The Family, Medical Decision-Making and Biotechnology: Critical Reflections on Asian Moral Perspectives (review)

Shui Chen Lee, ed., The Family, Medical Decision-Making and Biotechnology: Critical Reflections on Asian Moral Perspectives. Dordrecht: Springer, 2007. 220 pp, $119. Sarah Chan Received: 9 September 2009 /Accepted: 9 September 2009 /Published online: 19 June 2010 # National Science Council, Taiwan 2010 “Cross-cultural bioethics” is becoming not only something of a buzzword but an entire sub-discipline in the area of contemporary bioethics. Globalisation and the increasingly multi-cultural nature of the modern state result in ethically pluralistic societies in which there is a growing awareness of and interest in alternative modes of ethical thought, as well as heightened potential for conflict between them. Consequently, scholars of bioethics are now beginning to recognise the importance of understanding, analysing and applying ethical principles derived from a variety of cultures. One particular distinction often emphasised in this regard is the divide between so-called Western and Eastern bioethics. The questions with respect to such division are whether it is warranted, and if it is, what may be gained from first drawing and then crossing such a dividing line. The publication in 2007 of The Family, Medical Decision-Making and Biotechnology: Critical reflections on Asian moral perspectives, edited by Shui Chuen Lee, goes some way towards answering both of these. The existence of such a volume in itself clearly indicates and reinforces the idea that there is something distinctive about Asian ethical perspectives in comparison to Western bioethics; thus, the need to explore what this might be, while the inclusion of contributions from scholars versed in the various approaches highlights the tensions but also the similarities between what are often perceived as two discrete philosophical clades. The main “Asian moral perspective” covered in the book is that stemming from Confucianism, probably the predominant East Asian philosophical approach. Topics spanned by the 17 papers include the role of the family versus the individual in medical decision-making, the use of reproductive technologies, embryonic stem cell research and the politics of health care. All of these issues are ethically contentious even within what might be regarded as the “Western” bioethical tradition; what this East Asian Science, Technology and Society: an International Journal (2010) 4:165–169 DOI 10.1007/s12280-010-9127-0 S. Chan (*) Institute for Science, Ethics and Innovation, University of Manchester, Manchester, UK e-mail: sarah.chan@manchester.ac.uk volume contributes to the discourse is another set of alternative approaches within which these problems may be framed and understood. The focus of Chapters 2 to 6 is the concept of the family and its ontological significance as a central part of Confucian philosophy. Ruiping Fan provides an overview of Confucian familism and its implications for contemporary bioethical issues, including responsibility and decision-making in the health care context as well as the challenges posed by new reproductive technologies. Fan takes the view that “traditional Confucian bioethics is radically at odds with that of the dominant modern North American and Western European models”1 in that it contextualises the individual within the social and particularly the familial structure, leading to different models of ethical reasoning about these situations. Expositions on this theme are provided by Sheu and by Wear in their respective considerations of truthtelling in medicine. Erickson also contrasts Confucianism with what he terms “liberal secular individualism”2 , originating in the Western world but spreading its influence through increasing globalisation. Instead of emphasising the East–West divide, however, he finds resonances between Confucian thought and Western alternatives to individualism such as Hegel’s conception of human identity, in which family and community play a core role. In Chapter 7, Lee’s re-evaluation of the autonomy concept draws together a number of theoretical perspectives from both East and West. Lee explores the way in which feminist ethical notions of relational autonomy, themselves developed in the West as a critique of “traditional” autonomy, intersect with Kantian and Confucian concepts of moral action to define a sphere of ethical relational autonomy that centres on but also extends beyond the family. This can be used to ground family models of medical decision-making. Rei’s analysis of the application of sex selection technology in the essentially patriarchal society of Taiwan (Chapter 8...