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2013/12/3
Third International Conference on Bioethics,
Multiculturalism and Religion
Respect for cultural diversity and pluralism
Hong Kong, December 3-5, 2013
OUTLINE
Respect for cultural diversity and
p
pluralism
1. Context 1: UNESCO Universal Declaration on Bioethics and
Human Rights
2. Context 2: The emergence of global bioethics
3. The principle of respect for cultural diversity and pluralism
- Why this principle?
Henk ten Have, MD, PhD
- What does the principle imply?
Center for Healthcare Ethics,
Duquesne University, Pittsburgh,
USA
- How to apply the principle?
4. Conclusion
[email protected]
Context 1: UNESCO standard setting activities
1997
2003
2005
UNESCO: from genetics to global bioethics
October 2001: Roundtable Ministers of Science
“examine the possibility of developing … a universal
instrument on bioethics…”
October 2001: 31st General Conference
invite the DG to submit the technical and legal
studies undertaken regarding the possibility of
elaborating universal norms on bioethics
2002 – 2003: IBC feasibility study
Report on the Possibility of Elaborating a Universal
Instrument on Bioethics (June 2003)
October 2003: 32nd General Conference
The mandate from the Member States
The General Conference,
“considers that it is opportune and desirable to set
universal standards in the field of bioethics with due
regard for human dignity and human rights and freedoms,
in the spirit of cultural pluralism inherent in bioethics;”
“invites the Director-General to continue preparatory work on a
declaration on universal norms on bioethics, by holding
consultations with Member States, the other international
organizations concerned and relevant national bodies, and to
submit a draft declaration to it at its 33rd session.”
The process: development and negotiation
Three main phases:
1. Pre-drafting consultation on the
scope and structure
January 2004 – April 2004
2. Drafting process
April 2004 – January 2005
3. Finalization
January 2005 – September 2005
32nd Session of the General Conference of UNESCO - 2003
32 C/Resolution 24
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The product: Universal Declaration on Bioethics
and Human Rights
The product
1. Human dignity and human rights
2. Benefit and harm
3. Autonomy and individual responsibility
Unanimously adopted by all Member States in October 2005
15 principles for
global bioethics
Preambule
4. Consent
5. Persons without the capacity to consent
6. Respect for human vulnerability and
personal integrity
7. Privacy and confidentiality
General provisions
8 Equality,
8.
Equality justice and equity
aims
scope
9. NonNon-discrimination and nonnonstigmatization
10. Respect for cultural diversity and
pluralism
Principles
11. Solidarity and cooperation
Application of the principles
12. Social responsibility and health
13. Sharing of benefits
Promotion of the declaration
14. Protecting future generations
Final provisions
15. Protection of the environment, the
biosphere and biodiversity
Bioethics is weighing and balancing of ethical principles
Broader perspective of bioethics
Human dignity and human rights
individual
Benefit and harm
argumentation
justification
Autonomy and individual responsibility
Human vulnerability and personal integrity
Privacy and confidentiality
family/community
perspective
communities
Non-discrimination and non-stigmatization
Cultural diversity, pluralism and universalism
Solidarity and cooperation
Social responsibility
world
perspective
individual
perspective
societies
cultures
Sharing of benefits
Future generations
social/cultural
perspective
world
Protection of the environment and biodiversity
Context 2: Emergence of global bioethics
Globalisation of bioethics
1970s USA/UK/Netherlands
national
globalisation of
medicine, science
and technology
1980s: France, Argentina
1990s: Hungary, Bulgaria, Japan
regional
globalisation of
bioethics
continental
Council of Europe, European Commission
1987: European Society for Philosophy of
Medicine and Health Care
1997: Asian Bioethics Association
global
bioethics
global
UN system: UNESCO, WHO, FAO, WIPO,
UNU, ILO
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Globalisation of
bioethics
Global bioethics
Ethics committees
- worldwide
Ethics laws/
regulations/
guidelines/ codes
Ethics policies
Ethics textbooks/
manuals
Ethics journals
Ethics education
Ethics experts
Ethics research
- broad, encompassing
- new
ew topics
top cs
- new concepts
- new methods
Ethics centers/
units/
departments
Development of ethics in healthcare
Global bioethics
Medical ethics
- worldwide
- broad, encompassing
ew topics
top cs
- new
Bioethics
1971
Georgetown principlism
- new concepts
- new methods
2000
Global bioethics
UNESCO framework
Global Bioethics: Building on Potter’s bridges
Global bioethics
1. Bridge between present and future
Bioethics as new interdisciplinary approach with focus on long-term
interests and goals that safeguard the survival of humanity
Potter (1911-2001): cancer researcher in Wisconsin
2. Bridge between science and values
Bioethics is “a new discipline that combines biological knowledge
with a knowledge of human value systems in an open-ended
biocybernetic
y
system
y
of self-assessment…”
first use of the term ‘bioethics’ in 1970;
We need a new discipline, a science of survival, to
d l with
deal
ith the
th priority
i it problems
bl
jeopardizing
j
di i the
th
survival of humankind: population, peace,
pollution, poverty, politics and progress
3. Bridge between nature and culture
Van Rensselaer Potter:
Bioethics. Bridge to the Future,
1971.
