A ‘Neopotterian Theory of Global Bioethics’

For some time now, we have begun to apply a particular ethical theory to our normative studies in empirical bioethics [1]. This theory is ‘global bioethics’, and was first developed by the American biochemist and bioethicist Van Rensselaer Potter in the 1970s [2]. Nonetheless, in our own studies, practical limitations have emerged in the face of ‘cultural diversity’ and ‘moral pluralism’, and which seems to influence the likelihood of health and/or life science practices being social and/or political accepted. We have, therefore, reworked this theory to improve the operationality of our results. We began with two postulates [1]. The first is that ‘survival’ and ‘happiness’ are the only two bio-ethical purposes common to all of humanity, consciously or unconsciously. The second is that these purposes are nevertheless, wholly or partially, and explicitly or implicitly, conditioned by different ‘bio-ethical criteria’ based on different ‘moral frameworks’. Actually, there should have been two additional postulates [3]. The third postulate is that a solution to a bio-ethical issue is pertinent if it is accepted or acceptable, socially and/or politically, whether this acceptance or acceptability is individual or collective, explicit or implicit, real or potential, provided that it can be evaluated with quantitative and/or qualitative indicators. The fourth postulate is that this acceptance or acceptability results from a respect of significant bio-ethical criteria, within a particular zone and context, and at a given scale. Thus, in a previous letter [1], we introduced a dozen or so moral frameworks that we had already characterized with a view to constructing a criteriology. Since then, it occurred to us that other moral frameworks, at a family scale, might also influence social and/or political acceptance concerning health and/or life science practices, in care, research and/or prevention. Here's the reason for this new letter. As a means of improving our characterization of these other frameworks, and the corresponding bio-ethical criteria, we turned to the work of the French anthropologist and demographer Emmanuel Todd entitled ‘L'origine des systèmes familiaux. Tome I. L'Eurasie’ (N.B. ‘The origin of family systems. Volume I. Eurasia’ in English) [4]—which received an award from the Académie des sciences morales et politiques (N.B. ‘The French Academy of Moral and Political Science’ in English). We qualitatively, and manually, analysed this book, limiting ourselves for the moment to the parts relating to China, Central Asia, North Asia and Europe (N.B. n = 45 Asian countries, regions, or ethnic groups; and n = 48 European countries, regions, or ethnic groups): chapters 3, 7, 8, 9 and 10. We had previously analysed the introduction and chapters 1 and 2, which are more general, to gain an understanding of the concepts and vocabulary used. The main limitation of our work is, obviously, that it is based on secondary information, extracted from a single book—despite a quantitative approach that is mostly implemented by Todd in his own work—in French and not available in open access. At the end of the day, the result is a kind of synthesis of Todd's work, but rather into three main ‘family systems’, or structures, with one mode of organization by system, but different modes of functioning. These systems are the ‘communitarian system’ (N.B. ‘système communtaire’ in French), the ‘stem system’ (N.B. ‘système souche’ in French), and the ‘nuclear system’ (N.B. ‘système nucléaire’ in French) (Table 1(a)). Some modes of functioning are system-specific (i.e. ‘integrated bilocal’, ‘absolute’ and ‘egalitarian’), whereas others are not (i.e. ‘patrilocal’, ‘matrilocal’ and ‘bilocal’), or are less so (i.e. ‘temporary coresidence’). Similarly, some are present in one country, region or group (i.e. ‘bilocal communitarian system’, ‘stem system with additional temporary coresidence’ and ‘bilocal integrated nuclear system’), whereas others are present in several countries, regions or groups (e.g. ‘patrilocal communitarian system’, ‘patrilocal stem system’, etc.) (Table 1(a)). It is clear that some spaces are more heterogeneous than others (Table 1(a)). But the real contribution of our work is our interpretation of this result (N.B. because what follows is not specified by Todd, at least explicitly in this way). We believe that these three types of family systems can be considered as moral frameworks in their own right, because of the ‘moral values’ (i.e. to be or not to be; ex. to be ‘equal’, etc.), and the ‘moral standards’ (i.e. to do or not to do; ex. to do as a ‘group’, etc.), inferable from Todd's work, and on which these systems seem to be, above all, based (Table 1(b)). And what differentiates these three frameworks seems to be, above all, the level of importance accorded to these values and/or standards, which we have used to infer the corresponding bio-ethical criteria (ex. ‘equality’, ‘group’, etc.) (Table 1(b)). Parental authority over children Equality between child 1 and child n Household with 3 generations (or more) Parental authority over children Inequality between child 1 and child n Household with 2 generations (or more) Children's liberty from parental authority Equality or not between child 1 and child n Household with 1 generation (or more) We nevertheless need to moderate the systematicity of these moral frameworks and bio-ethical criteria which we have inferred (Table 1(b)), notably by distinguishing between rural and urban environments, and large conurbations in particular. For example, even when the ‘stem system’ seems to predominate nationally (Table 1(a)), large conurbations, as well as states and their institutions, can display a strong expression of moral values such as liberty and/or equality. In fact, two (i.e. the ‘nuclear framework’ and the ‘communitarian framework’) (Table 1(b)), but also 12 [1], other moral frameworks, and the corresponding bio-ethical criteria, may also be jointly, but differentially, expressed, due to complex acculturation and/or multiculturalism phenomena, following intra-regional and/or extra-regional flows of people, goods and/or ideas, whether recent or in the past, free or forced (N.B. as a reminder, the 12 moral frameworks concerned are the ‘Animist framework’, the ‘Buddhist framework’, the ‘Catholic framework’, the ‘Confucianist framework’, the ‘Hindu framework’, the ‘Islamic framework’, the ‘Jewish framework’, the ‘Kantian framework’, the ‘Lay framework’, the ‘Orthodox framework’, the ‘Protestant framework’ and the ‘Utilitarian framework’). The geographic, geopolitical and geohistorical dimensions are, thus, crucial for an effective implementation of this ethical theory, and its criteriology, in the field. In any case, these three new moral frameworks, and the corresponding bio-ethical criteria, could find an application in our own hospital practice, and could help to overcome the blind spots of our first criteriology. Nonetheless, a continuous improvement of our criteriology, as here and before, is necessary to lead to solutions more acceptable and, thus, more pertinent, but always in a given space and/or time—and, of course, without radical moral relativism. We thank Foch Hospital and our colleagues for support. The authors declare no conflicts of interest

Bioethics · Empirical research · Normative · Normative ethics · Politics · Social theory · Biomedical Ethics and Regulation · Climate Change and Geoengineering · Ethics in medical practice