Multiculturalism and Autonomy

Sartre posited a (nondual), nonreflexive, nonthetic, nonpositional awareness which makes all consciousness possible, and which underlies dualistic, thetic, positional consciousness of object. Though his description assumes dualistic, thetic, positional consciousness of object to be inherent in nondual, nonreflexive,nonthetic, nonpositional awareness and hence to be ineradicable, with some modifications it can explain the view of rdzogs-chen that the sems-sde series of teachings illustrate in nonphilosophical terms with the example of the primordial mirror in which both dualistic consciousness and its objects manifest (...) as the play of the mirror’s energy. Dualistic consciousness: (1) is not inherent in nondual awareness, but arises when the threefold thought structure (Tib. ’khor-gsum) causes the mental subject—an illusory, incorporeal phenomenon—to manifest in nondual awareness coemergently with the phenomenon of being that makes the subject in question appear to involve self-being, and as the (co)Gnitive capacity and motility of nondual awareness seems to lie in this subject, the latter seems to be a separate perceiver of experiences, thinker of thought and doer of action—so that the mental subject appears to be an individual, separate, autonomous dualistic consciousness; (2) together with the phenomenon of being, is the core of the basic human delusion at the root of unhappy consciousness (duhkha); and(3) can dissolve in nirvana, putting an end to the unhappy consciousness inherent in it. (shrink)

Informed consent, decision-making styles and the role of patient-physician relationships are imperative aspects of clinical medicine worldwide. We present the case of a 74-year-old woman afflicted with advanced liver cancer whose attending physician, per request of the family, did not inform her of her true diagnosis. In our analysis, we explore the differences in informed-consent styles between patients who hold an "independent" and "interdependent" construal of the self and then highlight the possible implications maintained by this position in the context (...) of international clinical ethics. Finally, we discuss the need to reassess informed-consent styles suitable to the needs of each patient regardless of whether he or she resides in the United States or in Japan. (shrink)

Communitarian writers argue that social identity is deeply important to individual autonomy and thus liberal societies have an obligation to recognize identity. Any liberal view that attempts to account for this charge must specify a procedure to recognize identity that also ensures that the liberal sense of autonomy is not weakened. In this article, I develop such an account. I argue that liberals must distinguish an identity that belongs to particular persons (particularized identity) from the collective form of that identity. (...) For instance, Naisha will have her own particularized way of being Indian in addition to the collective form of the culture that she shares with others. To determine which acts would be about recognizing the particularized form, I provide a counterfactual test. One major implication of the test is that special collective rights would not be endorsed. At the same time, the test is not equivalent to the liberal positions of insisting either that rights belong to individuals or that individuals are not harmed. Because identity is almost always viewed in terms of groups, valuing identity seems to be at odds with the principles of liberalism and democratic theory in which individual persons are the ultimate source of value. I show that there is a significant way to recognize identity that is harmonious with these principles. (shrink)

The 1970s and 1980s meant an ethnic politicization of the indigenous movement in Ecuador, until this moment defined largely as a class-based movement of indigenous peasants. The indigenous organizations started to conceptualize indigenous peoples as nationalities with their own economic, social, cultural and legal structures and therefore with the right to autonomy and self-determination. Based on this conceptualization, the movement developed demands for a pluralist reform of state and society in order to install a plurinational state with wide degrees of (...) autonomy and participation for indigenous nationalities. A part of those demands was the double strategy to fight for legal pluralism while already installing it at the local level. Even if some degrees of legal pluralism have been recognized in Ecuador since the mid-1990s, in practice, the local de facto practice prevails until today. Another central part of the demand for plurinationality is the representation of indigenous peoples in the legislative organs of the state, developing since their first appearance in the 1940s in a complex way. This article will analyze the development of right-based demands within the discourse of the indigenous movement in Ecuador, the visions of the implied state-reform and the organizational and political background and implication they have. Based on an analysis of the central texts of the indigenous organizations, conceptualizations of rights and laws and their appropriation within an autonomist discourse and a local practice will be highlighted. (shrink)

Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to all-purpose primary (...) goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need-based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless-pit problem. But there is a difference between needing something (first-order need) and needing to have the ability to need (second-order need). Even if we disagree about which first-order need to prioritize, we must accept the importance of satisfying our second-order need to have the ability to value things. We all have a second-order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first-order needs. (shrink)

I have argued in my dissertation, "Gender and Self in Islam: A Philosophical Interpretation," that Muslim interpretations on gender issues have produced the authoritative legitimacies that often contain contradictory claims. The hierarchical perspective, on the one hand, argues that the natural differences between men and women entail different moral, ethical, social, familial, financial, and political responsibilities. This accepted hierarchical claim of gender co-exists with the patriarchal culture that generates and nurtures the patriarchal system of Muslim culture. On the other hand, (...) the egalitarian perspective that acknowledges the equality of men and women is not adequately addressed. The unjustified prioritization of the anti-egalitarian and hierarchical concept of gender over an egalitarian principle of gender has resulted in the exclusion of the female self from her potential to be a full person and from humanity that is inclusive and conducive to her flourishing. ;There have been multiple elaborations of the systematic and structured interpretations that have generated and perpetuated gender hierarchy. In this respect, this dissertation has attempted to discuss the contradictory claims of gender hierarchy and egalitarian ism by examining the roots of the existing discourse of the hierarchical principle of gender using a philosophical analysis; the extent to which the process of human reproduction, especially the role of women in conception, contributes to anti-egalitarian theory of gender; the theological, cultural, and political apparatus of the masculine conception of femininity, which is internalized into women's bodies; the alienation of the self from a woman's sense of individuality, agency, and autonomy; and the possibility of providing an alternative reading of gender that is egalitarian and friendly to women. These analyses call for the recognition of a woman as a full person, who is an irreducible subject and is endowed with rights and responsibilities to her own self, other women, family, society, and the world. The inclusion of women as individuals and members of society is, therefore, a necessary pre-condition to allow all members of humanity to equally and fully participate in everyday activities in both private and public realms. (shrink)

Currently in Japan, it is extremely difficult to realize the basic wish of protecting personal dignity at the end of life. A patient’s right to refuse life-sustaining treatment has not been substantially warranted, and advance directives have not been legally enforceable. Unfortunately, it is not until the patient is moribund that all concerned parties start to deliberate on whether or not death with dignity should be pursued. Medical intervention is often perceived as a worthwhile goal to not only preserve life, (...) but also provide psychological benefit to the family, regardless of its effect on the patient. To feel they are doing something, family members tend to act against the imperative “Do not inflict on others what you would not wish done to you,” and permit extraordinary measures they would not want themselves. Another complication in Japanese culture is the necessity of unanimous decisions for end-of-life care. If there is conflict between a patient and his/her family on accepting medical intervention, the view of the latter is more likely to prevail due to different perceptions of human dignity. As a result, incapacitated patients in Japanese clinical settings often suffer through extraneous medical procedures, particularly during end-of-life care. Patient dignity is in danger from a national refusal to accept major bioethical principles such as having respect for patient autonomy, serving the best interests of the patient, doing no harm, and ensuring fairness at the end of life. We argue that more education about human dignity and legislation for death with dignity are necessary. Peace of mind for patients during end-of-life care will never be achieved in this society unless drastic changes take place in medical ethics and law. (shrink)

The availability of newer choices in contemporary bioethics, especially enhancement technologies, poses a challenge for Muslim patients and their care providers in making appropriate decisions. How should they reconcile personal autonomy with ethical guidelines of Islamic Shariah ? This article discusses such concerns.

