Journal of Bioethical Inquiry, Volume 4, Number 3 (December 2007)
Guest Editors: Ian Kerridge, Margaret Sleeboom-Faulkner, and Paul Komesaroff
Paul A. Komesaroff and Ian Kerridge
Jing-Bao Nie and Alastair V. Campbell
Erika Yu and Ruiping Fan
This paper focuses on Confucian formulations of personhood and the implications they may have for bioethics and medical practice. We discuss how an appreciation of the Confucian concept of personhood can provide insights into the practice of informed consent and, in particular, the role of family members and physicians in medical decision-making in societies influenced by Confucian culture. We suggest that Western notions of informed consent appear ethically misguided when viewed from a Confucian perspective.
Renuka M. Sharma
This paper discusses the persistent devaluation of the girl child in India and the link between the entrenched perception of female valuelessness and the actual practice of infanticide of girl babies or foetuses. It seeks to place female infanticide, or “gendercide,” within the context of Western-derived conceptions of ethics, justice and rights. To date, current ethical theories and internationally purveyed moral frameworks, as well as legal and political declarations, have fallen short of an adequate moral appraisal of infanticide. This paper seeks to rethink the issue.
In this essay, I indicate how social-science approaches can throw light on predictive genetic testing (PGT) in various societal contexts. In the first section, I discuss definitions of various forms of PGT, and point out their inherent ambiguity and inappropriateness when taken out of an ideal–typical context. In section two, I argue further that an ethics approach proceeding from the point of view of the abstract individual in a given society should be supplemented by an approach that regards bioethics as inherently ambiguous, contested, changeable and context-dependent. In the last section, I place these bioethical discussions of PGT in the context of Asian communities. Here, a critical view of what constitutes a community and culture proves necessary to understand the role of bioethical debates and the empirical manifestations of PGT in Asian societies. A discussion of the concepts of family and kinship in relation to PGT indicates that any bioethical analysis has to take into account that bioethical values are not just reflections of a cultural community, but embody both bioethical ideals and prevalent political rhetoric which is exhibited, propagated and manipulated by individuals and collectives for a variety of purposes. I end by summarising the contributions that social science could make to the understanding of the bioethics of PGT.
In Sri Lanka, termination of pregnancy, other than in extreme circumstances, is strictly illegal. Among the public and large sections of the medical community there is widespread support for some degree of liberalization of the law, particularly where this relates to serious genetic conditions which can be identified prenatally. Tension emerges out of a publicly maintained conservatism on issues of abortion on the one hand and a growing disconnection from unregulated practices of termination in the private sector on the other. Social science approaches have much to contribute when understanding the ‘therapeutic gap’ that opens up and, in particular, the way that local ideas of fate, destiny and how suffering might be ameliorated become blended with the predictive power of genetic testing.
Jyotsna Agnihotri Gupta
Epidemiologists and geneticists claim that genetics has an increasing role to play in public health policies and programs in the future. Within this perspective, genetic testing and screening are instrumental in avoiding the birth of children with serious, costly or untreatable disorders. This paper discusses genetic testing and screening within the framework of eugenics in the health care context of India. Observations are based on literature review and empirical research using qualitative methods. I distinguish “private” from “public” eugenics. I refer to the practice of prenatal diagnosis as an aspect of private eugenics, when the initiative to test comes from the pregnant woman herself. Public eugenics involves testing initiated by the state or medical profession through (more or less) obligatory testing programmes. To illustrate these concepts I discuss the management of thalassaemia, which I see as an example of private eugenics that is moving into the sphere of public eugenics. I then discuss the recently launched newborn screening programme as an example of public eugenics. I use Foucault’s concepts of power and governmentality to explore the thin line separating individual choice and overt or covert coercion, and between private and public eugenics. We can expect that the use of genetic testing technology will have serious and far-reaching implications for cultural perceptions regarding health and disease and women’s experience of pregnancy, besides creating new ethical dilemmas and new professional and parental responsibilities. Therefore, culturally sensitive health literacy programmes to empower the public and sensitise professionals need attention.
Suli Sui and Margaret Sleeboom-Faulkner
This paper provides an empirical account of commercial genetic predisposition testing in mainland China, based on interviews with company mangers, regulators and clients, and literature research during fieldwork in mainland China from July to September 2006. This research demonstrates that the commercialization of genetic testing and the lack of adequate regulation have created an environment in which dubious advertising practices and misleading and unprofessional medical advice are commonplace. The consequences of these ethically problematic activities for the users of predictive tests are, as yet, unknown. The paper concludes with a bioethical and social science perspective on the social and ethical issues raised by the dissemination and utilization of genetic testing in mainland China.
The case study examines an issue of public health ethics and obesity. How should healthy diets be developed? Can schools associate themselves with commercial fastfood companies? What are the ethical issues related to diet campaigns in an Asia context. The case study elicits several responses from different perspectives. The case study invites readers to think of different cultural contexts and broad issues.
This article was originally published in the Journal of Bioethical Inquiry 4(2): 157–158, http://dx.doi.org/10.1007/s11673-007-9048-3. It is reprinted here for the sake of coherence.
Sarah Jane Toledano and Leonardo D. de Castro
Fast food companies like Siam Burger that participate in health awareness campaigns create a conflict of interest between the social responsibility of promoting health and the business interest of increasing sales through marketing strategies like advertising. Alternative options of raising health awareness without mitigating the involvement of fast food companies either by denying advertisements or having a third party foundation should be explored.
Lalaine H. Siruno and Leonardo D. de Castro
The offer of the fast food company gives rise to suspicion. This seems to be based on unfounded stereotypes, however. This paper argues that we need to preserve choices in taking particular courses of action. There is nothing inherently wrong in fast food consumption so long as consumers are made aware of the importance of weight management and proper nutrition.
Els Reijn and Marcel Verweij