Critical care: why there is no global bioethics.
The high technology and the costs involved in critical care disclose the implausibility of applying the American standard version of bioethics in the developing world. The American standard version of bioethics was framed during the rapid secularization of the American culture, the emergence of a new image for the medical profession, the development of high technology medicine, an ever greater demand in resources, and a shift of focus from families and communities to individuals. This all brought with it a particular ideology of health care which promised Americans (1) the best of care, (2) equal care, and (3) physician/patient choice, without (4) runaway costs. This essay argues that this moral project is impossible in practice. This impossibility is especially salient in developing countries. In addition to the fact that it is financially impossible to provide all in the developing world with the standard of care accepted by law, policy, and convention in developed countries, different moral perspectives with different orderings of values will seem more or less plausible in different cultures. Indeed, such an approach would be harmful. A concrete bioethics applicable across the world does not appear possible.
Engelhardt
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Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas 77030, USA.
D001675:Bioethics; D003422:Critical Care / Q000592:standards*; D018864:Cultural Diversity; D003695:Delivery of Health Care / Q000592:standards; D003906:Developing Countries; D028781:Ethical Relativism; D017048:Health Care Costs; D015276:Health Care Rationing / Q000592:standards; D006801:Humans; D038622:Internationality; D026684:Personal Autonomy; D010684:Philosophy; D040841:Resource Allocation; D035621:Secularism; D012945:Social Values; D013675:Technology, High-Cost