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Beyond a Western Bioethics: Voices from the Developing World
  1. D Dickenson

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    Edited by A T Alora, J M Lumitao, preface by E D Pellegrino, introduction by H T Engelhardt. Georgetown University Press, 2001, £44.50, $59.95, pp 162. ISBN 0–87840–874–6.

    This book is a case of “too little, too late”: too little in that it represents voices not from the developing world as a whole but from a particular Catholic viewpoint in the Philippines, too late in that others have already gone “beyond a Western bioethics”—which, in any case, is not the unified and rigid set of principles that the authors make it out to be.

    The publication is a long delayed spinoff of a series of bioethics seminars held in Manila and Houston under the leadership of H Tristram Engelhardt Jr, who has contributed an introduction to the volume on Western bioethics reconsidered. (As Engelhardt writes: “Like good wine, this work has come slowly into its own” (page xii). Engelhardt’s bias is evident in the phrase he uses early on in this introduction, “the customary American/western European indoctrination in bioethics”. It may well be true that the old bioethics “establishment” has emphasised autonomy to the point of dogma in the past, although that was never true of major figures such as Daniel Callahan, but recent extensive work in feminist ethics, narrative ethics, hermeneutics, global bioethics, and empirical ethics must cast doubt on whether there is such a thing as one voice in Western bioethics any longer. That much was abundantly clear at the Fifth IAB/FAB International Conference on Bioethics in London in September 2000, where there was a much wider range of “voices from the developing world” and a serious consideration of issues in global bioethics such as the use of Third World populations by First World researchers. Within “Western” bioethics there are also considerable divergencies, not least between European values emphasising solidarity and US individualism—although that, too, is an oversimplification. Those different European voices have emerged in the two European Commission projects on teaching ethics in a non-autonomy-centred way in a wider European context, EBEPE (European Biomedical Ethics Practitioner Education) and TEMPE (Teaching Ethics: Materials for Practitioner Education), which have just completed their five year task.

    Just as the book posits a false unity in Western bioethics, so it also presents an idealised “happy families” picture rather than the promised “authentic” vision of Filipino values; several commentators from the Philippines at the Feminist Approaches to Bioethics conference in Tsukuba (October 1998) offered quite a different and much more pessimistic analysis. In addition the book assumes that the particular Filipino situation, with the dominance of the Catholic Church (except in the minority Muslim areas) and the “colonial mentality” (page 113) resulting from an unusually long history of direct rule by either Spain or the United States, is typical of the entire developing world. One might argue the reverse: that the Philippines would be the last place to look for an “authentic” set of “developing world values”. The myth of the noble savage, however, is alive and well in Engelhardt’s claim that in this book “the reader discovers that moral commitments can be lived without the objectification and thematisation that often occurs in the West”. An equally patronising tone is demonstrated in his assertion that “the developing world often is spiritually rich, even when it is financially impoverished” (page xiv).

    The most interesting bits of the book are those that depart from the rosy picture: the essays by Josephine Lumitao on AIDS and those by Angeles Tan Alora on ethical issues in research and the practice of “dumping” drugs that no longer pass Western standards on the Philippines. Generic drugs are scorned in the Philippines because the population (despite its supposed distaste for Western materialism) regards imported brand name products as superior to equivalent generic medications produced at home. Although the authors do not make this connection, or indeed, any wider comparisons with the rest of the developing world, this is a finding that might also have some relevance to the South African, Indian, and Brazilian generics drug cases concerning antiretrovirals. In the related case of “dumping”, Alora concludes that Filipinos are better off with “substandard” Western drugs than with no drugs at all, and more strongly still, that we ought to ask whether people who speak against dumped drugs are murderers”. The giant logical jumps here, however, are fairly typical of the level of analysis in the book as a whole.