Rethinking Autonomy: A Critique of Principlism in Biomedical Ethics

Chapter 5 Mental Health, Suicide, and Self-Centered Behavior

Chapter 5 Mental Health, Suicide, and Self-Centered Behavior My mother-in-law is very selfish [わがまま], because she has been living alone for a long time. She is so used to living alone that she thinks nothing of doing things like vacuuming at midnight. My mother-in-law only talks about herself and doesn’t seem very interested in her son or what other people say or are doing. This makes it difficult to interact and communicate with her. I do not want to take care of my mother-in-law should she become ill and this is something I think about, since my husband is the eldest son. —Takahashi Keiko (personal communication) 5.1. Self and Other In the previous chapters, I discussed Japanese concepts of self, mind, body, and family, arguing that the notion of autonomy for Japanese is not conceptualized along the lines of the Western ideal as presented in most ethics discourse. Essentially, Japanese do not really see each human as a morally autonomous locus of decision making—at least not in the relatively isolated sense common in Western moral philosophy. Although Japanese do recognize that each human is an independent entity and self, living is a process of social interdependence that prohibits truly autonomous action. For a person to act in a strongly autonomous way—that 95 96 Rethinking Autonomy is, to demand independence from others—is typically responded to with the term wagamama, which implies a self-centered, egotistical behavior and often a willful and highly independent response in contexts where being a “team player” is valued. To be wagamama is considered contrary to goodness and has consequences, usually in the form of social distancing , which in turn is anathema to (human) being itself, because to be a person necessarily implies interdependence with others. Of course, Americans also can and do view selfishness as negative, but the manner in which they conceptualize being self-centered is different from that of Japanese. This difference lies in the moral import placed on selfish and selfless behavior. For Americans, selfless behavior often is viewed as to some extent supererogatory—it goes above and beyond what is normal. The root assumption is that people will focus on their own needs and desires and then transcend that tendency in certain circumstances. Those who are able to do so regularly are seen in a very positive light. For Japanese, the root assumption is that one will continually be aware of the needs of others and try to anticipate those needs, even if it involves some level of personal self-sacrifice. A simple example I often have used in class to explain this tendency is found in the serving of coffee. Sometimes when I visit someone’s house or a government office in Japan, I will be served coffee without being asked if I like coffee or what I would like in my coffee. It will on occasion come with cream and sugar already mixed in—the aim of the host is to anticipate my needs, which is accomplished using the knowledge that many Americans like sugar and cream in their coffee. Unfortunately, I dislike sugar in my coffee, but the proper response is to drink it regardless of its (disgusting) taste. Again, this is not alien behavior to Americans, who also may drink the coffee in order not to insult the host, but the initial serving of the coffee will be accompanied by a question about whether the guest wants cream and sugar. The difference is that the good host in Japan should be sufficiently sensitive to the needs of a guest to be able to anticipate those needs, while the American host should ask about those needs to make sure they are adequately addressed. In recent years, I have found that Japanese hosts often serve coffee with cream and sugar on the side, allowing me the choice, but making sure that all possibilities are anticipated, or in some cases I am served both coffee and tea by those who know I have spent several years in Japan and may like tea rather than coffee. Although this example may be a bit trivial, it does capture the idea that, for Japanese, humans are not isolated, but must try to be attuned to those around 97 Mental Health, Suicide, and Self-Centered Behavior them, without asking a large number of questions about the desires of those surrounding consociates. In...