When I retired as president of The Hastings Center in August 1996, there was no question in my mind what I wanted to do next: to remain full time at the Center, and to focus my work on the relationship among medicine, ethics, and culture. Strachan Donnelley, my successor as president, was gracious enough to give me a new title of my own choosing, Director of International Programs; and the Board of Directors generously undertook a fund-raising campaign to provide some sustained financial support for my agenda on "good medicine, good society."
It has been a splendid year since, beginning with a four-month sabbatical at the Harvard Center for Population and Development Studies and ending with a summer trip to Adelaide, Australia, for an International Congress on Gerontology. In between, there was the Center's conference on the Goals of Medicine in Naples in June, two visits to Prague during the fall and spring (where I have been appointed an honorary professor in the Charles University Medical School), and conferences in Stockholm, Geneva, and Paris.
While those who like international travel might think this an envious schedule, most of the trips were short (3-4 days) and the work hard, with little time for resting, much less touring. Moreover, as others can attest, language difficulties add a special strain to international work, even though English is now (to the dismay of the French I would imagine) the lingua franca of academic and scientific discourse. As often as not, I wondered why I had not stayed home, where life is more familiar and less wearing.
A good question: why pursue international work? To me the answer seems almost self-evident, but I discovered Daniel Callahan is Director of International Programs at The Hastings Center. some years ago that It is anything but that to most American foundations and to many American intellectuals and scholars. The Center has had enormous difficulties over the years getting foundation support for international projects on health care ethics. At least two foundations provided some past support, but only on the condition that our proposal stress the American aspects of the projects, omitting altogether any mention of their international dimension. A long-time friend and colleague once said to me "why are you wasting time on that international stuff when there are so many serious problems in the United States?"
So what, then, is "almost self-evident" about the value of international perspectives? It is not simply that we live in an increasingly interdependent "global village," in medicine as well as just about everything else. Nor is it that other societies and cultures have much of value to teach us, though they do. It is also that we can better understand our own culture and problems by seeing them through different lenses and from sharply different angles.
Why are some issues deemed of immense importance in some countries and of utter disinterest elsewhere, as is the case, for instance, with the care of the dying? Hundreds of efforts are underway here to improve the process, but none at all in most other countries, which see no special problem. Why do Americans abhor the idea of health care rationing, taken to be inevitable and inoffensive elsewhere? Why do many highly secular European countries (save for Holland) find the idea of physician-assisted suicide morally repugnant while the ostensibly more religious United States is, according to public opinion surveys, far more supportive of the idea? Why Is it that the liberte-loving French are much more willing flatly to outlaw novel reproductive techniques than we in the United States? It is one thing to wryly note, as many have done, that Americans seem much less willing to accept death than people in other countries, and devote much more research money to combating lethal disease, but quite another to really understand why that disposition--going back to the Revolutionary War hero, Dr. …