Beyond a Western Bioethics: Voices from the Developing World (review)

Beyond a Western Bioethics: Voices from the Developing World. Edited by Angeles Tan Alora and Josephine M. Lumitao. Washington, DC: Georgetown Univ. Press, 2001. Pp. 176. $59.95.

The study and application of bioethics began as an American intellectual and cultural phenomenon. Americans often view their culture and its derivatives as superior to other cultures. They are anxious to spread their thinking and way of life to other countries and cultures. Too often, other cultures are also anxious to become Americanized. It is not only rock music, McDonald's, and Pizza Huts that are adopted by other cultures, but also our ethical traditions. Often those traditions—based on concepts of individual autonomy, informed consent, and truth-telling—do not fit the culture that tries to adapt them.

In the summer of 1986, through the support of the International Federation of Catholic Universities, H. Tristram Engelhardt, Jr., planned a bioethics seminar to be held in Manila with the co-sponsorship of the University of Santo Tomas and the Santo Tomas Hospital. The seminar, held in March 1987, began a tradition of seminars and intensive courses in bioethics in Manila or Houston, attended by participants from Indonesia, India, and Europe, as well as the Philippines. Beyond a Western Bioethics: Voices from the Developing World derives from those seminars. Edited by two physicians from the Philippines, Angeles Tan Alora and Josephine M. Lumitao, this volume is a comprehensive exploration of bioethical issues outside the dominant American and Western European milieu. Using the Philippines as a case study, they explore how a poor and impoverished traditional country has evolved an ethical system that reflects its own economy, religion, and culture, and how this ethical system has affected doctors, patients, family, and the Filipino society. After first noting the difference between Filipino bioethics and traditional Western bioethics, the contributors explore areas such as the family, care of the elderly, professional relationships in health care, honesty, loyalty, cheating, philanthropy, and nepotism. They next turn to issues facing family and clinicians in specialized areas, such as pediatric intensive care units, care of the dying, and human organ transplants. The final part of this volume deals with allocation of scarce resources and justice. All of these concepts are illustrated by clinical examples.

The volume is an eye-opener. It makes one face the reality that bioethics is not universal: there are large cultural conflicts between Western civilization and other civilizations that lead to differences in ethical hierarchy. No bioethical system is best; each develops organically in a particular culture and fits that culture and its traditions. Critical questions arise, however, when physicians and nurses train in one cultural system (a non-Western one), and then emigrate to a Western one. How can we train them to adapt and adopt our Western ethical values, and should we retrain them? If we are unable to do so, serious conflicts are bound to occur between staff and patients, staff and staff, and staff and other societal institutions, such as the criminal justice system. As migration and immigration continue and increase, it is critical that administrators and educators recognize potential conflicts between different ethical systems and their values and address them. For example, in the care of the dying, the clash between the Western tradition of patient autonomy as compared to the Filipino tradition of family decision-making can lead to serious problems.

This book is written for students and professionals and provides a fresh perspective on how medical ethics are developed and practiced in a developing nation. It successfully challenges the parochial wisdom of the notion of global bioethical standards. The volume argues effectively that in many situations a global bioethical standard makes no sense.