Bioethics In Social Context

2. Situated Ethics, Culture, and the Brain Death “ Problem” in Japan

Margaret Lock 2 Situated Ethics, Culture, and the Brain Death “Problem” in Japan Science must no longer give the impression it represents a faithful reflection of reality. What it is, rather, is a cultural system . . . specific to a definite time and place. Wolf Lepenies (1989:64) ANTHROPOLOGISTS ARE trained to be inherently skeptical of generalizations—to be alert to boundaries, margins, and differences. Most, but not all, of us are “splitters” in Tambiah’s idiom (1990); that is, we seek to relativize information by situating it in context. Moreover, to the majority of anthropologists, contextualization intuitively means the situation of knowledge in “cultural” context. But for many thoughtful anthropologists today, the problem of contextualization cannot be dealt with unless two issues are confronted head-on: (1) What do we mean by culture, and does this continue to be a useful category? (Similar questions arise with respect to history.) (2) Do we need to examine all knowledge and practices, including those that go under the rubric of science, in context; that is, must we subject the truth claims of science and their associated ethical commentaries to epistemological scrutiny? Specific, located practices, not theoretical abstractions, should provide the starting point for such examinations. The focus then becomes one of establishing how competing knowledge claims are legitimized and function in practice and, very importantly, determining what impact they have on the lives of the people they affect most directly. Anthropologists, in contrast perhaps to many philosophers and bioethicists, are wary of taking moral positions. Until recently, the object of their research endeavor has been descriptive rather than prescriptive. Over the past decade, however, certain anthropologists have moved to a position quite close to that of “contextualist morality,” as outlined by Hoffmaster (1990), in which morality becomes intelligible “only when the background that makes it possible is considered” (Hoffmaster 1990:250). 39 Contemporary anthropology, certain branches of which are influenced by both hermeneutics and semiotics, is a discipline in which selfre flection about the production of knowledge has become integral to its practice. In particular, the ways in which the knowledge and assumptions of the researcher are inextricably part of the final research product are recognized now. Contextualization is not, therefore, simply an exercise in situating knowledge and practices in a specific locality—in historical and cultural context—rather, it is recognized as an active creation to which the understandings of both observer and observed contribute. Among those who keep abreast of topics in bioethics, most will be familiar with the current situation in Japan, where transplanting solid organs obtained from donors diagnosed as brain dead was prohibited until 1997. Brain death, although a medical diagnosis, was recognized as the end of life in Japan in that year, but only under very specific circumstances . Since 1997 there have been just eight organ procurements from brain dead donors. I have been doing ethnographic research on this topic for approximately twelve years; that is, I have worked to generate a contextualized understanding of the Japanese situation and to translate this understanding into articles written for English language audiences. When I first undertook this research, my more than twenty years of experience in Japan as an anthropologist led me to assume that Japanese culture would in effect account for what is called the “brain death problem” (nôshi no mondai) and, further, that such a contextualized explanation could perhaps stimulate some self-reflection on the part of other societies involved with transplant technology about how their respective cultures are implicated (Lock and Honde 1990). In this chapter, using case studies about the concept of brain death for illustrative purposes, I will attempt to move to a more nuanced approach than the one I took earlier (Lock 1997a, 1997b), an approach in which certain basic concepts, including those of “culture,” “society,” “nature,” “the body,” and “technology” are critically examined. Such an exercise provides a cautionary tale about contextualization and suggests , at the minimum, that it is dangerous to argue that essentialized differences—for example, culturally constructed attitudes toward technology and its application—can pass as situated knowledge. In conclusion I will argue for a politicized situational ethics (following Haraway 1991), in which local knowledge is understood as part of history and culture and in which the agency of the people being researched is not 40 Margaret Lock only acknowledged, particularly with respect to relationships of power, but also...