PRINCIPLISM'S TROUBLES ARE well known. Critics bearing the concerns of feminism, religion, and multiculturalism have registered their discontent with the state of contemporary bioethics in the U.S.A. Heavily indebted to the principle-based method that became popular through James F. Childress and Tom L. Beauchamp's influential text, Principles of Biomedical Ethics, bioethics has been called to task for its emphasis on rights and duties over the development of character and virtue, as well as for its relative inattention to social, religious, and cultural features of moral experience and moral agency. (1) Chief among the complaints has been its perceived preoccupation with the maximization of individual autonomy and its willingness to accept as its goal the achievement of minimum consensus among "moral strangers." (2)
Increasingly, the "critique from within" is joined by a "critique from without." As bioethics has gradually developed a global consciousness, new voices from outside North America and Europe have emerged including voices from Africa, Asia, and Latin America, raising even more fundamental questions of adequacy and credibility. At issue is not only the relative emphasis within bioethics on rights versus responsibilities, on autonomy versus beneficence, but the international dominance of an approach to ethical issues in health and medicine that is drawn principally from Western philosophical traditions (indebted, in particular, to Kantian deontology and utilitarianism) and developed within institutional settings of the West and in light of European and North American legal and regulatory frameworks.
What follows is an attempt to survey some of the key challenges posed to bioethics by this emergent global consciousness and to suggest what might be involved in moving "beyond a Western bioethics." It is an attempt, in particular, to show how the moral geography for bioethics (i.e., the field of moral problems and responses) shifts when viewed from the perspective of the "two-thirds world." (3) Finally, this section concludes with some reflections on the critical and constructive role of theological ethics in forging a global bioethics.
HEALTH AND MEDICINE: FROM LOCAL TO GLOBAL
Commenting on current debates in bioethics, Lori Knowles observes that "globalization is often discussed as if it were a recent phenomenon relating primarily to the development of world financial markets and improvements in information and travel technologies. (4) Indeed, it is now becoming commonplace to describe this present era, with its mass consolidation of economic interests, rapid communication, and heightened sense of interdependence and "intercultural fertilization" as witnessing the birth of a "new global culture." (5) In the same way, most discussions of the global implications of developments in science and technology today are prefaced by an acknowledgment of a newly generalized sense of vulnerability, especially in the West, a sense, as British Prime Minister Tony Blair put it, of "the fragility of our frontiers in the face of the world's new challenges." (6) As Knowles goes on to argue, however, neither globalization nor shared risk per se is new. Globalization is, of course, "an ancient process, beginning with mercantile and cultural exchanges and facilitated by [incremental] advances in transportation." (7) And, as others have pointed out, the history of medicine contains many examples, from the Athenian plague of 430 B.C. to the influenza pandemic of the early 20th century, of disease overrunning national boundaries (or, as one commentator put it, of "involuntary microbiological warfare"). (8)
Still, it is undeniable that today we are witnessing the flow of information, people, and money at a pace, range, and depth of integration previously unknown. In the wake of what has been called the "death of distance," traditional distinctions between domestic and international …