Commentary on Asai: Against universalism in clinical ethics

- Yeruham Frank Leavitt, Ph.D.
Chairman, The Centre for Asian and International Bioethics
Faculty of Health Sciences
Ben Gurion University of the Negev, Beer Sheva, Israel
Fax: + 972-7-6477633

Eubios Journal of Asian and International Bioethics 10 (2000), 5.
I have to take issue with Atsushi Asai's statement that: " Systematic principles are necessary if we want to make universally-accepted and impartial decisions in clinical settings."

Although it is well known that the philosopher, Kant, believed that moral decisions have to be "universalizable", i.e. applicable to all rational beings everywhere, I see no reason to believe that what Kant said is true. I see nothing wrong with some cultural relativism, especially in clinical ethics where one's decision does not have international ramifications.

I do believe that there are some universal moral principles, like: "Don't murder". But the definition of what counts as murder can be different in different societies. I think it would be a waste of time, for example, to try to get every country to have the same laws about abortion or brain death.

Indeed I see nothing wrong with a situation, which seems to exist in Israeli hospitals, where each ward has its own policies about DNR. Live and death are too complex matters to expect one case to be like the other, or to expect every medical team to behave in the same way. I do think it would be good if in all hospitals such decisions were never made by one physician alone, even together with the family. They should be team decisions involving more than one doctor, more than one nurse, perhaps a hospital social worker and of course the patient's family -- if there is a family -- and obviously the patient if the patient is capable of participating. But that being said, I see no reason to demand that any two groups of this sort decide in the same way.

I think there is a need for a kind of universalism implying interference in serious human rights violations, but only when the victims or people close to them have called for help. There is a need also for universal agreement on environmental and public health issues which affect the entire planet.

Nor can universalism be excluded from all clinical questions. There is a need for some global policy, for example, to curb the trade in organs and human body parts, especially in the light of the many scandalous stories which are circulating (perhaps not all of them true) about organ theft and people being killed for their organs. But this has its implications for clinical ethics because obviously it would be unethical to use an organ which was acquired in a way which global consensus has declared to be unethical.

I see, however, no need to try to impose a universalism on the general run of decisions in clinical ethics, when the decision does not affect people other than those immediately concerned. Indeed I am not sure that national, or even hospital-wide, policies are either needed or wise. The best we can do is to try to educate doctors and nurses to think deeply and intelligently about these things, and then to listen openly to one another, and to patients and families. And then we should try to trust them to do the right thing at least most of the time.

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