Citizenship in liberal democracies has, until recently, been theorized as conferring equal legal status on all citizens irrespective of their race, religion, ethnicity, culture or language. While much discrimination and unequal treatment existed in practice, the theory was that all citizens should be treated equally, exactly the same, regardless of their individual characteristics; the state should be neutral in dealing with its citizens. In recent years, political theorists such as Charles Taylor, Will Kymlicka, Yael Tamir, J. Raz, Iris Marion Young, (...) and Anne Phillips have challenged both the practice and theory of the traditional view of citizenship. They argue that state neutrality has not been the case in actual practice; states discriminate in favour of dominant cultures. Furthermore the say such neutrality is, for a variety of reasons, impossible They also argue that it is not desirable even in theory. An individual's culture is essential to their being and deserves to be positively recognized by the state. ;This thesis argues that, while there are problems with the traditional view of a difference-blind citizenship and the idea of the neutral state, the philosophical arguments put forward by the critics are untenable. These arguments, and the political policies their implementation would entail, pose insurmountable problems for democratic deliberation and fail to take account of possible empirical results. The traditional view of citizenship and state neutrality can be rethought and implemented in what is called "the indifferent state"---a state which, while indifferent to its citizens' culture, religion etc., is not indifferent to the impact that these may have on the instantiation of such traditional liberal political values as equality and autonomy. ;The thesis concludes with three case studies which illustrate the differences in approach between the traditional view of citizenship, the view of the critics, and that of the indifferent state. (shrink)

Using the example of contemporary Islamic fundamentalism, and especially the writings of Sayyid Qutb, this article raises questions about discourse ethics as a mode of conflict resolution. It appears that discourse ethics is only relevant when all parties have already agreed to settle disputes deliberatively and already share the notions of rational deliberation and individual autonomy. This raises questions not only about the capability of discourse ethics to incorporate a deep plurality of worldviews, but also about its capability to successfully (...) solve disputes. When confronting situations where the willingness to deliberate is absent, discourse ethics is left standing empty handed. This, I argue, is due to both the conceptual distinction between communicative action and strategic action, as well as the abstracted nature of Habermas's discourse ethics. (shrink)

The movement to respect culturaldiversity, known as multiculturalism, poses a dauntingchallenge to healthcare ethics. Can we construct adefensible passage from the fact of culturaldifferences to any claims regarding morality? Or doesmulticulturalism lead to ethical relativism? Macklinargues that, in view of a leading distinction betweenuniversalism in ethics and moral absolutism, the onlyreasonable passage avoids both absolutism andrelativism. She presents a strong case againstethical relativism and its pernicious consequences forcross-cultural issues in healthcare. She alsoprovides sound criteria for the assessment of aculture's moral (...) progress. (shrink)

From Syrian asylum seekers to super-rich foreign investors, immigration is one of the most controversial issues facing Britain today. Politicians kick the subject from one election to the next with energetic but ineffectual promises to ‘crack down’, while newspaper editors plaster it across front pages. -/- But few know the truth behind the headlines; indeed, the almost daily changes to our complex immigration laws pile up so quickly that even the officials in charge struggle to keep up. -/- In this (...) clear, concise guide, Thom Brooks, one of the UK’s leading experts on British citizenship – and a newly initiated British citizen himself – deftly navigates the perennially thorny path, exploding myths and exposing absurdities along the way. Ranging from how to test for ‘Britishness’ to how to tackle EU ‘free movement’, Becoming British explores how UK immigration really works – and sparks a long-overdue debate about how it should work. -/- Combining expert analysis with a blistering critique of the failings of successive governments, this is the definitive guide to one of the most hotly disputed issues in the UK today. Wherever you stand on the immigration debate, Brooks’s wryly observed account is the essential roadmap. (shrink)

In this essay, Bruce Maxwell, David Waddington, Kevin McDonough, Andrée‐ Anne Cormier, and Marina Schwimmer compare two competing approaches to social integration policy, Multiculturalism and Interculturalism, from the perspective of the issue of the state funding and regulation of conservative religious schools. After identifying the key differences between Interculturalism and Multiculturalism, as well as their many similarities, the authors present an explanatory analysis of this intractable policy challenge. Conservative religious schooling, they argue, tests a conceptual tension inherent in Multiculturalism between (...) respect for group diversity and autonomy, on the one hand, and the ideal of intercultural citizenship, on the other. Taking as a case study Québec's education system and, in particular, recent curricular innovations aimed at helping young people acquire the capabilities of intercultural citizenship, the authors illustrate how Interculturalism signals a compelling way forward in the effort to overcome the political dilemma of conservative religious schooling. (shrink)

