Accounting for Culture in a Globalized Bioethics

See, e.g., Macklin R. , “Ethical Relativism in a Multicultural Society,” Kennedy Institute of Ethics 8, no. 1 (1998): 1–22; Baker R. , “A Theory of International Bioethics: Multiculturalism, Postmodernism, and the Bankruptcy of Fundamentalism,” Kennedy Institute of Ethics Journal 8, no.3 (1998): 101–32; Baker R. , “A Theory of International Bioethics: The Negotiable and the Non-negotiable,” Kennedy Institute of Ethics Journals, no. 3 (1998): 233–74; Marshall P.A. Thomasma D.C. Bergsma J. , “Intercultural Reasoning: The Challenge for International Bioethics,” Cambridge Quarterly of Healthcare Ethics 5 (1994): 321–28; Pellegrino E.D. , “Is Truth Telling to the Patient a Cultural Artifact?” JAMA 268 (1992): 1734–35; Levine R.J. , “Informed Consent: Some Challenges to the Universal Validity of the Western Model” Law, Medicine, and Health Care 19 (1991): 3–4.

Farmer P. , Pathologies of Power (Berkeley-. University of California Press, 2003): 203.

Id. at 203.

Rawls J. , A Theory of Justice (Cambridge, Mass: Harvard University Press, 1971); Walzer M. , Spheres of Justice: A Defense of Pluralism and Equality (New York, Basic Books, 1983); Moreno J.D. , Deciding Together (Oxford: Oxford University Press, 1995); Engelhardt H.T. Jr. , “Morality, Universality, and Particularity: Rethinking the Role of Community in the Foundations of Bioethics,” in Po-Wah J.T.L. , ed., Cross-Cultural Perspectives on the (Impossibility of Global Bioethics (Dordrecht: Kluwer Academic Publishers, 2002: 19–40).

Neoliberalism, as distinct from classical liberalism, refers to a quasi-religious belief in the market, and in market forces, separated from the actual production of goods and services. Market forces become ends in themselves, and hence social scientists speak of neoliberalism and not of liberalism. Market metaphors are applied to domains of human life, such as control of bodily integrity or body parts, that expand the bounds of liberal economics to domains previously considered off limits for inclusion. At its most extreme, neoliberalism becomes a philosophy of life, not simply a description of an economic structure. In this view, every human being is an entrepreneur managing his or her own life. In summary, neoliberalism is a philosophy in which the existence and operation of markets are valued in themselves, separately from any previous relationship with the production of goods and services, and without any attempt to justify them in terms of their effect on the production of goods and services; and where the operation of a market or market-like structure is seen as an ethic in itself, capable of acting as a guide for all human action, and substituting for all previously existing ethical beliefs. The concept is widely used in critical social science today, and is associated with the sociologist Pierre Bourdieu, among others.

Lieban R.W. , “Medical Anthropology and the Comparative Study of Medical Ethics,” in Social Science Perspectives on Medical Ethics, Weisz George , ed. (Philadelphia: University of Pennsylvania Press, 1990); Marshall P.A. , “Anthropology and Bioethics,” Medical Anthropology Quarterly 6 (1992): 49–73; Muller J.H. , “Anthropology, Bioethics, and Medicine: A Provocative Trilogy,” Medical Anthropology Quarterly 8 (1994): 448–67; Marshall P.A. Koenig B.A. , “Anthropology and Bioethics: Perspectives on Culture, Medicine and Morality” in Medical Anthropology: Contemporary Theory and Method, 2nd edition, Sargent C. Johnson T. , eds. (Westport, CT: Praeger Publishing Co., 1996); Kleinman A. , “Anthropology of Bioethics,” in Encyclopedia of Bioethics, Reich W. ed. (New York: Macmillan, 1995); Kleinman A. , “Moral Experience and Ethical Reflection: Can Ethnography Reconcile Them? A Quandary for ‘The New Bioethics,’” Daedalus 128, no. 4 (1999): 69–97; Coward H. Ratanakul P. , eds., A Cross-Cultural Dialogue on Health Care Ethics (Waterloo, Ontario, Canada: Wilfrid Laurier University Press, 1999); Brodwin P. , ed., Biotechnology and Culture: Bodies, Anxieties, Ethics (Bloomington, IN: Indiana Univ. Press, 2000); Turner L. , “Bioethics in a Multicultural World: Medicine and Morality in Pluralistic Settings,” Health Care Analysis 11, no. 2 (2003): 99–117.

