Biller-Andorno, Nikola

RERO DOC Digital Library

Determining what general rules mean inspecific situations and how global principlesand local context relate to each other are im-portant issues in medical ethics that have be-come the subject of an increasingly lively in-ternational debate [2, 4, 7, 9, 10]. I agree withÁrnason [1] that simple answers – be they“it’s all in the principles” or “it’s all in thecontext” – do not work. And I agree that wewill have to live with the creative tension thatis being brought about by the dual strife forenlightenment by global principles and sen-sitivity to local context.However, the fruitful exchange about therole of the global and the local is put at risknot only by the “rigid principlism” and “nar-row contextualism” that Árnason describes,but also by a third danger, for which I wouldlike to suggest the term “bioethical parochi-alism”.Bioethical parochialismWhat do I mean by my concern that the ten-sion between the global and the local maycollapse in the parochial? “Parochial” has adouble meaning: 1. pertaining or restrictedto a parish, and 2. limited, characterized bynarrow interests centered on oneself or one’slocal community, narrow-minded, provincial[5].The first aspect could be reasonably inte-grated into the global – vs. – local debate: Arethere moral arguments that are particularlyrelevant or even limited to a certain – local,religious, political or otherwise defined –community? A classic example is the rejec-tion of blood transfusions by Jehova’s wit-nesses, but there are many arguments inbioethics that would merit a closer look re-garding their “parochial” nature. What is thelegitimate role of such arguments in the glo-bal discourse on bioethical matters; shouldthey weigh in, be simply tolerated or rejectedif they are obviously bound to a belief systemor other particular perspectives? What arethe obligations of professional ethicists whoare also members of communities withstrong moral commitments; how can theymanage to adhere to academic standardswithout compromising their loyalty to thecommunity they belong to? “Parochial” con-cerns, values, arguments, in fact, form part ofspecific local contexts, and their articulationand reflection can indeed advance our under-standing of bioethics discourses, their way offunctioning as well as their limits.The second notion – parochialism as char-acterized by a narrow focus on the interestsof one’s own community and a disregard forthe moral questions (or answers) put forwardby others – is more difficult to integrate intoa genuine, open exchange on moral matters.It is this form of parochialism which I see asa threat to a fruitful debate and which I willturn to now. Moral parochialism in this sensebrings with it a more or less predefined list ofmoral issues considered worthy of discus-sion, with fixed priorities that distinguish be-tween the “real” issues and those that havebeen judged to be secondary. In a similar waywhat counts as “profound”, “superficial” and“misguided” arguments may be defined evenbefore a meaningful exchange has takenEthik in der Medizin 4 · 2006390Ethik in der Medizin aus internationaler PerspektiveEthik Med 2006 · 18:390–392DOI 10.1007/s00481-006-0470-6© Springer Medizin Verlag GmbH 2006Nikola Biller-Andorno · ZürichThe Global, the Local,and the ParochialA commentary on Vilhjálmur Árnasonplace. When the moral parochialists enter thescene, moral positions become interests thathave to be defended, and philosophers turninto politicians; creativity gets limited to itsstrategic dimension of how to best sell an ar-gument or force it upon others; open ques-tions and moral curiosity start being consid-ered ignorance and naïveté. This danger maybe the price of pluralism with its ambition tofind ways to exchange views about differentpositions on moral matters and to maybeeven reach sensible – if not rational – solu-tions. Recognizing this danger and making itexplicit may help contain it, possibly throughthe formulation of suitable rules for bioethicsdiscourses.Bioethical parochialism can take differentforms. To begin with, direct parochialism canbe distinguished from indirect parochialism.Direct parochialism advocates for its agendaby invoking the local context, thus arguingfor exceptions to generally recognized princi-ples or for a particular interpretation of theseprinciples. This argumentative strategy is,for example, used to defend female circumci-sion, which – at least prima facie – departsfrom theprinciples of nonmaleficence, benefi-cence, and in most cases of autonomy; localfactors, so the parochial argument, turn whatseems tobe aviolationof physical andpsycho-logical integrity into abeneficent act by ensur-ing thegirl andfuturewomanaregularplace inthe social structure inwhich she is embedded.Indirect parochialism, on the other hand,claims to be concerned about global princi-ples whereas in fact it aims to foster its ownparticular goals. Human dignity is a globallyrecognized concept that lends itself to beused as a foil for very different parochialagendas. For example, it is invoked by theproponents as well as the opponents of activeeuthanasia. It has also been quite impressiveto observe how particular agendas werefought for under the umbrella of global prin-ciples when the possibility of a convention onhuman cloning was debated in the United Na-tions [3].Parochialism can be either explicit or im-plicit, i.e. working with open or hidden agen-das, and it can be employed in an unaware orin a very conscious, reflected manner. It isthe indirect, implicit, conscious form of paro-chialism that should concern us most when itenters bioethical discourse; particularly so asmany bioethical issues touch on dearly heldbeliefs or convictions which provide the mo-tivation for fierce fights. Ethics done fromsuch a parochial perspective does not adhereto the usual standards of open, respectful in-tellectual exchange. It will use the tension be-tween the global and the local for its ownpurposes – bioethical discourse will either beinstrumentalized or turned into an irrelevantpuppet show, with the “real action” going onbehind the scenes.Parochialism and anti-bioethicsParochialism