Global bioethics and respect for cultural diversity: how do we avoid moral relativism and moral imperialism?

One of the major concerns of advocates of common morality is that respect for cultural diversity may result in moral relativism. On their part, proponents of culturally responsive bioethics are concerned that common morality may result in moral imperialism because of the asymmetry of power in the world. It is in this context that critics argue that global bioethics is impossible because of the difficulties to address these two theoretical concerns. In this paper, I argue that global bioethics is possible if we adopt a culturally responsive and self-critical attitude towards our moral values and those of others. I use the example of women's reproductive autonomy in indigenous African culture to show that the difference between the leading Euro-American and indigenous African construal of autonomy is that the former ascribes greater weight on individual self-determination while the latter emphasizes responsibilities towards the community. One develops dignity in virtue of their capacity for communing with others. Hence, women have rights, but as members of the community, they also have obligations including the duty to procreate. The involvement of the family in reproductive decisions does not contravene women's dignity and human rights. In applying the principle of autonomy in this communitarian context, one has to be sensitive to these ontological and moral specificities. The aim of global bioethics should not be to reach common grounds at all costs; any common norms should be the result of a negotiated democratic dialogue between cultures and not the result of imposition by the preponderant culture(s).

Relativism or tolerance? Defining, assessing, connecting, and distinguishing two moral personality features with prominent roles in modern societies.

OBJECTIVE: This work disentangles moral tolerance from moral relativism and reveals their distinct personological meanings. Both constructs have long been of interest to moral philosophers, moral psychologists, and everyday people, and they may play prominent roles in the feasibility of modern diverse societies. However, they have been criticized as devaluing morality and as producing overly permissive societies. Moreover, although they lack necessary conceptual implications for each other, they are easily (and often) conflated. METHOD: Three studies included nine samples (total N > 3,200, 40%-50% female, Mage  = 38-40, 83% white). Participants completed (online) new measures of moral tolerance and moral relativism, along with measures of 40 additional constructs. RESULTS: Results reveal robust psychometric quality of the new measures (the Moral Relativism Scale and the Moral Tolerance Scale), demonstrate that the constructs are empirically overlapping but separable, and highlight their distinct personological networks. Moral relativism was associated with liberal political views and a lowered valuing/enacting of moral values. Moral tolerance was weakly associated with liberal political views but was strongly related to a broad range of both liberal and conservative moral values. CONCLUSION: This work yields new tools for investigating moral character, and it reveals the differential meaning of two important moral constructs.

Bioethics and multiculturalism: nuancing the discussion.

In his recent analysis of multiculturalism, Tom Beauchamp has argued that those who implement multicultural reasoning in their arguments against common morality theories, such as his own, have failed to understand that multiculturalism is neither a form of moral pluralism nor ethical relativism but is rather a universalistic moral theory in its own right. Beauchamp's position is indeed on the right track in that multiculturalists do not consider themselves ethical relativists. Yet, Beauchamp tends to miss the mark when he argues that multiculturalism is in effect a school of thought that endorses a form of moral universalism that is akin to his own vision of a common morality. As a supporter of multiculturalism, I would like to discuss some aspects of Beauchamp's comments on multiculturalism and clarify what a multicultural account of public bioethics might look like. Ultimately, multiculturalism is purported as a means of managing diversity in the public arena and should not be thought of as endorsing either a version of moral relativism or a universal morality. By simultaneously refraining from the promotion of a comprehensive common moral system while it attempts to avoid a collapse into relativism, multiculturalism can serve as the ethico-political framework in which diverse moralities can be managed and in which opportunities for ethical dialogue, debate and deliberation on the prospects of common bioethical norms are made possible.

Reconciling female genital circumcision with universal human rights.

One of the most challenging issues in cross-cultural bioethics concerns the long-standing socio-cultural practice of female genital circumcision (FGC), which is prevalent in many African countries and the Middle East as well as in some Asian and Western countries. It is commonly assumed that FGC, in all its versions, constitutes a gross violation of the universal human rights of health, physical integrity, and individual autonomy and hence should be abolished. This article, however, suggests a mediating approach according to which one form of FGC, the removal of the clitoris foreskin, can be made compatible with the high demands of universal human rights. The argument presupposes the idea that human rights are not absolutist by nature but can be framed in a meaningful, culturally sensitive way. It proposes important limiting conditions that must be met for the practice of FGC to be considered in accordance with the human rights agenda.

Two conceptions of conscience and the problem of conscientious objection.

