Second challenge: cultural imperialism or managing cultural pluralism
Raymond De Vries and Leslie Rott draw an analogy between teaching bioethics to students from developing countries and missionary work (de Vries and Rott
2011). They interviewed students of one edition of the EMMB during their period of study in Leuven, Belgium. In their paper one finds criticism of the EMMB program. De Vries and Rott expressed their worry that a noble intent to spread ethical standards could lead to unwitting harm. The international standards do not really fit to the local circumstances of developing countries; consequently, students were left confused and/or with non-applicable knowledge. De Vries and Rott also noticed that some students felt themselves not listened to and that the communication had mainly one direction: from teachers to students. But there are even more serious accusations, that bioethics, and in consequence bioethics education, is a tool of moral imperialism (Chattopadhyay and De Vries
2008) and that there is a coincidence between launching international bioethics programs and conducting clinical trials in developing countries (de Vries and Rott
2011). Therefore, the second challenge for the EMMB was to create space for an intercultural meeting and dialogue. According to De Vries and Rott, the EMMB failed here.
Were the faculty of the EMMB program covert imperialists? This charge can be understood in two different ways. First, bioethics is a tool of imperialist power. While it may appear innocent or even noble, bioethics is, in fact, a projection of power. Some would call it
soft power, but as long as it is power, it is an instrument of coercion. One way to avoid this charge is to share the power. In practice, this entails inviting students, scholars, and government representatives from developing countries to take part in designing curricula and teaching courses. Sharing the power and involving parties from developing countries is a good idea. Unfortunately, however, it must face two problems. First, it takes the imperialism charge for granted whereas the criticism is fragile to notable objections as we supply below. Second, it may not satisfy a kind of radical anti-imperialist who may hold that the involvement of students and scholars from developing countries is only a case of “indigenization” (de Vries and Rott
2011). Namely, those students from developing countries are used as means of colonization (Hellmann et al.
2016). At the beginning they are indoctrinated in the West, then sent back to a developing country to spread the western ethics and facilitate penetration of ethically suspicious research activities sponsored by foreign governments.
The second interpretation of the imperialism charge is symbolic. Bioethics teachers are not imperialists themselves, but there is an analogy between the approach of imperialists and that of teachers. Both imperialists and bioethics teachers do not listen and they are strongly convinced that they have something precious to offer, whereas people from developing countries should just listen and enjoy the nice gifts. In order to avoid this charge we have to find a common ethical ground. It can be an ethical theory that is acceptable by all and can be an official ethical background of the study program. Some argue that human rights are commonly accepted and understood ethical standards (ten Have
2010; Annas
2005). These proposals are not unproblematic and have notable limitations. First, human rights are a legal instrument that can be useful in the context of individual claims against a government. But it is not necessarily the ideal instrument for cultural and ethical conflicts that are not addressed by existing, recognized rights claims. Second, human rights are often general and, even where established, must still be interpreted in a concrete situation. This being the case, a reference to human rights as the normative backdrop for bioethical consideration is often insufficient to resolve specific, contextual moral problems. Consider for instance a ban on wearing Islamic headscarves. Some argue that the ban on full face veil violates human rights law because it limits individual religious freedom (Amnesty International
2010). But the proponents of the ban also refer to human rights and gender equality (Marshall
2006). Thus a declaration of commonly accepted rules is not sufficient for achieving resolution in the form of actual consensus and understanding. It seems that cultural openness and understanding cannot be just written down in a curriculum, but has to be present in teachers’ attitude and behavior.
There is also a possibility to debunk directly the imperialism charge. Those, who make this accusation may not have adequately considered two important facts. First, the international students are not only mere passive receivers of information. They could have been a bit overwhelmed at the beginning of their studies when surveyed by De Vries and Rott summarized above. But de Vries and Rott interviewed students very early in the course of their studies before being exposed to the rest of the curriculum and coursework. After the period of study in Leuven, Belgium, students travelled to Nijmegen, Netherlands and to Padua, Italy. In consequence students could not evaluate the whole program while being interviewed. In our experience, the EMMB students were intellectually-independent individuals, professionals of many kinds, who learned greatly one from another. Second, the imperialist critique overlooks a fact that, in a democratic and pluralistic society, any kind of cultural, religious or even philosophical indoctrination cannot succeed. Edmund D. Pellegrino writes “the best protection against indoctrination by someone else’s ethical values is possession of the skill of critical ethical judgment. This is precisely what a good class in ethics should provide”(Pellegrino
1989). Therefore teaching critical and independent thinking is the best antidote for ethical imperialism.
Although this reply to imperialist critique has its merits, it nevertheless not entirely sufficient. It does not take into account the significance of profound cultural and ethical differences. It may be true that the charge of moral imperialism is exaggerated, but the cultural differences and cultural misunderstanding might significantly interfere into the educational process. Also the education itself is not a passive receipt of content. To illustrate in the context of medical education, Federic Hafferty distinguishes three kinds of curriculum: a formal, an informal and a hidden (Hafferty and Franks
1994; Hafferty
1998). The formal curriculum is written down in official documents. The informal manifest itself at the interpersonal level and refer to a teacher a role-model for a student. The hidden curriculum invokes the organization culture and it has to be deciphered from the policy making, resource allocation, evaluations, and institutional slang. The hidden organizational culture and informal factors may have impact on the content of curriculum and the way it is actually realized. This factors should also be taken into account.
Recommendation 3: create an open educational environment and involve your students
We submit that it is very difficult if not impossible to create an ethnically and culturally neutral message, but what really matters is not the message itself, but the forum: where critical ideas and reflections are discussed by the students. The values of program should be clearly declared, but there should be space to contest them. Matti Häyry writes that European values should not be treated as a tool of ethical colonization, but they can be a point of departure to promote discussion on significant aspects of bioethical issues (Häyry
2003). If the students are given intellectual tools, they can become even more critical, independent, and immune to indoctrination (cf. Pellegrino
1989). In our opinion, the key is organizational culture and the informal aspects of the educational program such as the promotion of dialogue and exchange. Also it is a great idea to create educational programs in active cooperation with students and scholars from developing countries, who can contribute to the teaching.
We hold that overall message of the EMMB program was not that of moral imperialism, but rather dialogue within moral and cultural pluralism. As the EMMB students ourselves, we gained a very unique experience of studying and living with persons from all over the world, in our case: from Indonesia, the Philippines, Germany, Slovakia, Nigeria, Malawi, UK, to name a few. The students came from different countries, but they had also diverse worldviews and religious background: Christian, Muslim, and atheistic. Our colleagues mostly were already experienced professionals who practiced as physicians, nurses, public health specialists, or had backgrounds in philosophy and theology. Suffice it to say, the dialogue amongst the students was vigorous and intellectually-stimulating: always enriched by representations of diverse philosophical and cultural worldviews. The discussion did not always reached consensus, but offered students critical insights and skills to appreciate a given problem or dilemma from many different points of view. We discussed not only ethical principles and cultural values, but also we were exchanging insights into what may be morally required in a particular set of circumstances.