Wolf S.M. , “Shifting Paradigms in Bioethics and Health Law: The Rise of a New Pragmatism,” American Journal of Law and Medicine 20, no. 4, (1994): 395–415.

See, e.g., Rothman D. , Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision-Making (New York: Basic Books, 1991).

Fox R.C. Swazey J.P. , “Medical Morality Is Not Bioethics — Medical Ethics in China and the United States” Perspectives in Biology Medicine 27 (1984): 336–60; Fox R.C. , “The Evolution of American Bioethics: A Sociological Perspective,” in Social Science Perspectives on Medical Ethics, Weisz G. , ed. (Philadelphia: University of Pennsylvania Press, 1990); Weisz G. , Social Science Perspectives on Medical Ethics (Philadelphia: University of Pennsylvania Press, 1990); DeVries R. Subedi J. , eds., Bioethics and Society: Constructing the Ethical Enterprise (Upper Saddle River, N,.J,.: Prentice Hall, 1998); Marshall PA Koenig BA , “Anthropology of Bioethics,” in Encyclopedia of Bioethics 3d edition, Post S. , ed. (New York Macmillan, 2003); Kleinman , 1999, supra nose 5; Turner , 2003, 1999, supra note 4.

Evans J. , “A Sociological Account of the Growth of Principlism,” Hastings Center Report 30, no. 5 (2000): 31–38, at 37.

See Fox 1984 and 1990, supra note 7.

Callahan D. , “The Social Sciences and the Task of Bioethics,” Daedalus 128, no. 4 (1999): 275–94, at 279.

Frank G. Blackhall L.J. Michel V. , “A Discourse of Relationships in Bioethics: Patient Autonomy and End-of-Life Decision Making among Elderly Korean Americans,” Medical Anthropology Quarterly 12 (1998): 403–23; Drought T.S. Koenig B.A. , “‘Choice’ in End-of-Life Decision Making: Researching a Fact or a Fiction?” The Gerontologist 42 (Special Issue III) (2002): 114–28.

See Callahan , supra note 10, at 279.

See id. at 280.

De Vries R. this issue.

Scholars such as Carl Elliott have called attention to the potential conflict of interest issues within bioethics itself. Who funds the bioethics enterprise? Can one truly be independent when competing for funding from the biotechnology or pharmaceutical industry? See, e.g., Elliott C. , “Pharma Buys a Conscience,” The American Prospect 12, no. 17 (2001) vol. 17: 16–20.

See Callahan , supra note10.

See, e.g., Farmer , supra note 1; Mann J. Gruskin S. Grodin M.A. Annas G.J. , Health and Human Rights (New York: Routledge, 1999).

See Callahan , supra note10, at 283.

Rapp R. , Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America (New York: Routledge, 2000).

Id. at 37–38.

Of course some women do actively chose prenatal diagnosis (in spite of beliefs in opposition to abortion), in order to plan for the care of an ill or dying infant. However the work of Nancy Press and Carole Browner demonstrates that particularly for individuals from impoverished or culturally diverse backgrounds, the use of prenatal diagnosis is often not an active or conscious choice involving planning, even for those opposed to abortion. See, e.g., Press N. Browner C.H. Carol H. , “Characteristics of Women Who Refuse an Offer of Prenatal Diagnosis: Data from the California Maternal Serum Alpha Fetoprotein Blood Test Experience,” American Journal of Medical Genetics 78 (1998): 433–45.

Beck S. , “Genetic Transparency and Social Unpredictability: Remarks on a Genetic Screening Program in Cyprus,” paper presented at the Stanford Center for Biomedical Ethics. Program in Genomics, Ethics, and Society, December 19, 2000.

See, e.g., Po-Wah J.T.L. , ed., Cross-Cultural Perspectives on the (Im) Possibility of Global Ethics (Dordrecht: Kluwer Academic Publishers, 2002).

Macklin R. , Against Relativism: Cultural Diversity and the Search for Ethical Universals in Medicine (New York: Oxford University Press 1999), at 4.

Veatch R. , “Is There a Common Morality?” Kennedy Institute Journal of Ethics 13, no. 3 (2003): 189–92, at 192.

Beauchamp T. , “A Defense of the Common Morality,” Kennedy Institute Journal of Ethics 13, no. 3 (2003): 259–74, at 259.

DeGrazia D. , “Common Morality, Coherence, and the Principles of Biomedical Ethics,” Kennedy Institute Journal of Ethics 13, no. 3 (2003): 219–31.

See Turner , supra note 4; Turner L , “Zones of Consensus and Zones of Conflict: Questioning the ‘Common Morality’ Presumption in Bioethics,” Kennedy Institute of Ethics Journal 13 (2003): 219–31.

