Bioethics around the Globe. Catherine Myser, ed., New York: Oxford University Press, 2011, 336 pp.
In 2005, UNESCO passed the Universal Declaration on Bioethics and Human Rights, giving special attention to building capacities in developing countries to address ethical issues in the implementation of new medical technologies and human subject research. The declaration is part of a larger trend over the past two decades led by UNESCO, the EU, NGOs, and government agencies around the world to promote the institutionalization of bioethics though a discourse of democratization and human rights. In this way, bioethics, as a set of ideas and practices in medicine and science that emerged in the United States during 1970s, is imagined to be a presumed universal able to travel unimpeded and unchanged by the new context into which it is transported. Catherine Myser commissioned a multidisciplinary group of regional experts and native scholars to reflect on bioethics in nine developing countries and five developed ones. The result is a volume that challenges the idea of global bioethics and reflects the way that bioethics is both shaped by and implicated in national, cultural, political, and economic interests and projects around the world.
The book is divided into four sections. Section One, Globalizing Bioethics, looks at perils of exporting bioethics to “eastern countries.” Section Two, A Robust Range of Sociocultural Interests and Forces around the Globe, features discussions of bioethics in France, the United Kingdom, Eastern and Central Europe, Chile, Costa Rica, Malawi, South Africa, and China. Discussions range from bioethics in relation to economy, communist ideology, nationalism, colonialism, and human rights to the pharmaceutical industry. Section Three, Bioethics as a Means of Negotiating Social, Regional, and/or National Identity, is a focused look at two case studies: the first, of bioethics and national identity in Canada; the second, of the ways that bioethics debates serve as a means to negotiate competing visions of society in Egypt. Finally, Section Four, Bioethics as a Battleground for Religious and/or Political “Culture Wars,” shows how bioethics is implicated in political power struggles in Australia and reflects on ideas about liberalism in United States. Together, the essays raise several important points about exporting bioethics.
The volume is a timely reminder that bioethics, both as a theory and a global enterprise, is not value free. De Vries and Rott, for example, discuss theological foundation of bioethics, comparing exporting bioethics to missionary work. Likewise, Myser raises a concern that the movement of bioethics around the globe might be promoting values other than those its theory aims to advance: “Bioethics may thus unwittingly be advancing ideologies, power structures and institutions that in the end undermine the ethics enterprise and overall social justice” (p. xx). Emphasizing that value is already built into bioethics can help dislodge the view of the U.S. model of bioethics as neutral and normative.
The essays speak to recent scholarship that has criticized bioethics for serving as a regulatory discourse, protecting interests of pharmaceutical companies, and remaining within a narrow circle of exports, thus failing to respond to needs of the public. By showing how bioethics fails to affect people on the ground, the volume indirectly brings into question the discourse linking bioethics to democracy. For example, in Chapter 1, De Vries and Rott highlight how in India, where government-sponsored bioethics activities barely reach or engage the public, social scientists, religious authorities, or activists (p. 31), bioethics is reduced to a meaningless bureaucratic exercise. In Chapter 3, Simpson argues that bioethics efforts speak to an “imagined international audience” (p. 47), instead of to citizens who are in need of protection. A similar concern, co-optation of bioethics, is raised by Gifford and Rodriguez in Chapter 8 in a discussion of the way the institutionalization of bioethics in Costa Rica is done haphazardly, with questioning levels of expertise and training, lack of government oversight, and private for-fee RECs (research ethics committees) running the show. The chapter serves as a great reminder that, since 1990s, a lot of the bioethics activities around the globe were generated by and meant to support the need of international pharmaceutical research, with private organizations that facilitate clinical trials playing a large role in globalizing bioethics.
Many chapters note a lack of alignment between bioethics as a theory and the local context in which it is transplanted. The authors raise very important issues, such as how do culture, religion, health care structure, corruption, deregulation, open market economy, and lack of trust in providers affect the way bioethics works? For example, Subrata Chattopadhyay shows how in India the idea of bioethics isolated from the collective notion of morality is inconceivable because the individual is considered embedded in social relationships (p. 24).
For many authors, the focus on individual rights, autonomy, and the compartmentalization of knowledge is particularly troublesome. Van Niekerk and Benatar, for example, examine the social functions of bioethics in South Africa and successfully trace the co-emergence of humanitarian concerns in bioethics and the struggle against apartheid and liberation struggle (p. 137). Yet, while these issues are raised, most chapters lack substantial discussion and analysis on precisely how they relate to bioethics. This is partially due to the ambitious projects that many of the authors had undertaken, which is to portray bioethics in a given country from all perspectives (cultural, political, economic). The section on nationalism and national identity building stands out in this regard as more focused and thorough. The volume leaves one with a sense that exporting bioethics to other countries is a fraught process, but without completely achieving the editor’s aim “to explore, identify and analyze the evolution, cultural meanings, and social functions of bioethics theories, practices, and institutions around the globe” (p. xx).
The volume would be suitable for teaching public health and could serve well in medical anthropology classes to give a sense of a range of concerns that arise when bioethics is presumed to travel lightly. It brings together accounts of bioethics largely from perspective of bioethicists, physicians, public health experts, and sociologists. However, essays bring up bioethics largely in terms of fit—i.e., by considering the extent to which a product of U.S. history, culture, and politics, works or not, in the new sociocultural contexts. In that sense, the volume can leave the anthropologically curious audience unsatisfied. Bioethics is also actualized through this traveling around the globe, and, as a reader, I wanted to hear more about the new ethical assemblages that emerge when bioethics meets a particular local context. Furthermore, claims made in chapters discussing cultural and historical difference can seem broad and unsubstantiated. Anthropological perspective would be helpful in this regard because it could show just how bioethics travels around the globe and the way new contested notions of good emerge through that travel.
At times, the authors discuss bioethics as a singular, coherent set of ideas, stabilizing the monolithic view of bioethics that has animated a lot of criticism of bioethics coming from social sciences in the last two decades. In the final chapter, the way Jonathan Moreno examines different philosophical traditions in bioethics through two distinct notions of liberalism is helpful because it complicates the common singular view of bioethics as based on principles and centered around the concept of individual autonomy. Given that most contributors come from a bioethics background, focus on theory is not surprising. More attention to practice, however, instead of ideas, could help bring empirical weight to claims made in the volume and balance the monolithic view of bioethics.
Nevertheless, the volume raises the important question of whether global bioethics is possible or something to aspire to, and suggests that bioethicists in North America and Europe could learn from ethical traditions in developing countries. As Bruce Jennings notes in Chapter 6, bioethics is becoming more engaged with questions of global health equity and health disparities, so this seems like an important contribution.