Bioethics ISSN 0269-9702

Volume 13 Number 3/4 1999

IS THERE AN ASIAN BIOETHICS?

LEONARDO D. DE CASTRO

ABSTRACT
Is there an Asian Bioethics?
Some people might consider it blasphemous even to ask this question. But
this paper asks it not so much to seek an answer as to clarify what it could
actually mean. The idea is to sort out the presuppositions and possible
implications of asserting the existence of an Asian bioethics.
In the end, this paper makes the following points: (1) In the attempt to
assert an Asian identity, one must be careful not to commit the mistake of
universalizing (among Asians) a single Asian perspective; and (2) In the
face of pluralism and multi-culturalism, there is some room for a kind of
universalist ethics that is founded on a collage of culturally inspired
perspectives rather than on a single standard of morality.

QUALIFICATIONS OF AN ASIAN BIOETHICS

What would it take for a bioethics to be Asian (or, say, Japanese
or American)? Two things seem naturally to come to mind.
Firstly, Asian bioethics must be peculiar (or contain features that
are peculiar) to Asia. Secondly, Asian bioethics must be common
to Asians.
Being peculiar is necessary because, if Asian bioethics Ð more
particularly, the features that make it Asian Ð were not peculiar
to Asia or to Asians, there would not be much sense in
distinguishing Asian from non-Asian bioethics. If there were no
peculiar features or qualities that characterized Asian bioethics, it
would be like any other bioethics.
It seems natural also to suppose that Asian bioethics should
have features shared by Asians. For if there were no such features,
there would be no special reason to speak of a bioethics as Asian.
There would be nothing to unify Asian bioethics.
But, how far can these requirements be expected to hold? How
much peculiarity and commonality can there be?
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228 LEONARDO D. DE CASTRO

We have seen papers intended to mark out the Asian from the
non-Asian in some aspects of bioethics. One example is an article
by Ruiping Fan that differentiates an East Asian from a Western
principle of autonomy. Fan observes that `the East Asian prin-
ciple of autonomy contains the minimal substantive content of
family-sovereignty, an objective conception of the good and har-
monious dependence, while the Western principle of autonomy
carries the minimal substantive content of self-sovereignty, a sub-
jective conception of the good and individual independence'.1
What Fan's analysis strives to provide are features of East Asian
bioethics that are supposed to be peculiar to it. Presumably,
those features are not to be found in Western bioethics.
Presumably also, those features are held in common by smaller
subsets of East Asian bioethics. If it is important to find features
that are peculiar to East Asian Ð or Asian bioethics so that it can
be set apart from Western bioethics, it is important also to find
features shared by all East Asian bioethics.
In another project, James F. Drane takes note of the varying
moral categories, strategies, and perspectives that Ibero-
American bioethicists employ to address the problems that they
face in their societies. According to him:
In the United States the most often asked questions have to do
with the humane use of technology: questions about withhold-
ing and withdrawing life-saving or life-sustaining machinery,
and questions about consenting and refusing to consent to
high tech treatment. In Ibero-America, however, the very
existence of high tech tertiary care medical centers poses
major questions about discrimination and injustice in health
care delivery. The more pressing problems in this region are
not about how one uses medical technology humanely but
about who gets access to modern medicines and how society
fairly delivers health care to different groups of people.2
And in so far as theoretical content is concerned:
Solidarity and justice are the principles which occupy a place
in Ibero-American bioethics, similar to the place which
autonomy occupies in the United States and Europe.3

1
Ruiping Fan, `Self-Determination vs. Family Determination: Two
Incommensurable Principles of Autonomy', Bioethics, 11 (1997), pp. 309±322,
esp. p. 319.
2
James F. Drane, `Bioethical perspectives from Ibero-America', Journal of
Medicine and Philosophy, 21 (1996), pp. 557±569, esp. p. 559.
3
Ibid.