This article presents a view of bioethics in the Spanish context. We may identify several features common to Mediterranean countries because of their relatively similar social organisation. Each country has its own distinguishing features but we would point two aspects which are of particular interest¨: the Mediterranean view of autonomy and the importance of Catholicism in Mediterranean culture. The Spanish experience on bioethics field has been marked by these elements, trying to build a civic ethics alternative, with the law as (...) an important support. So, Spanish bioethics has been developed in two parallel levels: in the academic and policy maker field (University and Parliament) and in clinical practice (hospitals and healthcare ethics committees), with different paces and methods. One of the most important changes in the paternalistic mentality has been promoted through the recognition by law of the patient’s rights and also through the new generation of citizens, clearly aware on the exercise of autonomy. Now, the healthcare professionals have a new challenge: adapt their practice to this new paradigm. (shrink)

Más allá de la clásica concepción de la Escolástica como manifestación ideológica del poder político de los conquistadores, este estudio intenta ser un acercamiento a la interesante figura de Alonso Briceño. Del original punto de vista del filósofo chileno sobre el conocimiento intelectual y la experiencia de la individualidad deriva un principio de individuación que tiene carácter de positividad y realidad. En tal marco es posible destacar una objetiva relación entre la búsqueda política de una libre y autónoma identidad de (...) los pueblos latinoamericanos y la profundización de las fuentes filosóficas europeas, en este caso la Escolástica.Beyond the classical conception about the Scholastic as an ideological manifestation of “the conquistadores” political power, this essay treats to be an approach to the interesting figure of Alonso Briceño. From the Chilean philosopher’s point of view about intellectual knowledge and the experience of individuality derives an individuation principle that has a positive and real character. In this context it’s possible to underline an objective relationshipbetween the political search for a free and autonomous identity of the Latinamerican people and the deepening of the European philosophical sources, in this case the scholastic one. (shrink)

This paper approaches "multiculturalism" obliquely via conceptions of social and political pluralism in the pragmatist tradition. As a matter of social analysis, the advent of multiculturalism implies some loss of confidence in our prior conceptions of accommodating ethnic, social, and religious diversity: the conversion of traditional American cultural diversity into a war of political interest groups. This, and the corresponding tendency toward cultural relativism and "anything goes," is fundamentally a product of over-centralization and cultural-political exhaustion in the wake of the (...) long ordeal of the Cold War. An over-emphasis on the political, and national centralization, has pressured our cultural variety toward more political forms, and "multiculturalism" is both product and backlash.<br><br> Many issues connected with the general theme of multiculturalism parallel philosophical debates on objectivity and the diversity of cultural perspectives. Successful treatments of these themes, drawing on the pragmatist tradition, need to be developed and applied to contemporary problems. The general approach here emphasizes a relative autonomy of religious, ethnic, and cultural-racial groups, the need to be wary of both exclusion and self-insulation, and the roles of individuals in mediating group differences. In the concluding section, specific issues relating religious pluralism and secularism will be addressed.<br><br>. (shrink)

In his reflections on the problems raised by the Christian ethics, Troeltsch’s starting point has always been a general theory of ethics, which should have been structured of a theoretical and of a practical part. In this sense he can be seen as a representative of the development of the modern moral thought; in particular his intention was to develop Herrman’s idea of integrating Kant’s subjective ethics with Schleiermacher’s objective ethics. This Grundkonzeption of Troeltsch’s is extremely evident when analysing his (...) courses of lessons held at WS in 1905/06 and in 1911/12, where he indicates the concepts of moral duty or moral law, of evil , of a system of moral aims or of objective or cultural values, as the “fundamental concepts” of ethics. As for the Christian ethics, if the fact that morality and religiosity are tightly intertwined implies that “all the moral commandments of reason, which aim at the conquest of personality, are presented as emanations of God’s divine will”, then “theonomy speaks in autonomy’s name”, and the respect of the moral law is immediately recognised as a “divine obligation”. From this point of view the Christian ethics intersects the law of nature, and its story can be identified with that of the Christian natural law, interpreted and practiced from time to time “either in a more conservative, either in a more radical or democratic form”. (shrink)

