Cross-Cultural Ethics of Health and Responsibility

Summary

Previous studies have shown Israel and Germany to constitute opposites in terms of professional culture, and their juxtaposition is thus expected to highlight the context of cultural variation and pluralism in the moral assessment and evaluation of bioethical dilemmas. However, we also expect to find overarching principles, moral attitudes and general social conflicts related to health care and research in biomedicine which are shared by Israeli and German lay people - patients and non-patients. These overarching phenomena might offer a basis for developing cross-cultural robust ethical principles for biomedicine. 

Against this background, the current GIF (German-Israeli Foundation) research project "Cross-Cultural Ethics of Health and Responsibility: Expert and lay perspectives regarding bioethical dilemmas in Germany and Israel" (PIs: Aviad E. Raz and Silke Schicktanz, 2010-2012, with the assistance of: Dr. Julia Inthorn and Nitzan Rimon-Zarfaty) extends the conventional comparative analysis of expert discourse in Germany and Israel by exploring the 'public moralities' of lay people (including those affected by a disease) regarding responsibility in the context of end-of-life (EoL) decisions and genetic testing (GT) of adults. In addition to the analysis of guidelines and bioethical expert discourses, the methodology comprises focus group discussions with lay persons comprising affected, religious, and national categories. Major topics we are interested in include lay notions of responsibility, hopes/fears, duties and rights when using, discussing or rejecting biomedical options such as genetics and advance directives for planning family or one's life. These will be further compared within the context of other important cultural factors such as religion, concepts of health/illness and consumerism. 

The main research steps are: 

1. Analysis of comparative background and baseline information; 
2. Focus groups with lay people in Germany and Israel; 
3. Comparative analysis of moral argumentation, especially regarding constructions of responsibility; 
4. Comparative analysis of cultural factors underlying moral argumentation; 
5. Reflection and dialogue, including meta-ethical and methodological aspects of the inter-relations between empirical and ethical assumptions.

The current project is part of a continuing enterprise comprising several research projects and workshops. Preliminary studies conducted by Raz and Schicktanz (2009a,b) examined lay attitudes (including attitudes of people affected by genetic diseases) in Germany and Israel towards genetic testing of adults, focusing on the differences between cultural and personal argumentations, as well as between affected and non-affected perspectives. With regard to three major emerging themes – medical technology/technocratic medicine; economic aspects of healthcare; and personal decision-making – a national contrast was apparent on the cultural level of argumentation, but not in the personal context of decision-making or in the concerns of people affected by genetic diseases. Preliminary analysis revealed three major themes of 'genetic responsibility' towards risk, where national differences need to be studied further: self-responsibility, responsibility for kin, and responsibility of society towards its members. In the context of end of life (EoL) policies, our preliminary comparisons revealed Israel to be more restrictive in relation to Germany in terms of how patients' autonomy and doctors' duties are morally and legally balanced, for example with respect to the withholding and withdrawing of medical treatment in EoL situations and the implementation of advance directives (Schicktanz, Raz, and Shalev, 2010).