Schuklenk and Smalling argue that it is practically impossible for civic institutions to meet the conditions necessary to ensure that conscientious objection does not conflict with the core principles of liberal democracies. In this response, I propose an alternative definition of conscience to that offered by Schuklenk and Smalling. I discuss what I call the 'traditional' notion of conscience, and contrast this with the existentialist conception of conscience (which I take to be a close cousin of the view targeted by Schuklenk and Smalling). I argue that the traditional notion, grounded in an objective moral order, avoids the criticisms advanced by Schuklenk and Smalling; the existentialist conception, in contrast, does not. I conclude by discussing the benefits and risks of a 'restricted view' of respect for conscience.

Further clarity on cooperation and morality.

I explore the increasingly important issue of cooperation in immoral actions, particularly in connection with healthcare. Conscientious objection, especially as pertains to religious freedom in healthcare, has become a pressing issue in the light of the US Supreme Court judgement in Hobby Lobby Section 'Moral evaluation using the basic principles of cooperation' outlines a theory of cooperation inspired by Catholic moral theologians such as those cited by the court. The theory has independent plausibility and is at least worthy of serious consideration-in part because it is an instance of double-effect reasoning, which is also independently plausible despite its association with moral theology. Section 'Case study: Burwell v. Hobby Lobby' examines Hobby Lobby in detail. Even if the judgement was correct in that case the reasoning was not, as it involved applying a 'mere sincerity' test to the cooperation question. The mere sincerity test leads to absurd consequences, whereas a reasonableness test applied using the theory of cooperation defended here would avoid absurdity. Section 'A question of remoteness: "accommodations" and opt-outs' explores the post-Hobby Lobby problem further, examining opt-outs and accommodations: the Little Sisters of the Poor case shows how opt-outs are misunderstood on a mere sincerity test, which the court rightly rejected. Section 'Application to the medical field: Doogan and Wood' discusses the UK case of Doogan and Wood, concerning participation in abortion. Again, a judicially recognised ethic of cooperation, if it were part of the fabric of legal reasoning in such cases, would have enabled the conscientious objectors in this and similar situations to have their freedom of conscience and religion respected in a way that it currently is not.

Why high-risk, non-expected-utility-maximising gambles can be rational and beneficial: the case of HIV cure studies.

Some early phase clinical studies of candidate HIV cure and remission interventions appear to have adverse medical risk-benefit ratios for participants. Why, then, do people participate? And is it ethically permissible to allow them to participate? Recent work in decision theory sheds light on both of these questions, by casting doubt on the idea that rational individuals prefer choices that maximise expected utility, and therefore by casting doubt on the idea that researchers have an ethical obligation not to enrol participants in studies with high risk-benefit ratios. This work supports the view that researchers should instead defer to the considered preferences of the participants themselves. This essay briefly explains this recent work, and then explores its application to these two questions in more detail.

Selling conscience short: a response to Schuklenk and Smalling on conscientious objections by medical professionals.

In a thought-provoking paper, Schuklenk and Smalling argue that no right to conscientious objection should be granted to medical professionals. First, they hold that it is impossible to assess either the truth of conscience-based claims or the sincerity of the objectors. Second, even a fettered right to conscientious refusal inevitably has adverse effects on the rights of patients. We argue that the main problem with their position is that it is not derived from a broader reflection on the meaning and implications of freedom of conscience and reasonable accommodation. We point out that they collapse two related but distinct questions, that is, the subjective conception of freedom of conscience and the sincerity test. We note that they do not successfully show that the standard norm according to which exemption claims should not impose undue hardship on others is unworkable. We suggest that the main reason why arguments such as no one is forced to be a medical professional are flawed is that public norms should not constrain citizens to choose between two of their basic rights unless it is necessary. In fine, Schuklenk and Smalling, who see conscience claims as arbitrary dislikes, sell freedom of conscience short and forego any attempts at balancing the competing rights involved. We maintain the authors neglect that most of legal reasoning is contextual and that the blanket restriction of healthcare professionals' freedom of conscience is disproportionate.

Reasons, reasonability and establishing conscientious objector status in medicine.

This paper builds upon previous work in which I argue that we should assess a provider's reasons for his or her objection before granting a conscientious exemption. For instance, if the medical professional's reasoned basis involves an empirical mistake, an accommodation is not warranted. This article poses and begins to address several deep questions about the workings of what I call a reason-giving view: What standard should we use to assess reasons? What policy should we adopt in order to evaluate the reasons offered by medical practitioners in support of their objections? I argue for a reasonability standard to perform the essential function of assessing reasons, and I offer considerations in support of a policy establishing conscientious objector status in medicine.