This paper reflects on the presumption that there are distinct ethical differences between the supposedly ‘Anglo-Saxon liberal’ and ‘Latin (Southern European) paternalist’ ethical traditions. The predominance of the bioethical paradigm (principalism) is measured by a comparative analysis of regional moral opinion reflected in nation-state health laws. By looking at the way the ethico-legal concept figures into various national ordinances, we attempt to ascertain the extent and nature of variation (if any) between localities by exploring the understanding and application of principalism’s (...) keystone: patient autonomy. (shrink)

This chapter reviews the extent to which laws based on promotion of individual 'autonomy' (such as durable powers of attorney) conform with the lived lives and preferences of those for whom they are designed. It considers alternative conceptions of rights, including communitarian and social citizenship models, and discusses ways in which positive rights may better promote human flourishing.

Table of Contents: Politics, morality, and pluralism -- Liberal morality and political legitimacy -- Political legitimacy and social justice -- Williams's concept of the political -- Legitimacy, stability, and morality -- The politics of morality -- A moral point of view -- Manners and morality -- Morality and conflict -- Moral conflict and political theory -- The morality of politics -- Feminism and multiculturalism -- A defense of culture -- Politics and normative conflict -- The political as moral viewpoint -- (...) Morality and politics: a review -- Political unity and pluralism -- The liberal archipelago -- Loose linkage and political legitimacy -- Political unity and the body politic -- Social justice and political unity -- The bonds of civility -- Nationhood and the liberal polity -- The nature of nationhood -- Pluralism and nationalism -- Nationalism and social justice -- Deliberative democracy and the liberal polity -- Liberalism and democracy -- Democracy and deliberative discourse -- The terms of deliberative discourse -- Normative discourse and political legitimacy -- Deliberative democracy and intragroup politics -- Group autonomy and intergroup discourse -- Politics, history, and reason -- Principle and justice in the liberal polity -- Liberal institutions and liberal ideals -- Stopping history -- Rationalism and politics. (shrink)

International borders concentrate opportunities in some societies while limiting them in others. Borders also prevent those in the less favored societies from gaining access to opportunities available in the more favored ones. Both distributive effects of borders are treated here within a comprehensive framework. I argue that each state should have broad discretion under international law to grant or deny entry to immigration seekers; but more favored countries that find themselves under immigration pressure should be legally obligated to fund development (...) assistance for countries that generate immigration pressure. Funding should be subject to conditions of fair and effective use in recipient countries, and should aim at a near-term target of immigration-pressure equilibrium. Equilibrium obtains between two countries when, given appropriate background circumstances, the same proportion of individuals in each manifests a preference to migrate to the other. If meeting the equilibrium target in the short term would be to the long-term disadvantage of the worst-off countries, then a Pareto-superior alternative target supersedes. It mandates development assistance at the level that yields the most favorable human development projections for the worstoff countries. An implementable set of institutions is described that can achieve the equilibrium goal in the long term without unduly sacrificing other important ends, including economic growth, political stability, cultural integrity, the political autonomy of distinct societies, and their proper accountability for policy choices. Key Words: global justice • immigration • borders • development • distributive justice • development assistance • equality • international law • cosmopolitanism. (shrink)