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 IS THERE AN ASIAN BIOETHICS? 229

REGIONAL VARIATION IN BIOETHICAL THINKING

Fan attributes the difference between the American and the East
Asian concepts of autonomy partly to the influence of the
Confucian understanding of the nature of the family and
individuals: `It is a Confucian moral requirement that one
should take one's family as an autonomous unit from the rest of
society, flourishing or suffering as a whole.'4
On the other hand, Drane cites the Latin influence on Ibero-
American societies, as he notes the significance of historical
awareness: `[W]ithout an understanding of the differences
between the histories of North and South America, it would be
difficult for bioethicists to appreciate the differences in bioethics
style and emphases ....'5
Having identified distinguishing features of East Asian and
Ibero-American bioethics, both Fan and Drane are quick to point
out the variation in bioethical thinking within each region. Fan
acknowledges that Buddhism, Taoism and Shinto have all
combined to bring about variations in bioethical thinking from
country to country, or from area to area.6 And Drane observes
that Ibero-American bioethics is not a self-contained unified
theoretical system providing a single, coherent perspective:
`Instead, different orientations and divergent views co-exist and
compete with one another, creating a complex set of
reflections.'7
The existence of variations or of different orientations and
divergent views across countries within a region raises some
questions about the idea of a shared regional perspective. For if,
as Drane notes about Ibero-American bioethics, `it is far from
being a unified theoretical system or a single coherent
perspective',8 how significant could any shared features be? Of
what importance are the shared features if they do not amount to
a unified theoretical system or a single coherent perspective?
Would not the shared features be merely coincidences or
intersections that have nothing necessarily to do with their being
Ibero-American, East Asian, etc.? Would the shared features have
anything to do with identity?

4
Ruiping Fan, `Self determination vs. family determination', 1997, p. 317.
5
Drane, `Bioethical perspectives', 1996, p. 557
6
Ruiping Fan, `Self determination vs. family determination', 1997, p. 318
7
Drane, `Bioethical perspectives', 1996, p. 56
8
Ibid.

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230 LEONARDO D. DE CASTRO

IDENTITY AND AUTHENTICITY

In this kind of discourse, the concept of identity is of crucial
importance. Many Asian and Latin American bioethicists have
found it useful Ð even necessary Ð to assert their respective
identities in light of the proliferation of what they perceive as
alien concepts and principles in mainstream, i.e., numerically
prevalent, bioethics literature. Hence, Fan raises the question:
`ought bioethics in East Asia to use the same approaches
(assumptions, principles, theories, styles, methods, concepts) as
bioethics developed in the West, or ought it to reflect a
specifically East Asian approach to the subject?'9
Earlier on, Sakamoto offered an answer to this question in
connection with the brain death debate in Japan as he noted that
the public exchanges touched on `aspects that may be peculiar to
the Japanese', that `some of us began to doubt the applicability of
Euro-American bioethics to Japanese climate', and that `we had a
common feeling that, though we learn from Euro-American
bioethics much more, ``our bioethics'' should be based on our
own culture and, therefore, it should be somewhat different from
the Euro-American ones'.10
The issue appears to be one of identity. The crucial values are
authenticity and integrity. The unarticulated argument is that if
we are to be authentic, we must be true to ourselves. Given a
religion-oriented culture, this could mean having to be guided
mainly by religious thought on the various topics of bioethics.
Where there is no dominant religious world-view, `being true to
ourselves' could mean being cognizant and respectful of one's
traditions, history, and cultural heritage. This is what Charles
Taylor seems also to have in mind when he says:
Only if I exist in a world in which history, or the demands of
nature, or the needs of my fellow human beings, or the duties
of citizenship, or the call of God, or something else of this
order matters crucially, can I define an identity for myself that is
not trivial.11
On the whole, what authenticity entails is a responsibility to live
our lives in accordance with the values that constitute our unique
cultural perspective. The implication is that Asians need to think

9
Ruiping Fan, `Self determination vs. family determination', 1997, p.310
10
H. Sakamoto, `New Initiatives in East Asian Bioethics', Eubios Journal of
Asian and International Bioethics, 5 (1995), p. 30.
11
Charles Taylor, The Ethics of Authenticity, (Harvard University Press,
Boston, 1991), pp. 40±41.