Bioethics: combining the science of living systems,
biological knowledge (bio) and knowledge of human
value systems, philosophy (ethics).
Bioethics as responsibility for the future and as a way to engage
science to accomplish cultural evolution
4. Bridge between man and nature
Bioethics is a new ethics that takes into account the new science of
ecology and regards human beings as interrelated with their
environment
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Global bioethics
Global bioethics
Ethical principles
Ethical principles
Benefit and harm
New concepts
Common heritage of humankind
- Common good
Human dignity and
human rights
Human dignity and human rights
Human vulnerability and
personal integrity
Autonomy and individual responsibility
- Benefit sharing
Cultural diversity,
pluralism and
universalism
Human vulnerability and personal integrity
Privacy and confidentiality
Non-discrimination and non-stigmatization
Cultural diversity, pluralism and universalism
- Future generations
Solidarity
Sustainability
Social responsibility
Intergenerational justice
Sharing of benefits
Solidarity and cooperation
Diversity
Future generations
Social responsibility
Protection of the
environment and
biodiversity
Sharing of benefits
Future generations
Protection of the environment and biodiversity
Global framework of principles but application is
always local
“Think globally, act locally”
Global bioethics
Ethical principles
New concepts
Applications
Globalisation
Closer linkage with international law
- Human rights discourse
Human dignity and
human rights
Human vulnerability and
personal integrity
Cultural diversity,
pluralism and
universalism
Solidarity
Common heritage of
humankind
• status of human genome
- Common good
• ppatenting/property
g p p y rights
g
- Benefit sharing
• vulnerable groups
Globalised localism
- Notions of social responsibility and
global justice
- Notion of common heritage
- Future generations
Sustainability
• pain and suffering
Intergenerational justice
• food (obesity/ hunger)
Social responsibility
• international clinical trials
Sharing of benefits
Future generations
Localisation
Closer linkage with social sciences and
anthropology
Localised globalism
• migration of health professionals
Protection of the
environment and
biodiversity
• organ trafficking
• bioprospecting/ biopiracy
The locality of global bioethics
The locality of global bioethics
Bioethics always has a historical context: diachronical
Philosophy
of
medicine
Medical
ethics
Challenge: how to apply ethical principles in a local context?
Bioethics
Bioethics always has a socio-cultural context: synchronical
Developed
within a specific
culture
culture
religion
bioethics
Broader
context
religious values
traditional
values
professional
values
society
Applied within
specific societies
Broadening of
perspective
Internal morality
Deontology
External morality
Professionalization
Applied ethics
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The locality of global bioethics
Global bioethics
diachronical
context
How can universal discourse be sensitive to
cultural, social and religious contexts?
synchronical
context
How to bring the context into bioethical discourse?