Turner , 2003, id.

Id. at 196.

Beauchamp T. Childress J. , Principles of Biomedical Ethics, 5th ed., (New York: Oxford University Press, 2001).

See Turner , 2003, supra note 32, at 197.

See, e.g., Geertz C. , The Interpretation of Cultures (New York: Basic Books, 1973); Geertz C. , Local Knowledge (New York: Basic Books, 1983); Shweder R. Muchj N. Mahapatra M. Park L. , “The ‘Big Three’ of Morality (Autonomy, Community, Divinity) and the ‘Big Three’ Explanations of Suffering,” in Morality and Health, Brandt A. Rozin P. eds., (New York: Routledge, 1997: 116–69).

Engelhardt H.T. Jr. , “Introduction: Bioethics as a Global Phenomenon,” in Peppin J.F. Cherry M.J. , eds., Regional Perspectives in Bioethics (Lisse, The Netherlands: Swets & Zeitlinger Publishers, 2003), at xiii.

For the purposes of this article, we do not engage the debate about whether access to health care services is a “second order” right or a first order human right.

Benatar S.R. Daar A.S. Singer P.A. , “Global Health Ethics: The Rationale for Mutual Caring,” International Affairs 79 (2003): 107–36, at 108.

World Health Organization, Ethics and Health website, at <http://www.who.int/ethics/en/>.

See Beauchamp and Childress, supra note 35.

Macklin R. , “After Helsinki: Unresolved Issues in International Research,” Kennedy Institute of Ethics Journal 11 (2001): 17–35; Killen J. Grady C. Folkers G. Fauci A. , “Ethics of Clinical Research in the Developing World,” Nature Reviews 2 (2002): 210–15; Benatar S. , “Reflections and Recommendations n Research Ethics in Developing Countries,” Social Science and Medicine 54 (2002): 1131–41.

See, e.g., Marshall P.A. , “The Relevance of Culture for Informed Consent in U.S.-Funded International Health Research,” in Ethical and Policy Issues in International Research: Clinical Trials in Developing Countries, vol II, (Bethesda, MD: National Bioethics Advisory Commission; 2001: C-1–C38); Loue S Okello D Kawuma M . “Research Bioethics in the Ugandan Context: A Program Summary,” Journal of Law, Medicine and Ethics 24 (1996): 47–53.

Beyrer C. Kass N.E. , “Human Rights, Politics, and Reviews of Research Ethics,” Lancet 360 (2002): 246–51.

National Bioethics Advisory Commission, Ethical and Policy Issues in International Research: Clinical Trials in Developing Countries, vol I, (Bethesda, MD: National Bioethics Advisory Commission, 2001); Hyder A.A. Wali S.A. Khan A.N. Eeoh N.B. Kass N.E. Dawson L. , “Ethical Review of Health Research: A Perspective from Developing Country Researchers,” Journal of Medical Ethics 30 (2004): 68–72.

Ornter S.B. , The Fate of “Culture”: Geertz and Beyond (Berkeley: University of California Press, 1997).

Kuper A. , Culture: The Anthropologists' Account (Cambridge, MA: Harvard University Press, 1999) at 227.

Wilson R. Dissanayake W. , eds., Global/Local: Cultural Production and the Transnational Imaginary (Durham, North Carolina: Duke University Press, 1996); Gupta A. Ferguson J. , eds., Anthropological Locations: Boundaries and Grounds of a Field Science (Berkeley: University of California, 1997).

Appadurai A. , Modernity at Large: Cultural Dimensions of Globalization (Minneapolis: University of Minnesota Press, 1996: 45).

Brown M.F. , Who Owns Native Culture? (Cambridge: Harvard University Press, 2003).

See Appadurai , supra note 50, at 13. 53- See Kuper , supra note 48, at 227.

Taylor C. , Multiculturalism: Examining the Politics of Recognition (Princeton, N. J.: Princeton University Press, 1992).

Cowan J.K. Dembour M.B. Wilson R.A. , Culture and Rights: Anthropological Perspectives (Cambridge: Cambridge University Press, 2001); Niezen R. , The Origins of Indigenism: Human Rights and the Politics of Identity, (Berkeley: University of California Press, 2003).

See Macklin , supra note 24.

Carrese J.A. Rhodes L.A. , “Western Bioethics on the Navajo Reservation,” JAMA 274 (1995): 826–29.

See Macklin , supra note 24, at 264.

Id. at 92.

