Bioethics in Asia — Global Bioethics

1 Bioethics in Asia — Global Bioethics The inaugural issue of the Asian Bioethics Review made the point that Asian bioethics could be more appropriately referred to as bioethics in Asia. Here, we make the point that bioethics in Asia is also global bioethics. Bioethics in Asia is not meant to limit scope or to define Asian bioethics in a purely geographic way. Being Asian in terms of origin of a particular debate, location of participants, regional relevance of the issues deliberated upon, principles or world views invoked in the discussions, or some other geographically related factor, serves merely as a contextual starting point. It does not serve to set a boundary beyond which Asian Bioethics cannot tread. The ethical issues that confront Asians in medicine, science and technology are not radically different from the issues that confront people in other parts of the world. The starting discourse in various places may differ in terms of sophistication, maturity or dominant theoretical frameworks but ideas and concepts now have a way of travelling swiftly over great distances and people find themselves eventually engaged in bioethics conversation that transcends physical boundaries. A number of articles in this issue illustrate this transcendent conversation. The article co-published with the Hastings Center, Dan Brudney’s “Choosing for Another: Beyond Autonomy and Best Interests”, reminds us of the global character of many issues that arise in bioethics discourse. Choosing for “another” is something many Asians find themselves having to do insofar as medical management options are concerned. But people find themselves having to choose for another under situations different from those stipulated in the article. Thus, some do it not because the “other” for whom they are choosing has lost the capability or has explicitly delegated the responsibility by way of an advance directive, but because it is a practice thought to be justified by a need to protect a loved one from the difficulty of making a choice as an embattled patient. Asian Bioethics Review March 2009 Volume 1, Issue 1 1–4 F r o m t h e E d i t o r F R O M T H E E D I T O R A s i a n B i o e t h i c s R e v i e w M a r c h 2 0 0 9 Vo l u m e 1 , I s s u e 1 2 A few choose for another in order to protect that loved one (the other) from what they take to be the “horrors” associated with knowing one’s truly desperate situation. It would be very interesting to speculate on the extent to which Brudney’s analysis could be stretched to apply to those cases. In those cases, surrogate decision making (choosing for another) takes on a meaning that may be difficult to understand outside the cultural context in which relationships and responsibilities are defined. The second piece that is being co-published with the Hastings Center Report, D. Alan Shewmon’s “Brain Death: Can it be Resuscitated?” reviews the white paper on death recently released by the U.S. President’s Council on Bioethics. Shewmon credits the President’s Council for avoiding the ‘question-begging and ambiguous term “brain death,” replacing it with the philosophically neutral and physiologically clearer term “total brain failure.”’ The white paper may be expected to have a global impact on thinking about matters related to the determination of death and Shewmon’s review highlights the focus of controversies that are addressed in the white paper. Notwithstanding their value for clarifying and enhancing the debates surrounding the determination of death, the white paper and the review fail to acknowledge the need to understand the notion of death within a particular cultural context. Reference is often made to the death of the organism but beyond the organism is a person who has lived a social life — an existence beyond the “organismic”. This point relates to Ratanakul’s observation in his retrospective that “Thai Buddhists are … sceptical about the capacity of medical science to determine the exact moment of death when consciousness ceases.” Perhaps it is not merely scepticism about the moment when...