Global
bioethics
Avoiding two objections:
principle of respect for
cultural diversity and
pluralism
• moral imperialism: moral values are imposed in a
specific context and culture
But in the development and application of bioethics:
context usually ignored or regarded as background or of
secondary importance
Respect for cultural diversity and pluralism
• moral protectionism: moral values cannot be used in
other contexts and cultures because they are culturespecific; double standards are inescapable
Respect for cultural diversity and pluralism
Why this principle?
Article 12:
The importance of cultural diversity and pluralism
should be ggiven due regard.
g
However, such
considerations are not to be invoked to infringe
upon human dignity, human rights, and
fundamental freedoms, nor upon the principles
set out in this Declaration, nor to limit their
scope.
Respect for cultural diversity and pluralism
October 2013: Dr Ahmet Akgündüz, Rector of Islamic
University Rotterdam in the Netherlands:
No dialogue possible with persons who are not Sunni muslim
Globalization makes us more aware of existing diversity in
values, principles, virtues and moral behavior
Responses to globalization show growing intolerance for
diversity and for views that differ from one’s own
normative perspective
Respect for cultural diversity and pluralism
The politics of hatred
June 2013: Public opinion poll in the Netherlands
No debate with people with western lifestyle
"Thus, we could say that, according to most jurists, the basic punishment for
apostasy
t
is
i capital
it l punishment,
ih
t which
hi h is
i applied
li d to
t men. On
O the
th other
th hand,
h d the
th
substitute punishment is that apostates are imprisoned until they become Muslims
again, which is what is done with women." (Ahmet Akgündüz in Islamic Public
Law, 2011, p. 371)
"By way of analogy with adultery, jurists declare sodomy punishable by
death, sometimes by stoning but often with a public ignomy attached to the
execution, such as being thrown from a high building or buried alive"
(Ahmet Akgündüz in Islamic Public Law, 2011, p. 408)
- 55%: stop immigration from muslim countries
- 63%: no new mosques
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72%:
%: constitutional
co s u o
prohibition
p o b o of
o sharia
s
law
w
- 77%: Islam is not an enrichment for the country
- 68%: there is more than enough Islam in the Netherlands
Geert Wilders: “the results are crystal clear: the Netherlands is fed up with Islam”
Partij voor de Vrijheid (Party for Freedom):
October 2013: with 17% of votes largest political party in the polls.
“Beating your wife is allowed, but not too often” (Trouw, 7 November
2000)
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Respect for cultural diversity and pluralism
What does the principle imply?
The problem with definitions
Conceptual ambiguity:
- culture?
- cultural diversity?
- pluralism?
Respect for cultural diversity and pluralism
Respect for cultural diversity and pluralism
CULTURE
Culture
UNESCO Universal Declaration on Cultural Diversity,
2001
Preamble:
“…culture should be regarded as the set of distinctive
spiritual, material, intellectual and emotional features of
society or a social group, and … it encompasses, in
addition to art and literature, lifestyles, ways of living
together, value systems, traditions and beliefs.”
from Latin ‘cultura’ , ‘colere’ =
1. caring for, cultivation of the
soil
2. refine, educate (Cicero:
cultura animi, culture of the
soul
Nature
- the entire material universe
- inherited, innate or original
essential traits of a person or thing
What is produced by human beings
What is given
- patterns of human activity
- symbolic structures and systems
defining feature of human beings
Respect for cultural diversity and pluralism
CULTURAL DIVERSITY
Respect for cultural diversity and pluralism
CULTURAL DIVERSITY
UNESCO Universal Declaration on Cultural Diversity, 2001
• the common heritage of humanity;
ARTICLE 1 Cultural diversity: the common heritage of
humanity
Culture takes diverse forms across time and space. This
diversity is embodied in the uniqueness and plurality of the
identities of the groups and societies making up humankind. As
a source of exchange, innovation and creativity, cultural
diversity is as necessary for humankind as biodiversity is for
nature. In this sense, it is the common heritage of humanity and
should be recognized and affirmed for the benefit of present and
future generations.
it should be safeguarded for the benefit of present and
future generations
• it is a source of exchange, innovation and creativity
it is as necessary for humankind as biodiversity for
nature
• policies for the inclusion and participation of all cultural
groups and citizens are guarantees of vitality, social
cohesion and peace
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Respect for cultural diversity and pluralism
PLURALISM
= the affirmation and acceptance of diversity
used in a wide range of areas: politics, science,
medicine, medical practices, religion, philosophy
and ethics
Respect for cultural diversity and pluralism
How to apply the principle?
