Cross-Cultural and Religious Critiques of Informed Consent assembles a diverse collection of critical perspectives on what is perhaps the normative core of secular Western bioethics that arise from outside this dominant mold. As editors, Joseph Tham, Alberto García Gómez, and Mirko Daniel Garasic have produced a short book on the much-debated topic of informed consent that will bring important new considerations to the attention of even its most informed readers.
Emerging partly out of a workshop arranged by the UNESCO Chair in Bioethics and Human Rights, this volume remains faithful to the Chair’s global focus by presenting a range of cultural and religious traditions over the course of ten main chapters. Tham’s introduction frames the book’s content in terms of two central facts of contemporary global life: multiculturalism and religious diversity. These give rise to the book’s two sections and jointly disrupt the “Western idealization of the autonomous self” (7) that underpins the discourse of informed consent in bioethics.
The first part of the book deals with “multiculturalism,” though it lacks any specific definition of the term that is used to describe the mere existence of multiple cultures in one society in sociology or a normative position that answers political questions confronting such societies in philosophy. Yet the contributors are all consistent enough for the reader to understand that multiculturalism is discussed as a feature, not a philosophy, of modern societies that nevertheless has normative implications for informed consent in clinical interventions and research practices. The result is a plausible set of conceptual analyses and practical recommendations that address the implications of informed consent in clinical contexts where conflicting cultural values and perceptions are present.
Those familiar with bioethics will have come across the standard requirement for patient comprehension that is built into the concept of informed consent, but may be challenged by Gómez and Garasic’s suggestion, in the first essay in the volume, that religious concepts may explain clinical goals to patients or research participants. For example, the contributors suggest that the Islamic notion of maslahat al-ummah (public interest) or the Hindu idea of dharma (the cosmic law governing right behavior) may be used to emphasize the role of receiving vaccinations in meeting one’s “duties towards society as a whole” (15). In a field dominated by Western liberal neutrality, this recommendation points towards a major rethinking of the secular practice of bioethics through illustrative appeals to such concepts.
Similarly, the notion of relational autonomy has become well known as a “middle way” between conventional hyper-individualism and a radical rejection of the value of autonomy, but benefits from fresh attention throughout this volume’s first section. Garasic and Fabio Macioce argue that as an “alternative conceptualization of freedom and self-government in a socially constituted agent” (23), relational autonomy implies responsibilities to engage families and communities, Gómez and Garasic argue, in informed consent procedures. The contributors clarify, however, that such efforts must serve the principle of autonomy, which distinguishes their project from what Magherita Daverio calls the “collectivism or authoritarian and paternalistic versions of communitarianism” (39) that may put off some readers.
Part 2 of the volume canvasses perspectives on informed consent from the six largest world religions, with Buddhism, Confucianism, Hinduism, Judaism, Christianity, and Islam each receiving a chapter. The constraints of this structure necessarily lead to some homogenizing of these diverse traditions, but the contributors make admirable efforts to avoid any misleading generalizations by presenting the implications of core tenets held across schools of thought. A pleasing consequence is that the contents of the chapters will be accessible to interested readers, from bioethicists to clinical researchers, who are unfamiliar with the basic beliefs and practices of these religions.
Those with a background in the Abrahamic faiths will learn a great deal from the second part’s three chapters on Eastern religions, which together constitute a highlight of the volume. It is of clear conceptual interest that Western ideas about informed consent contrast so vividly with the conceptions of the self and individual action that Ellen Y. Zhang’s essay discusses in Buddhism and Ruiping Fan’s in Confucianism, both emphasizing virtue, not rights, as the basis for individual dignity. Moreover, Fan’s essay notes the practical consequences of these ideas in China, where “Confucian medical familism” (75) often means that informed decisions are taken by a whole family, which should encourage Western clinicians to reflect on their assumptions about engaging with relatives.
Western readers of this volume will likely be more familiar with the basic conclusions reached in the second part’s discussion of Christianity, Judaism, and Islam, which balance commonalities with the view of informed consent in secular Western bioethics alongside important differences. For example, the conclusion of David Heyd’s essay reads that “despite adopting the general idea of informed consent, the Jewish way of thinking does not accept the principle of autonomy as the grounds for informed consent” (101). Reproductive issues also have a different significance for religious as opposed to secular bioethics, raising a “particularly thorny issue” (111) for Christianity when Laura Palazzani’s essay discusses women’s consent to take contraceptives if they are required for participating in a trial that may harm a fetus. Making sense of the balance to some extent, Aasim I. Padela’s finishing chapter wisely distinguishes between Islam’s theological synergies with secular models of informed consent and the features of modern Muslim cultures that call for their adaptation, such as legal traditions and “a communitarian ethos” (123).
The fruitfulness of linking informed consent to religious belief is evident across this book’s two sections, and a distinctive strength of the volume is its placement of religious thought and plurality within a context of wider debates about multiculturalism. Consequently, readers with a strong interest in religion in its varied cultural contexts are likely to benefit from this volume, whether their primary focus is on the political, philosophical, or social aspects of cross-perspective dialogues about the ethics of clinical research and practice.
Jonathan Adams is a doctoral research fellow at the University of Oslo.
Jonathan Adams
Date Of Review:
June 27, 2023