Worldwide, obtaining valid informed consent prior to carrying out medical, therapeutic, and diagnostic procedures has long been recognized as an elementary step in fulfilling the physician’s obligations towards the patient. Obtaining this consent is essential in building a successful physician-patient relationship and increases patient satisfaction and compliance with treatment. However, in Mexico, as relatives become the main decision-makers, often influenced by the family’s economic situation; the real and effective application of concepts such as informed consent and patient autonomy is questionable.Methods: (...) To gain insight concerning the type of patient seen at this cancer hospital, we studied the socio-economic characteristics of 339 randomly selected patients seen during 2007 contained in each individual electronic chart. Confidentiality of the information was guaranteed by limited access to the charts. This initial information provided us with some insight for designing a semi-structured questionnaire to be applied in focus-groups and interviews.Patients invited to the focus groups were randomly selected in advance by the Institution’s social workers. Group conformation was unsystematic and included eight patients who were waiting for consultation and/or out-patient chemotherapy/radiotherapy the day the focus group was planned to take place. Selection of family members was managed likewise. Most of the times, these were not related to the patients participating in the same focus group. Four groups of eight patients each and two groups of eight relatives were made up. After explaining the purpose of the research and the procedures to be employed, we obtained verbal permission to tape the interviews. Questions with regards to the information provided on the patient’s disease, treatments, prognosis and disease stage, the name of the physician, the definition of “informed consent”, etc., were posed, and each patient or relative was encouraged to participate. A final comment was allowed.Results: The information obtained from the initial chart evaluation showed that 20% of the patients were illiterate, and 50% had six or fewer years of education. The daily family income of over 50% of the patients seen at the Hospital was $2.00 U.S. dollars or less.Focus group interviews showed that the patient’s need for information changed along with the disease. However, poor understanding of their disease and treatment was evident. At all times, patients were grateful to their physicians and mentioned that they had signed informed consent. The main concerns of the relatives were financially related which in turn influenced their decision making regarding treatment.Discussion: This study shows that the cornerstone of patient autonomy in terms of the patient’s right to self-determination in the West may be different from Mexican family-based decision-making. During interviews it was clear that the patients’ sole concern was “the disease” in terms of physical pain and life expectancy. None played an active role in treatment decisions, financial arrangements, or the long-term socioeconomic consequences for themselves or their families. Most of the decisions were influenced by family members. Poor health literacy should be acknowledged by physicians, and proper measures should be implemented to improve physician-patient communication. At present, the validity of informed consent is questionable. (shrink)

It is a widely supported claim that liberal democratic institutions should treat citizens with equal respect. I neither dispute nor champion this claim, but investigate how it could be fulfilled. I do this by asking, as a sort of litmus test, how liberal democratic institutions should treat with respect citizens holding minority convictions, and thereby dissenting from a deliberative output. The first step of my argument consists in clarifying the sense in which liberal democracies have a primary concern for the (...) respectful treatment of citizens qua self-legislating persons. Taking the second step, I address critically the common tendency in the literature to concentrate on what I have termed the ex ante legem phase, focusing solely on the structure of institutionalized decision-making processes. I submit, rather, that the principle of equal respect for persons demands more of liberal democratic institutions to enhance citizens' chances to give voice to their consciences and influence, on that ground, the formulation of the rules to which they should conform. Fulfilling this commitment requires democratic theorizing to go beyond the ex ante legem phase and regard forms of ex post legem contestation as an extension of citizens' right to political participation. Against this backdrop, I take the third and last step and argue that a promising way forward consists in the adoption of an ex post legem version of conscientious exemptionism, granting citizens a conditional moral right to request exemptions on the grounds of conscience from certain controversial legal and political provisions. (shrink)

In “Feminist ethics, autonomy and the politics of multiculturalism”, Sawitri Saharso argues that the feminist concern to protect women’s autonomy legitimates and permits two practices which might otherwise seem antithetical to feminism: hymen repair surgery and sex-selective abortion. Sex-selective abortion is given pragmatic support: since it is rare in the Netherlands (the focus of Saharso’s paper), and since limitations on abortion would adversely affect the autonomy of women who sought an abortion for other reasons, Saharso concludes that Dutch law ought (...) not to be changed to make such abortions more difficult. Hymen repair surgery is given much stronger support: she concludes that making it available is “both a multiculturalist action and good feminism” (Saharso, 2003: 211), thus suggesting that there need be no clash between feminism and multiculturalism. In this paper, I argue that Saharso’s argument takes inadequate account of the ways in which the practices reinforce sex inequality in the culture as a whole. As a result, her treatment of women’s autonomy gives insufficient weight to culture despite her aim to support multiculturalism. (shrink)

Three claims are defended. (1) There is a conception of moral autonomy in Confucian ethics that to a degree can support toleration and freedom. However, (2) Confucian moral autonomy is different from personal autonomy, and the latter gives a stronger justification for civil and personal liberties than does the former. (3) The contemporary appeal of Confucianism would be strengthened by including personal autonomy, and this need not be seen as forsaking Confucian ethics but rather as an internal revision in response (...) to new social circumstances. From this inclusion emerges a new theory of liberties that recognizes the value of personal autonomy and the importance of the ethical good that liberties instrumentally serve to promote. (shrink)