Only article in the UNESCO Declaration in which the text states:
It cannot be invoked to infringe upon or limit the scope of
- human dignity, human rights and fundamental freedoms
- the principles set out in this Declaration
Positive: it is one of the fundamental principles of global bioethics
Value pluralism
There are several values, equally correct and
fundamental and yet in conflict with each other.
Respect for cultural diversity and pluralism
How to apply the principle?
Negative: if there is a hierarchy among the principles, this comes
at the lowest level; it is the weakest principle
Respect for cultural diversity and pluralism
Limitation 1
Human dignity, human rights and fundamental freedoms
Four types of limitations
1. Human dignity,
g y, human rights
g and fundamental
freedoms
- Respect for cultural diversity can never be invoked when it
infringes upon human dignity, human rights and fundamental
freedoms
- Value
V l pluralism
l li cannott be
b usedd as a way off justifying
j tif i
discrimination and stigmatization
2. Domestic law, national regulations and international
human rights law
3. Indigenous knowledge and practices
4. Principles set ou in the Declaration
Respect for cultural diversity and pluralism
Limitation 1
Respect for cultural diversity and pluralism
Limitation 2
Domestic law, national regulations and international human rights law
Universal Declaration on Cultural Diversity, 2001:
ARTICLE 4 Human rights as guarantees of cultural diversity
The defence of cultural diversity is an ethical imperative,
inseparable from respect for human dignity. It implies a
commitment to human rights and fundamental freedoms, in
particular the rights of persons belonging to minorities and those
of indigenous peoples. No one may invoke cultural diversity to
infringe upon human rights guaranteed by international law, nor
to limit their scope.
- legal limits
Example: blood transfusions for children in the case
of Jehovah’s witnesses
- moral limits
Example: sex selection by the use of prenatal and
pre-implantation genetic diagnosis without any medical
reason
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Respect for cultural diversity and pluralism
Respect for cultural diversity and pluralism
Limitation 3
Limitation 4
Principles set out in the Declaration
Indigenous knowledge and practices; traditional healing
Respect for cultural diversity requires that they are protected and
promoted,
- Problem of bioethics: several principles do apply at the same time for the
same case; we need to analyze, argue, balance and justify
decisions
but:
- Although respect for cultural diversity is important, we cannot use this
principle to override other ethical principles.
-
As long as they are effective
-
As long as there is no scientific evidence of harm or toxicity
-
Evaluation by the concerned societies
-
Authorization at national level
Example: Consent versus Cultural diversity
Principle of respect for
cultural diversity
Respect for cultural diversity and pluralism
Controversies of research in developing countries
-
- Need to balance principle, as appropriate and relevant in the circumstances;
application of principles in different circumstances
1996 Trovan trial in Nigeria
Principle of consent
Adaptation to local circumstances
Consent
- procedure for securing consent is different
- principle remains the same: genuine consent to participate must be
obtained from each participant
1997 AZT trials (N. Engl.J.Med.)
2005 Malaria study in Amapa, Brazil
Nuffield Council on Bioethics: The ethics of research related to
healthcare in developing countries (April 2002)
www.nuffieldbioethics.org
Respect for cultural diversity and pluralism
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Conclusion
1. Important that respect for cultural
diversity is accepted as one of the
fundamental principles of global
bioethics
2. It can,, however,, be misused,, to override
other fundamental principles
3. The principles in the Declaration are
universal principles that cannot be
‘relativized’ by the principle of respect
for cultural diversity
Impose specific
moral views because
they are superior
Antidote to moral
imperialism;
two faces
Specific moral
views cannot be
used because they
are ours, not yours
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