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 IS THERE AN ASIAN BIOETHICS? 231

and behave as Asians. They need to uphold values and make

moral judgments that are reflective of an Asian identity.
People also need to retain their integrity as a group. They must
uphold the shared values that unite them. They must seek
recognition for their identity as a people. To be remiss in this
responsibility is to participate in the annihilation of their identity.
What seems to be at stake, then, is the survival of an identity Ð in
a way, the preservation of a cultural self.
Still, we are left with the question: what would it take for `our
bioethics' to be an Asian bioethics? To partake of an Asian
identity, a bioethics needs to have qualities that would set it apart
from a non-Asian bioethics. But it should also have qualities
common to Japanese bioethics, Chinese bioethics, Indian
bioethics, Korean bioethics, Philippine bioethics, etc. As we look
more closely at this requirement, we realize how extensive and
difficult Ð even impossible Ð the task is. For in how many
respects can so many Asian bioethics cultures be similar to one
another and yet be different from non-Asian bioethics? How
many integrative features can they have in common that will set
them apart from `Western bioethics'?
This paper offers no definite answers to these difficult
questions. The main concern here is not the possibility or
impossibility of finding integrating features to bind the cultures.
It is, rather, to make the point that in the search for those
integrating features one ought to guard against committing
precisely the same mistake that one warns against Ð the
universalization of what are meant to be differentiating
characteristics.

SHARED INTEGRATING FEATURES

If authenticity is a real value, i.e., if it is morally important that we
be true to ourselves, we must strive to assert our identity as Asians
and not allow ourselves to be swallowed up by the homogenizing
tendencies of universalist bioethics. Thus, it is understandable
that shared integrating features should be sought in order to
characterize an Asian perspective on bioethics that can be
contrasted with a Western one.
However, the exercise involved could be tricky. The moment
we engage in this kind of activity, we also try to lump together
various `sub-Asian' perspectives that are unique in their own
right. This can only be done to an extent that the preservation of
each perspective will allow. To go beyond this limit is to threaten
survival. We have to remember that if there are unique features

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232 LEONARDO D. DE CASTRO

that set apart an `Asian identity', there are other unique

characteristics that set apart many distinct Asian identities.
As Becker has pointed out:
... there is no such thing as `the' Western values which would
neatly define human practice in countries from the Urals to
the Rocky Mountains. The `West' too is not a monolithic entity
but embraces a variety of value-laden cultures and traditions.12
But if so, we also have to accept that there is no Asian bioethics in
a sense that would cover the entire range of Asian countries. And,
if we must guard against the homogenizing tendencies of, for
instance, universalist principles of bioethics, we must also guard
against the homogenizing tendencies of bioethical discourse
declaring faith in an Asian identity.
By this, I do not mean to deny the importance of having a
sustained discourse on Asian bioethics. I mean only to warn
against directing such a discourse towards the attainment and
observance of a single Asian standard of moral evaluation.

SIGNIFICANCE OF REGIONAL CHARACTERIZATION

The assertion of regional or cultural identity has acquired greater
importance in light of massive and extensive interaction among
people of varying situations, values and histories:
Nowadays, physicians and therapists must face new problems
rising from the great migration of populations, and
consequently the deep mixing of cultures. Until a short time
ago, Western medicine imposed its universal validity primarily
through the diffusion of missionaries throughout the world. In
the different countries touched by colonialism, the local
cultural expressions were naturally considered primitive, and
therefore, of a lower level.13
Hence, the need for unique responses that could advance the
twin values of integrity and authenticity.
However, if it is necessary to focus on differences in order to
assert identity, it is also important to find points of contact that
can allow for cross-cultural communication. Again referring to
the Ibero-American experience, Drane sees that `dialogue is ...
12
Gerhold K. Becker, `Asian and Western Ethics: Some Remarks on a
Productive Tension', Eubios Journal of Asian and International Bioethics, 5 (1995)
pp. 31±33, esp. p. 32.
13
S. Gindro, `Transcultural Issues in the Ethics of Health Care', EACME
News, 4 (1995), pp. 6±8, esp. p. 6.

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 IS THERE AN ASIAN BIOETHICS? 233

needed because there are bioethical problems common to North

America, Latin America, and other parts of the world. Ethical
concepts and standards originating in the United States exist
which may be applied to an Ibero-American context and vice
versa.'14

