Correspondence and reprint requests: Kerry Bowman, Department of Social Work, The Toronto Hospital Western Division, 399 Bathurst Street, Toronto, Ontario, M5T 2S8
In recent decades Canada, which has a substantial aboriginal population and increasingly a multicultural population, has made a commitment to cultural pluralism and equality. However, we have not yet explored the usefulness of bioethics in a pluralistic society. Modern bioethics, which is based on Western moral philosophy and Western biomedical perspectives, has evolved within a complex, highly individualistic culture that draws a sharp distinction between church and state and tolerates a multitude of values. This discipline defines its principles in secular and objective terms that often are bewildering to people of non-Western origin.
In addition, we tend to neglect the substantial differences in the way people of different cultures perceive, experience and explain illness, because our approaches tend to be limited to a biomedical focus that neglects the context of the situation. Often, when patients and health-care workers come from different cultural backgrounds, they interact under the influence of unspoken assumptions about health care that are so different that they prevent effective communication. (1) (2) (3)
This paper explores the capacity of Western bioethics to adapt to the realities of a culturally pluralistic society by exploring the sociocultural roots of bioethics, by considering three perspectives from the social sciences that are useful in analyzing cultural differences, and by identifying aspects of bioethics that give rise to particular problems in cross-cultural application.
The Sociocultural Development of Bioethics
Western biomedicine came to its dominant position at the turn of the 20th century in part as a by-product of society's unquestioning faith in scientific positivism. To date, bioethics has been tied directly to Western biomedicine, which has close links with science and technology and assumes itself to be separate from religion, politics, economics and morality. (4) (5) (6) (7) (8)
Particularly in its early stages, the primary intellectual and professional leaders of bioethics were philosophers, theologians, lawyers, physicians and biologists (9) and this discipline built its position using the rules of scientific analysis that were compatible with the positivism of philosophers and lawyers. This parallelism has conferred a sense of universal validity on much of bioethical theory. (10)
Western culture is becoming aware of the need to re-examine its social institutions and associated value systems in relation to the many cultures in our society. Bioethics has begun an empirical and philosophic analysis of cultural differences (11) (12) (13) (14) (15) and already has identified significant differences in perspectives rooted in culture. (16) (17) However, the limited amount of cross-cultural research done so far has not yet had a significant influence on the fundamental assumptions of bioethics.
Social Science Perspectives and Bioethics
As described by Edward Hall, (18) generally speaking Western culture is low-context and non-Western culture is high context. Although cultural context has many features, the most salient for bioethics are that low-context cultures emphasize independence, the individual and a future-time orientation. Communication takes place almost exclusively through language. High-context cultures emphasize interdependence, interconnections with others and a present-time orientation. In high-context communication, less information is conveyed by verbal expression and most of the message is embedded in the social context or internalized in the communication process itself. For example a person in a high-context culture may show their support to a bereaved person solely through their actions rather than ever directly discussing their loss. …