- Margaret Lock, Ph.D.,
Dept. of Social Studies of Medicine,
McIntyre Medical Sciences Bldg.,
3655, Drummond St., McGill University,
Montreal H3G 1Y6, CANADA
Morioka raises many important points, and it is impossible to comment on them all, I will simply take up those which strike me as most significant. Morioka is right to highlight the "negative" atmosphere which has been created as a result of the brain death debate. As someone who has attended meetings of several citizen's rights groups fighting to maintain the status quo in Japan, I can attest to the vituperative tone of much of the discussion. Television programs also reveal how much the debates on both sides of the argument are ideological and emotionally-laden, even though those medical professionals supporting change usually try to justify their position as scientifically grounded. Morioka points out that reference is often made in the debate to facets of Japanese culture not conducive to accepting either brain death as the end of life or organ transplants. It is evident that many outspoken medical professionals share these feelings, and the public is well aware that there is no consensus among the so-called experts. Morioka reminds us that "discourse is a tool of persuasion," and the Japanese debate is exemplary in this respect. The rhetorical strategies and metaphors used most frequently insist that these technologies are "unnatural," and in some way provide a threat to Japanese identity. But, as Morioka notes, no one has bothered to find out what the Japanese public really thinks -- there has been no systematic exploration of public responses to the debate other than superficial nation-wide polls ad nauseam. An assumption of national unity is usually evident in this rhetoric, an assumption of "us Japanese" in opposition to the "other" of the West. In particular, attitudes towards the dying, the cohesiveness of the family, sensitivity to non-verbal communication, the lack of a mind/body split, and an infusion of personhood throughout the entire body, are routinely marked as identifiers of Japanese uniqueness. Obviously, for any rhetoric to have lasting value it must in some way resonate with ideas, values, and behaviors present in society at large, this does not, however preclude the possibility that some of those ideas are patently false, nor does it tell us to what extent they are actually distributed throughout society, or are perhaps outmoded, or alternatively are predominantly a reflection of the interests of certain powerful individuals.
Morioka is, quite rightly, wary of this rhetoric, but does not rest his argument there, and raises a further crucial point of key interest to the readers of this journal. Bioethics, with its fundamental concern about human rights, is usually assumed to be a by-product of modernity, in turn of course, intimately associated with secularization, rationalization, democracy, and the rise of individuality -- all values deeply associated with the West. For many Asian countries, including Japan, bioethics as a discipline presents a dilemma, Morioka suggests, because it is readily associated with a kind of cultural colonization (an echo of recent physical colonization in some cases). The question becomes one of whether the path to modernization and beyond should slavishly imitate values associated closely with the West, in particular America, or whether a self- conscious effort should be made to preserve values thought to be central to a "traditional" cultural identity. Japan has been struggling for nearly half a century with this problem, long before bioethics appeared on the scene, and it is clear that in economics, business, and education, for example, a self-confidence has emerged in which walking the thorny path of modernization, while drawing judiciously on innovations from both inside and outside the country, mixed with aspects of the traditional, although difficult, is not impossible. Morioka is concerned, however, that in the case of bioethics, which after all has barely got off the ground in Japan, there should not be a retroactive move in favor of tradition, as the brain death debate suggests it well could. He argues, I believe quite rightly, that the bioethics community should strive to get beyond Japan/West or East Asia/West dichotomies. Such essentialism precludes a sensitivity to diversity and, I would add, to hierarchies, inequalities, and gender difference. Nevertheless, the fascinating question remains of why the brain death debate and not, for example, abortion or genetic screening, have triggered this Japanese altercation.
Morioka's discussion of discourse and cultural imperialism, with its inherent schism of self and other, reveals why the Japanese brain death problem should not be dismissed by outsiders as an anomaly. In North America, for example, it is important to ask why we find the rhetoric of the "gift of life" and a "shortage of organs," so moving, and why we apparently have little difficulty in accepted a warm body as no longer living. This is in no way to suggest that organ transplants from brain dead donors should never have been instigated, but rather to reflect on why, in a "modern" society, there was no widespread public discussion before the technologies were introduced, and also about future directions and the setting of limitations. Certain commentators are at present suggesting that we should do away with the brain death formulation altogether, and assess whether or not organs should be donated independently of any single account of death (Halevy and Brody:1993) -- surely the time is overdue for public discussion of this technology? There is also the larger, more demanding question, the obverse side of the Japanese situation, of why debates about abortion and the new genetics have such rhetorical power among the media and the public in North America, whereas brain death and organ transplants have failed to catch the public imagination. Surely something cultural is at work here? But to settle the analysis entirely as one of cultural difference, is, as Morioka suggests, dangerous, because culture inevitably embraces tacit, unexamined assumptions about what is good and morally correct. Sensitivity to cultural relativism is important, but cultural relativism is not the last word and, moreover, the Euro/American tradition should in no way be set up as a gold standard, and therefore "above and beyond" culture. Bioethics and allied disciplines, such as the social sciences, must routinely question the culturally infused truth claims of both biomedicine and philosophy: A critical analysis of the values embedded in the application of biomedical technologies is essential, and so too is one of a philosophical approach which takes the Georgetown mantra as a universal given. Bioethics should become sensitive to cultural and historical context, to local diversity, to inequalities, and to relationships of power -- it is only by doing so that this discipline can overcome its present parochialism, and address the more basic and exceedingly complex questions of the rights of humans, not simply as individuals, but as participants in social collectivities in a rapidly changing, globally linked, technological environment.
Halevy, A & Brody, B. (1995) "Brain Death: Reconciling Definitions, Criteria, and Tests. Annals of Internal Medicine 119: 519-525.
Lock, M. (1995) "Contesting the natural in Japan: Moral dilemmas and technologies of dying", Culture, Medicine and Psychiatry 19: 1-38.
- Masahiro Morioka
International Research Center for Japanese Studies
3-2 Oeyama-cho, Goryo, Nishikyo-ku, Kyoto 610-11, JAPAN