NEW CHALLENGES
Indeed, there are bioethical problems common to all people all
over the world. As well, there are ethical concepts and standards
germane to one culture that can be adopted by others without
loss or cost. More than ever, perhaps, this is the time for people
of various nationalities and cultures to learn from one another's
mistakes and experiences. We are having to face more and more
situations that have no precedents in terms of traditions or
shared experiences that can provide a meaningful basis for
ethical decisionmaking. Hence, rapid advances in medical
biotechnology are posing a different kind of challenge to our
authenticity and integrity not only as Asians, or Ibero-Americans,
or Americans, but also as persons. Given recent developments in
reproductive and genetic technology, we find ourselves having to
re-invent the concept of a person and, hence, redefine what it
should take for us to be true to ourselves.
This kind of challenge cannot be met adequately by a
standardization of principles and outlooks. It will not do to
insist on a mechanism for decision-making that can cross
comfortably from one culture to another. But it will help to
have a universal perspective that is not incompatible with the
authenticity and integrity of individual cultures. Such a
perspective must not be seen as a universal view from nowhere
that trumps all other moral outlooks. Instead, it must come as a
pluralist view from everywhere that is anchored on a policy of
accommodation and compromise.
In the end, universalization can be understood as a process of
putting together a collage of varying perspectives without having
to assert a neutral standard of measure. This process cannot be a
simple and precise one. As Taylor surmises:
... it is reasonable to suppose that cultures that have provided
the horizon of meaning for large numbers of human beings, of
diverse characteristics and temperaments, over a long period
of time Ð that have, in other words, articulated their sense of
the good, the holy, the admirable Ð are almost certain to have
14
Drane, `Bioethical perspectives', 1996, p. 560.

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234 LEONARDO D. DE CASTRO

something that deserves our admiration and respect, even if it

is accompanied by much that we have to abhor and respect.15
No one can hope, at this point in time, to make out the shape
of the final outcome Ð if ever there is going to be one. But this
should not be a cause for concern. We can keep trying to improve
the process by dialogue, accommodation and compromise in
order to build up a critical mass of shared experiences. In turn, it
is this critical mass of shared experiences that can lead us to
intersections of perspectives that are essential to closer cross-
cultural cooperation and understanding.

CONCLUSION
The search for an Asian identity that could stand up to the
alleged imperialism of Western concepts and bioethical
principles acquires increasing importance in the face of a
shrinking world characterized by dizzying advances in
communications, transportation and biomedical technology.
But the exercise also sets up a trap into which we can easily
fall. For in the attempt to characterize an Asian bioethics that is
significantly different from Western bioethics, we can easily
commit the mistake of universalizing (among Asians) a single
Asian ethical perspective.
Notwithstanding this word of caution, I feel that there is room
for some kind of universalism. In a world characterized by
increasing cross-cultural encounters and ethical pluralism, we
cannot abandon the drive for universal acceptance and
understanding. However, the universality of our ideals cannot
be found in a single standard that is common to all outlooks but,
rather, in a collage of culturally informed perspectives built upon
an ever-increasing aggregate of shared experiences.
Permit me to end this presentation with a small anecdote that
has, up to now, occurred to me as a little bit of a puzzle.
When I was once having a conversation with some Filipino
friends about that dish called curry, somebody who came from
the Bicol Region remarked that Bicolano curry always contains a
lot of coconut milk. Someone from another Filipino region
immediately contested the claim and replied that you could tell
whether a curry came from their region if it was lavished with
coconut milk.

15
Charles Taylor, Multiculturalism and `The Politics of Recognition', (Princeton
University Press, Princeton, 1992), p. 72.

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 IS THERE AN ASIAN BIOETHICS? 235

During a subsequent conversation with Asian friends

concerning the same subject, I heard a Malaysian and an Indian
claiming that each country's curry contained more milk than that
coming from the other's. The argument was not settled.
Then one evening, I chanced upon a Sri Lankan program on
cable television where curry was the subject of a cooking lesson.
Towards the end, the host proudly declared: `The real mark of
Sri Lankan Curry is that it contains a lot of coconut milk.'
Each person in this anecdote appears to be making the same
assertion with respect to the distinguishing feature of authentic
curry Ð that it must contain `more' coconut milk than it usually
does in other places. That sameness binds the characters and
provides a point of contact that makes communication possible.
However, underlying the commonality is a unique perspective
provided by each person's own experiences within his or her own
culinary culture. We can only appreciate the subtlety that I think
pervades the discourse if we are able to achieve a harmonious
balance between the attention that needs to be given to the
commonalities and the attention that needs to be given to the
differences. This is as true in the field of bioethics as it is in the
nobler pursuit of culinary excellence.

Department of Philosophy
University of the Philippines

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