The deployment of prenatal diagnostic techniques raises complex ethical decisions which lie at the intersection of Technology, Law and Society. The paper examines socio-ethical dilemmas posed by a judgment delivered by the Mumbai High Court in 2008, denying a post-diagnostic abortion at twenty-four weeks of pregnancy. It examines the power relations and ideologies that underlie decision-making and contends that the judgment is framed in medical language without addressing moral ambiguities posed by technologies. Discourses dominated by medical language overlook both macro- (...) level structural issues related to health care as well as subjective feelings and affects. The judgement also raises doubts about whether scientific foreknowledge by itself empowers women. Furthermore, in India with poor provision of genetic testing and treatment and lack of institutional support mechanisms, ethics of care needs to take precedence over autonomy and beneficence in resolving the debate. The paper makes a plea for a more dynamic, flexible and contextual decision-making based on ethics of care. (shrink)

The idea of this paper came to me from my junior colleague and friend Saikat Sarkar who mentioned in a different context this paper's title. Existing work in this field registers two themes: those scholars who are abroad perforce critique whites since their unwritten code for getting tenure etc. is to lessen the guilt of their masters in First World social sciences' and humanities departments. And then there is the instance of First world scholars using these (mostly) subaltern-studies' scholars to (...) invade developing world academic systems with agenda of their own. This essay mentions the first sort and then deviates from contemporary scholarship in proving that multiculturalism may not be the right solution to ethnic plurality. It goes on to show how these Third World scholars attempted and attempt to erase individuality in the name of Cosmopolitanism. This last is the latest fad in humanities' departments in South East Asia, especially, India. (shrink)

This essay illustrates what the Chinese family-based and harmony-oriented model of medical decision making is like as well as how it differs from the modern Western individual-based and autonomy-oriented model in health care practice. The essay discloses the roots of the Chinese model in the Confucian account of the family and the Confucian view of harmony. By responding to a series of questions posed to the Chinese model by modern Western scholars in terms of the basic individualist concerns and values (...) embedded in the modern Western model, we conclude that the Chinese people have justifiable reasons to continue to apply the Chinese model to their contemporary health care and medical practice. (shrink)

The practice of critical care medicine has long been a difficult task for most critical care physicians in the densely populated city of Hong Kong, where we face limited resources and a limited number of intensive care beds. Our triage decisions are largely based on the potential of functional reversibility of the patients. Provision of graded care beds may help to relieve some of the demands on the intensive care beds. Decisions to forego futile medical treatment are frequently physician-guided family-based (...) decisions, which is quite contrary to the Western focus on patient autonomy. However, as people acquire knowledge about health care and they become more aware of individual rights, our critical care doctors will be able to narrow the gaps between the dif ferent concepts of medical ethics among our professionals as well as in our society. An open and caring attitude from our intensivists will be important in minimizing the cross-cultural conflict on the complex issue of medical futility. (shrink)

This paper argues against the continued practice of Confucian familism, even in its moderate form, in East Asian hospitals. According to moderate familism, a physician acting in concert with the patient's family may withhold diagnostic information from the patient, and may give it to the patient's family members without her prior approval. There are two main approaches to defend moderate familism: one argues that it can uphold patient's autonomy and protect her best interests; the other appeals to cultural relativism by (...) construing the principle of ‘family autonomy’ to be incommensurable with that of individual autonomy. We respond to the first approach by explaining how the familist arguments either depend on some unreasonable assumptions or simply fail to articulate. The critique of the second approach is based on our recent survey showing that there is no dichotomy of relevant values between the East and the West: we believe that the result can effectively block the familist's reliance on certain traditional or cultural values to explain their resistance to the incorporation of pluralist values. Despite our disagreement with familism, we consider the Eastern emphasis on the family to be conducive to the communication between patient, family members and medical personnel, which is indispensible to the patient's well being and autonomy. We conclude that respect for patient autonomy is perfectly consistent with the involvement of the family in making medical decision as long as the family plays a merely consultant role. (shrink)