Myser C. , “Differences from Somewhere: The Normativity of Whiteness in Bioethics in the United States,” American Journal of Bioethics 3 (2003): 1–11.

Baker R. , “Balkanizing Bioethics,” American Journal of Bioethics 3 (2003): 13–14.

See Benatar Daar Singer , supra note 39.

See Farmer , supra note 1, at 201.

Gostin L. , “Emerging Issues in Population Health: National and Global Perspectives,” Journal of Law, Medicine and Ethics 31 (2004): 476–80.

See, e.g. Thomasma D.C. , “Bioethics and International Human Rights,” Journal of Law, Medicine and Ethics 25 (1997): 295–306; Kleinman A. Das V. Lock M. , Social Suffering (Berkeley: University of California Press, 1997); Macklin R. , supra note 28; Mann J Gruskin S. Grodin M. Annas G.J. , Health and Human Rights (New York: Routledge, 1999); Kass N.E. , “An Ethics Framework for Public Health,” American Journal of Public Health 91 (2001): 1776–82; Gostin L.O. , Public Health Law and Ethics: A Reader (Berkeley: University of California Press, 2002).

See Benatar Daar Singer , supra note 39, at 108.

Farmer P. “On Suffering and Social Violence: A View from Below,” in Social Suffering, Kleinman A. Das V. Lock M. , eds. (Berkeley: University of California Press; 1997): At 278.

Mukherjee J. , “HIV-1 Care in Resource-Poor Settings: A View from Haiti,” Lancet 362 (2003): 994–95.

DeVries R. , “Bioethics and Sociology,” Journal of Law, Medicine and Ethics 32, no. 2 (2004).

Farmer P. Gastineau N. , “Bioethics and Human rights in the Global Era,” Journal of Law, Medicine and Ethics 32, no. 2 (2004).

See, e.g., Hoffmaster B. , ed., Bioethics in Social Context (Philadelphia: Temple University Press, 2001); Das V. , “Public Good, Ethics, and Everyday Life: Beyond the Boundaries of Bioethics,” Daedalus 128 (1999): 99–133; Bradley P. Burls A. , Ethics in Public and Community Health (New York: Routledge, 2000); Levin B.W. Schiller N.G. , “Social Class and Medical Decision making: A Neglected Topic in Bioethics,” Cambridge Quarterly of Healthcare Ethics 7 (1998): 41–56.

See, e.g., Blackhall L. Murphy S. Frank G. Michel V. Azen S. , “Ethnicity and Attitudes Toward Patient Autonomy,” JAMA 274 (1995): 782–825.

Jones J. , Bad Blood: The Tuskegee Syphilis Experiment (New York: Free Press, 1993).

Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare (Washington D.C.: National Academy Press, 2003).

Harris D.R. Andrews R.M. Elixhauser A. , “Racial and Gender Differences in the Use of Procedures for Black and White Hospitalized Adults,” Ethnicity and Disease 7 (1997): 91–105.

Fox R.C. Swazey J.P. , The Courage to Fail: A Social View of Organ Transplants and Dialysis (Chicago: University of Chicago Press, 1974); Fox R.C. Swazey J.P. , Spare Parts: Organ Replacement in American Society (New York/Oxford: Oxford University Press, 1992); Ohnuki-Tierney E. , “Brain Death and Organ Transplantation,” Current Anthropology 35 (1994): 233–54; Sharp L. , “Organ Transplantation as a Transformative Experience: Anthropological Insights into (he Restructuring of the Self,” Medical Anthropological Quarterly 9 (1995): 357–89; Lock M. , “Contesting the Natural in Japan: Moral Dilemmas and Technologies of Dying,” Culture, Medicine and Psychiatry 19, no. 1 (1995): 1–38; Scheper-Hughes N. , “Theft of Life: The Globalization of Organ Stealing Rumors,” Anthropology Today 12, no. 3 (1996): 3–11; Ikels C. , “Kidney Failure and Transplantation in China,” Social Science and Medicine 44 (1997): 1271–83; Das V. , “The Practice of Organ Transplants: Networks, Documents, Traaslations,” in Living and Working with the New Medical Technologies: Intersections of Inquiry, Lock M. Young A. Cambrosio A. , eds. (New York: Cambridge University Press, 2000); Marshall P.A. Daar A.S. , “Ethical Issues in Human Organ Replacement: A Case Study from India,” in Global Health Policy, Local Realities: The Fallacy of the Level Playing Field, Whiteford L.M. Manderson L. , eds., (Boulder, CO: Lynne Publishers, Inc., 2000); Gordon E.J. , “They Don't Have to Suffer for Me: Why Dialysis Patients Refuse Offers of Living Donor Kidneys,” Medical Anthropology Quarterly 5 (2001): 1–22; Lock M. , Twice Dead: Organ Transplants and the Reinvention of Death (Berkeley: University of California Press, 2002);

Fox Swazey , supra note 78.

