with the physician as self-interested. According to Veatch, therein lies one of the problems: this model requires physicians to be supererogatory. It also ignores the fact that conflicts of interest cannot be removed simply by forbidding physicians to own laboratories to which they can send specimens from their patients. Any choice that involves pay to the doctor involves a potential conflict of interest; however, a physician must earn a living. As for the entrepreneurial model, which construes physicians as businessmen, it too has problems. Caveat emptor requires the patient to be a more informed "buyer" than the doctor might be able to help him become. A sensible patient/buyer might want to know the doctor's economic incentive structure, utilization rates, investment interests and so on. In addition, Veatch argues, the more patients regard physicians as entrepreneurs, the less reason they have to trust them. In time, with sufficient information, rigorous outside regulation would become necessary. Veatch does not draw conclusions from these observations, leaving readers to make up their own minds. However, he does look briefly at Japanese culture, asking whether Japanese face the same choice
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