- Michael S. Yesley, J.D.
MS A187, Los Alamos National Laboratory Los Alamos, NM 87545, USA
As Becker points out, the West is hardly a monolithic entity. In the United States alone, there is a debate among bioethicists about the need to consider patient characteristics, such as ethnicity, gender and insurance status, in a bottom-up ethical analysis, rather than apply rules top-down. Surely a "domestic" analysis that is striving toward diversity would admit the same considerations internationally. My own view is that bioethics is much less specific or conclusive than many perceive this field to be. I see bioethics in terms of process, as a questioning approach to an area of decision making that was formerly governed by silent tradition and/or emotion. Bioethics is not a code, though it may be incorporated in codes, but a questioning of our treatment of human beings in medicine and related fields, in light of certain principles that have universal or near-universal acceptance, and our own values.
The application of the principles is highly indeterminate because the principles are often in conflict, and they are so general that results in particular cases depend on additional factors that may differ from person to person, institution to institution, and culture to culture. Bioethics does not dictate that we recognize - or not recognize - the notion of brain death, but that societies question the bounds of acceptable treatment of persons without brain activity. Societies may learn from each other, but there is no requirement to emulate each other.
Thus, I believe bioethics is universal at the abstract level and ethos-centered at the application level. Also, I believe the application level is more important than the abstract level, and so I am comfortable with the notion that different cultures will go in different directions from the same starting place. At the same time, I believe there is a common starting place. Do we not all believe in fairness and "do no harm" and respect for the individual, though these broad principles may lead different people in different directions?