See Lock , Twice Dead, supra note 78; Youngner S.J. Arnold R.M. Schapiro R. , eds., Definition of Death: Contemporary Controversies (Baltimore: Johns Hopkins University Press, 1999).

Lock M. , “Death in Technological Time: Locating the End of Meaningful Life,” Medical Anthropology Quarterly 10 (1996): at 575.

See, e.g., Joralemon D. , “Organ Wars: The Battle for Body Parts,” Medical Anthropology Quarterly 9 (1995): 335–56; Lock M. , “Transcending Mortality: Organ Transplants and the Practice of Contradictions,” Medial Anthropology Quarterly 9, no. 3 (1995): 390–92; Lock M. , “Displacing Suffering: The Reconstruction of Death in North America and Japan,” Daedalus 125 (1996): 207; Fox R.C. O'Connell L. Youngner S. , eds., Meanings and Realities of Organ Transplantation (Madison: University of Wisconsin Press, 1996); Hogle L. , Recovering the Nation's Body: Culture Memory, Medicine, and the Politics of Redemption (New Brunswick, N.J.: Rutgers University Press, 1999); Sharp L. , “Commodified Kin: Death, Mourning, and Competing Claims on the Bodies of Organ Donors in the United States,” American Anthropologist 103 (2001): 112–33.

Cohen L. , “Where it Hurts: Indian Material for an Ethics of Organ Transplantation,” Daedalus 128, no. 4 (1999): 135–65; Scheper-Hughes N. , “The Global Traffic in Human Organs,” Current Anthropology 41 (2000): 191–224.

Reddy K.C. , “Controversies in Paid Organ Renal Transplantation — An Indian Viewpoint,” Asian Journal of Surgery 17, no. 4 (1994): 326–30; Marshall P.A. Thomasma D. Daar A.S. , “Marketing Human Organs: The Autonomy Paradox,” Theoretical Medicine 17 (1996): 1–18; Murray T. , “Organ Vendors, Families, and the Gift of Life,” in Fox R.C. O'Connell L. Youngner S. , eds., Meanings and Realities of Organ Transplantation (Madison: University of Wisconsin Press, 1996); Nelkin D. Andrews L. , “Homo Economicus: The Commercialization of Body Tissue in the Age of Biotechnology,” Hastings Center Report 28, no. 5 (1998): 30–39; Radcliffe-Richards J.R. Daar A.S. Guttmann R.D. Hoffenberg R. Kennedy I. Lock M. Sells R.A. Tilney N. , “The Case for Allowing Kidney Sales, International Forum for Transplant Ethics,” Lancet 351 (1998): 1950–52; Joralemon L. , “The Ethics of the Organ Market: Lloyd Cohen and the Free Marketeers,” in Biotechnology, Culture, and the Body, Brodwin P. , ed. (Urbana: University of Indiana, 2000); Cohen C.B. , “Public Policy and the Sale of Human Organs,” Kennedy Institute of Ethics Journal 12, no. 1 (2002): 47–64. Delmonica D.F.L. Arnold R. Scheper-Hughes N. , “Ethical Incentives — Not Payment — for Organ Donation,” N. Engl. J. Med. 346, no. 25 (2002): 5.

Radcliffe-Richards J.R. , “Nepharious Goings On: Kidney Sales and Moral Arguments,” Journal of Medicine and Philosophy 21, no. 4 (1996): 375–416; Gui M.B. Sade R.M. , “Paying for Kidneys: The Case Against Prohibition,” Kennedy Institute of Ethics Journal 12, no. 1 (2002): 17–45.

Joralemon D. , “Shifting Ethics: Debating the Incentive Question in Organ Transplantation,” Journal of Medical Ethics 27 (2001): 30–35.

See id.; Joralemon D. , supra note 84.

Veatch R.M. , “Why Liberals Should Accept Financial Incentives for Organ Procurement,” Kennedy Institute of Ethics Journal 13 (2003): 19–36, at 19.

Khan J.P. , “Three Views of Organ Procurement Policy: Moving Ahead or Giving Up?” Kennedy Institute of Ethics Journal 13, no. 1 (2003): 45–51.

Lock M. , Transcending Mortality: Organ Transplants and the Practice of Contradictions, Medical Anthropology Quarterly 9 (1995): 390–99.