Conscientious objection in healthcare, referral and the military analogy.

An analogy is sometimes drawn between the proper treatment of conscientious objectors in healthcare and in military contexts. In this paper, I consider an aspect of this analogy that has not, to my knowledge, been considered in debates about conscientious objection in healthcare. In the USA and elsewhere, tribunals have been tasked with the responsibility of recommending particular forms of alternative service for conscientious objectors. Military conscripts who have a conscientious objection to active military service, and whose objections are deemed acceptable, are required either to serve the military in a non-combat role, or assigned some form of community service that does not contribute to the effectiveness of the military. I argue that consideration of the role that military tribunals have played in determining the appropriate form of alternative service for conscripts who are conscientious objectors can help us to understand how conscientious objectors in healthcare ought to be treated. Additionally, I show that it helps us to address the vexed issue of whether or not conscientious objectors who refuse to provide a service requested by a patient should be required to refer that patient to another healthcare professional.

Conscientious objection in healthcare and the duty to refer.

Although some healthcare professionals have the legal right to conscientiously object to authorise or perform certain lawful medical services, they have an associated duty to provide the patient with enough information to seek out another professional willing to authorise or provide the service (the 'duty to refer'). Does the duty to refer morally undermine the professional's conscientious objection (CO)? I narrow my discussion to the National Health Service in Britain, and the case of a general practitioner (GP) being asked by a pregnant woman to authorise an abortion. I will be careful not to enter the debate about whether abortion should be legalised, or the debate about whether CO should be permitted-I will take both as given. I defend the objecting GP's duty to refer against those I call the 'conscience absolutists', who would claim that if a state is serious enough in permitting the GP's objection in the first place (as is the UK), then it has to recognise the right to withhold any information about abortion.

Conscientious objection in healthcare: why tribunals might be the answer.

A recent focus of the debate on conscientious objection in healthcare is the question of whether practitioners should have to justify their refusal to perform certain functions. A recent article by Cowley addresses a practical aspect of this controversy, namely the question of whether doctors claiming conscientious objector status in relation to abortion should be required, like their counterparts claiming exemption from military conscription, to defend their claim before a tribunal. Cowley argues against the use of tribunals in the medical case, on the grounds that there are likely to be fewer unjustified claims to conscientious objection in this context than in the military, and that in any case tribunals will not be an effective way of distinguishing genuine and false cases. I reject these arguments and propose a different conception of the role of a medical conscientious objection tribunal.

Complicity and torture.

One of the great merits of On Complicity and Compromise is that it wades into specific swamps where ordinary theorists fear to slog. It is persuasive that in general it can be right sometimes to be complicit in wrongdoing by others through causally contributing to the wrongdoing, but not sharing its purpose, if by being involved one can reasonably expect to lessen the extent of the wrong that would otherwise be suffered by the victims. I focus on whether the book's general thesis is applicable to torture, which depends on what torture and the torture situation are in fact like. I focus on the case to which the chapter several times refers: the innovative CIA paradigm of torture. First, to the extent that the paradigm, which is predominantly mental, or psychological, torture succeeds in its goal of producing regression to a compliant state, the physician would be unable to rely on the torture victim's expressions of preferences or interests as authentically his own. Second, since disorientation plays such a large role in the CIA's style of torture (adopted at Guantanamo by the military), the authorities would refuse to allow a stable relationship to be built up with any one doctor by any victim, making comprehension of the victim's preferences difficult. Third, even if the doctor could somehow judge what the victim's genuine interests were, the control of the situation is much too totalistic to allow the physician any action independent of what the torture regime requires.

Against the accommodation of subjective healthcare provider beliefs in medicine: counteracting supporters of conscientious objector accommodation arguments.

We respond in this paper to various counter arguments advanced against our stance on conscientious objection accommodation. Contra Maclure and Dumont, we show that it is impossible to develop reliable tests for conscientious objectors' claims with regard to the reasonableness of the ideological basis of their convictions, and, indeed, with regard to whether they actually hold they views they claim to hold. We demonstrate furthermore that, within the Canadian legal context, the refusal to accommodate conscientious objectors would not constitute undue hardship for such objectors. We reject concerns that refusing to accommodate conscientious objectors would limit the equality of opportunity for budding professionals holding particular ideological positions. We also clarify various misrepresentations of our views by respondents Symons, Glick and Jotkowitz, and Lyus.

