- Margaret Lock, Ph.D.
Dept. of Social Studies of Medicine, McGill University, Montreal, Quebec H3G 1Y6, CANADA
Medical ethics has a history of more than 1000 years, but it is a history, both in Asia and Euro-America, which has until very recently been dominated by commentary produced from within the medical profession itself. David Rothman, who has traced the history of bioethics in North America, shows how it is in connection with human experimentation, from the late 1960's on, that a new group of commentators -- lawyers, philosophers, and legislators, became actively engaged with the issue of what was being done to human subjects in the name of scientific research (Rothman:1991). Since that time the majority of bioethical concerns have been about the development and application of new biomedical technologies, in particular those used in connection with pregnancy and birth and dying and death.
The history of technology has usually been transmitted as an heroic tale about the conquest of the enemy, whether it be human or the natural world -- a narrative of progress, and of the betterment of humanity in general. Of course, the dominant ideology has, for the past 100 years at least, been accompanied by a counter discourse replete with ambivalence and warnings about the consequences of technology gone wild. Ellul claimed, for example, that "Technique has become autonomous; it has fashioned an omnivorous world which obeys its own laws and which has renounced all tradition" (1964), a sentiment echoed by John Kenneth Galbraith, Rene DuBos, and Martin Heidegger, each from their very different vantage points. Autonomy in the Kantian tradition is, of course, associated with the notion of free will, of an individual no longer subject to externally created laws. As Winner has pointed out, the very idea of an autonomous technology raises an "unsettling irony, for the expected relationship of subject object is exactly reversed" (1977:16). We humans have apparently lost out to the monster, but nevertheless rush eagerly ahead creating new devices. Like Shiva in Hindu iconography, Pfaffenberger suggests, technology is both creator and destroyer, an agent of future promise and of culture's destruction (1992:495).
It has generally been assumed that the major driving force behind the creation of technologies is to meet universal human needs. Marcuse was one who accepted this position, and, although he was concerned about the way in which the products of technological progress could be subverted under the name of rationality for ideological purposes, he nevertheless emphasized that mastery of nature could if properly applied, be associated with freedom and autonomy (1964). Habermas, building in part on Marcuse, insisted that an apparent consensus created around supposed rationality of technological progress veils the interests of powerful elites and removes debate from the public sphere (1970). Activities associated with technology are far from autonomous, but on the contrary intimately associated with the social and political order. Nevertheless, for both Marcuse and Habermas, since the creation of technology is a rational endeavor designed to meet universal human needs, there is nothing inherently questionable about the endeavor, provided that one goes about it in the right way. Basalla (1988) and Sahlins (1976), both anthropologists, take more radical positions; they stress that, aside from the fundamental requisites for sustaining it is culture and not nature which defines necessity. Necessity is not, after all, mother of invention in any predetermined way, on the contrary, human technology is a "material manifestation of the various ways men and women throughout time have chosen to define and pursue existence" (Basalla, 1988:14). Technology is thus an integral part of the history of human aspirations and "the plethora of made things are a product of human minds replete with fantasies, longings, wants, and desires" (Basalla,1988:14). To simply link technology with power is to leave tacit the dominant modernist ideology of progress as an inherently rational pursuit to which culture makes no contribution.
It is easy to assume that among the many forms of technology those related to medicine exist, by definition, to meet basic human needs, in particular to reduce suffering and avert premature death. It is not surprising, perhaps, that aside from a concern about run away expenditure and unwanted side effects on the body, there has been, until recently, relatively little resistance in principal to the development and application of medical technology. Despite the fact that the interests of powerful elites are often directly involved with the creation, manufacture, distribution, and application of medical technology, an assumption usually holds sway that techniques which allow us to penetrate with increasing facility into the recesses of the body, together with those that supposedly relieve pain, remove suffering and prolong life, are inevitably for the good.
At present disputes with respect to biomedical technology usually revolve around questions of individual rights, autonomy, and justice. It has become increasingly evident, however, that bioethics as we currently understand it is grounded in a style of moral philosophy, characteristically Anglo-American, in which rules and principles are set out from which can be derived moral judgments which are assumed to be universal. Once we become sensitive to the fact that the creation of technology and its application in medicine is culturally produced and reflects in large part local value systems, then it becomes clear that bioethics cannot be a universal endeavor in any pre-determined way. Nevertheless, it is my opinion that even though research into ethical issues in medicine should be historically and culturally contextualized, an extreme form of cultural relativism is not appropriate. Clearly in the case of East Asia an appreciation of the Confucian tradition is essential, just as a sensitivity about the Judeo/Christian heritage is important in any analysis of the situation in the West, but this is only a beginning. If we are to do away with inequalities, oppression, and unexamined assumptions about what is "natural" and "good," then we cannot simply draw on romanticized versions of outmoded philosophies from previous centuries. Instead, we have to actively create a contemporary bioethics in which due attention is given to the way in which ideas about what constitutes an individual, a family, and society, and what are taken as definitions of life and death and so on, are constituted and contested in local settings. This means starting from practice and not from theory, and drawing on the knowledge and experience of all people and not simply on so-called professionals, medical, philosophical, or legal.
A comparative study of the relationship of culture to the creation and application of biomedical technology is an exciting prospect and, if successful, a sure way to promote self-reflection into tacit, unexamined values in local settings. But we cannot stop here, because many of the topics we are debating have consequences for humankind, in particular those concerned with the manipulation of genes, and especially the germ-line. For issues such as these, we must work with and around cultural difference to create international guidelines and, for some purposes, international law. If we do not do this then we are indeed in danger of blindly following an ideology of unfettered progress and creating a technology which will fundamentally transform ourselves and the world as we know it today with little or no forethought as to the consequences. I trust that the new Journal of Asian and International Bioethics will create a vital forum for discussion of these urgent issues.