is a global phenomenon. Is thebioethics discourse in Germany more at riskthan in other places? There are several localfeatures that could be discussed as providinga fertile soil for an instrumentalization ofbiomedical 1 ethics debates for parochial pur-poses.One of these features is a certain form of“anti-principalism”. This does not addressthe anthropological contextualist critique ofprincipalism that Árnason describes in hispaper [1], which anyway has been more pro-nounced in North America than in Europe.Nor does this problematic form of “anti-prin-cipalism” refer to replies from “continentalphilosophy”, among them Kantian, herme-neutical or phenomenological approaches.Rather, what is meant is a vague but strongdiscomfort with mid-level principles as beingtoo soft, too amenable to negotiation andcompromise, too void of “real” values. Onceyou start weighing and balancing mid-levelprinciples, so the concern, you are alreadyhalfway down the slippery slope. 2 The pro-Ethik in der Medizin aus internationaler PerspektiveEthik in der Medizin 4 · 2006 3911 ”Biomedical” is understood here as comprising bio – aswell as medical ethics.2 The suspicion is thus not so much directed against theprinciples as such but against their mid-level nature andthe inductive element the approach contains. The caselaw approach that gives considerable weight to contex-tual details provokes similar concerns.posed alternative consists in reassuring our-selves of traditional or supposedly universalvalues. This re-orientation towards the well-known, secure might be an expression of asociety in crisis [6] that does not have confi-dence in its ability to approach bioethicalquestions through open, fair, participatorydiscourses that could do justice to the plural-ist nature of contemporary societies butviews such an approach as naïve or danger-ous.Another feature is a moralizing and in partaggressive anti-utilitarianism that polarizesbetween utilitarians that supposedly limittheir moral argumentation to accruing bene-fits, ephemeral as they may be, and those “ser-ious” ethicists that judgemoralactionsby con-centrating onthe “real” values that areat stake.Inthisperceptionutilitarianswould, forexam-ple, allow handicapped newborns to be killedin order to remove cumbersome obstacles tothepursuit of happiness, whereas serious ethi-cists would not be so easily distracted fromcore values like the sanctity of human life.Framed this way it is clear from the outsetwho the “good guys” and who the “bad guys”are, without a further exploration of the com-plexities of the argumentation inquestion.Ac-cordingly, intellectual exchange is replaced bydefamation or even overt hostilities [8]. Thiskind of anti-utilitarianism fits well with a gen-eral “anti-bioethics” attitude, which suspectsthat “bioethicists” are in fact just servants tothe biotechnological industry.This fundamental disrespect for a genuineand open exchange on bio- and medico-ethi-cal matters can serve as legitimation for un-dermining bioethical discourse through par-ochialist strategies. Those who already knowthat “they” are the “good people” defendingthe “real values” may see it as perfectly justi-fiable to instrumentalize bioethics for advan-cing their own – morally right – agenda. InGermany this move is sometimes given moreweight by a feeling of special responsibilityfor historical reasons to counter any possibleerosion of moral standards.Itwouldbefatal formedical ethicsasanaca-demic discipline if the parochial succeeded insuffocating bioethical discourse. Those criticswould thenbe right who see bioethics as noth-ing else than window-dressing or a stage forpolitical power fights. To help prevent such asorry state and to foster the development ofmedical ethics by providing an appropriateforum for exchange and debate may well bethe most important task of the Academy forEthics inMedicine in the twenty years to come.AnschriftProf. Dr. Dr. Nikola Biller-AndornoLehrstuhl für Biomedizinische EthikEthik-Zentrum der Universität ZürichZollikerstr. 1158008 Zürich, SchweizE-Mail: biller-andormo@ethik.unizh.deLiteratur1. Árnason V (2006) The Global and the Local: Fruitful Tensionsin Medical Ethics. Ethik Med 182. Biller-Andorno N (2001) Gerechtigkeit und Fürsorge. ZurMöglichkeit einer integrativen Medizinethik. Campus, Frank-furt a.M. New York3. Biller-Andorno N (2006) Cross-Cultural Discourse inBioethics: It’s a Small World After All? In: Roetz H (ed) Cross-Cultural Issues in Bioethics. The Example of Human Cloning.Rodopi, Amsterdam, pp 459–4634. Eich T, Hoffmann TS (Hrsg) (2006) KulturübergreifendeBioethik. Zwischen globaler Herausforderung und regionalerPerspektive. Karl Alber, Freiburg München5. http://www.webster-dictionary.net/definition/Parochial; ac-cessed on September 29, 20066. Krones T (2006) The scope of the recent bioethics debate inGermany: Kant, crisis, and no confidence in society. Camb QHealthc Ethics 15(3):273–2817. Macklin R (1999) Against Relativism: Cultural Diversity andthe Search for Ethical Universals in Medicine. Oxford Univer-sity Press, Oxford New York8. Schöne-Seifert B, Rippe KP (1991) Silencing the Singer. Anti-bioethics in Germany. Hastings Center Report 21(6):20–279. Schulz-Baldes A, Jakovljevic A (2006) Zur Möglichkeit einerkulturübergreifenden Bioethik. Interdisziplinärer Workshopdes Lehrstuhls für Biomedizinische Ethik und der Arbeits-und Forschungsstelle für Ethik (Universität Zürich) in Koo-peration mit der Jungen Akademie der Berlin-Brandenbur-gischen Akademie der Wissenschaften und der Akademiefür Naturforscher Leopoldina. Ethik-Zentrum der UniversitätZürich, 30. März bis 1. April 2006. Ethik in der Medizin18:261–26610. Tao J (ed) (2002) Cross-cultural Perspectives on the (Im)Pos-sibility of Global Bioethics. Kluwer, Dordrecht Boston Lon-donEthik in der Medizin 4 · 2006392Ethik in der Medizin aus internationaler Perspektive

The Global, the Local, and the Parochial: A commentary on Vilhjálmur Árnason

http://doc.rero.ch/record/316347/files/481_2006_Article_470.pdf

The Global, the Local, and the Parochial: A commentary on Vilhjálmur Árnason

Abstract

Similar works

Full text

Available Versions

RERO DOC Digital Library