From Ethical Exceptionalism to Ethical Exceptions: The Rule and exception Model and the Changing Meaning of Ethics In German Bioregulation.

Germany is an interesting case with respect to the governance of reprogenetics. It has a strong profile in the technosciences and high aims regarding the global bioeconomy, yet her regulation of human genetics, reproductive medicine and embryo research has for a long time been rather restrictive. German biopolitical exceptionalism has often been explained by reference to Catholicism and the legacy of the Nazi past. The Germans, so goes the common story, have learnt the lessons of history and translated them into unconditional respect for human dignity, which in turn translates into unconditional protection of human life, including the human embryo, and the firm repudiation of any eugenic distinction between 'life worth to live' and 'life not worth to live'. This, however, is not the whole story. Alongside deontological strictness we find another strand of governing body politics and reprogenetics in Germany, the rule-and-exception model, running from the mid-1970s abortion law via the 2002 Stem Cell Act to the 2011 regulation of pre-implantation genetic diagnosis. In contrast to the former, that strongly draws on Kant and his concept of human dignity, the latter bears resemblances to Carl Schmitt's concept of state of exception. The article will show that the rule-and-exception model builds the exception into the rule and transforms the meaning and mandate of ethics, namely from safeguarding ethical standards to deciding about the exception. Given that the exception has now tended to become the rule, the question is whether the lessons of history will govern German reprogenetics for much longer.

Between Moral Relativism and Moral Hypocrisy: Reframing the Debate on "FGM".

The spectrum of practices termed "Female Genital Mutilation" (or FGM) by the World Health Organization is sometimes held up as a counterexample to moral relativism. Those who advance this line of thought suggest the practices are so harmful in terms of their physical and emotional consequences, as well as so problematic in terms of their sexist or oppressive implications, that they provide sufficient, rational grounds for the assertion of a universal moral claim--namely, that all forms of FGM are wrong, regardless of the cultural context. However, others point to cultural bias and moral double standards on the part of those who espouse this argument, and have begun to question the received interpretation of the relevant empirical data on FGM as well. In this article I assess the merits of these competing perspectives. I argue that each of them involves valid moral concerns that should be taken seriously in order to move the discussion forward. In doing so, I draw on the biomedical "enhancement" literature in order to develop a novel ethical framework for evaluating FGM (and related interventions--such as female genital "cosmetic" surgery and nontherapeutic male circumcision) that takes into account the genuine harms that are at stake in these procedures, but which does not suffer from being based on cultural or moral double standards.

Between relativism and pluralism: Philosophical and political relativism in Feyerabend's late work.

Relativism is one of the most problematic terms associated with philosophical discourse, with Feyerabend considered among the most important twentieth century theorists subscribing to it. This paper provides a detailed overview of relativist positions advanced in Feyerabend's mid-to-late work and investigates the associated epistemic and political applications. Emphasis is placed on how Feyerabend supported certain aspects of relativism, and at what stage he rejected others. It is noted that Feyerabend had already imposed limitations on relativism in Farewell to Reason, in which he entertained the possibility of epistemic definition within stable contexts, and advanced the notion that opportunities and equality associated with political and cultural units could only be valid within a democratic system. In Conquest of Abundance, political relativism is largely discarded, while epistemological relativism is increasingly treated as an appeal for diversity in all areas. In this re-reading of his work, it becomes clear that Feyerabend was already advocating a moderate form of epistemic and political relativism in the middle of his career, which he subsequently developed in the direction of "ontological pluralism" in his later work. This paper thus shows that Feyerabend's relativism should not be completely rejected, but rather that it continues to offer interesting food for thought.

Relativism in Feyerabend's later writings.

This paper reconstructs, and distinguishes between, Feyerabend's different forms of relativism in his later writings. Science in a Free Society remains close to familiar forms of relativism, while, at the same time, developing an original but under-argued form of political relativism, and rejecting "conversion" models of cultural exchange. Farewell to Reason moves away from common renderings of relativism, and develops a range of different new forms. Central here are links between relativism, skepticism and infallibilism. In the last six years of his life, Feyerabend often criticizes a peculiar radical form of relativism that arguably no-one has ever proposed or defended. In the same context, Feyerabend sketches an "ontological" form of relativism. It combines "Kantian humility", metaphysical pluralism and constructivism.