Cross-Cultural Ethics of Health and Responsibility: Expert and Lay Perspectives regarding Bioethical Dilemmas in Germany and Israel

Summary

There are major differences between Germany and Israel with regard to bioethical expert debates. A comparison therefore promises insights into cultural differences and pluralism in the moral evaluation of bioethical dilemmas. However, commonalities with regard to certain principles, moral attitudes, and societal conflicts in the context of biomedical treatment and research can also be expected, both among Israeli and German laypersons as well as between laypersons and affected persons/patients and between laypersons and experts. These overlaps could provide a basis for the development of cross-cultural ethical principles in the field of biomedicine.

The research project "Cross-Cultural Ethics of Health and Responsibility: Expert and lay perspectives regarding bioethical dilemmas in Germany and Israel" complements the comparative analysis of expert discourses in Germany and Israel by exploring the moral attitudes of laypersons (including affected persons). The main focus is on the role of responsibility sharing in end-of-life decisions (e.g., therapy limitation, living wills, euthanasia) and genetic testing in adults. In addition to examining guidelines and professional bioethical debates, the methodology includes focus group discussions with laypersons of different levels of concern, religious affiliation, and nationality. The central research interest is to analyze and ethically reflect notions of responsibility, but also hopes/fears, rights, and obligations related to the use, consideration, or rejection of new biomedical options for life and family planning, such as genetics and living wills. The findings will also be examined in light of other important influencing factors such as religion, conceptions of health and disease, and market-based thinking.

The project is part of an overarching, multi-level research enterprise that includes various research projects and workshops. Previous studies by Raz and Schicktanz (2009a,b) examined attitudes of laypersons (including persons affected by genetic diseases) regarding genetic testing in adults. The focus was on differences between cultural and personal reasoning and between affected and unaffected individuals. With regard to the three major themes identified - medical technology/technocratic medicine, economic aspects of health care, and personal decision-making processes - a contrast between the two countries could be demonstrated at the cultural level, but not in the context of individual decisions or the concerns of those affected by genetic diseases. A preliminary analysis revealed three major sets of issues regarding genetic responsibility and risk where national differences need to be explored in more detail: Individual responsibility, responsibility for relatives, responsibility of society toward its members. In the context of end-of-life decisions, our previous research showed that Israeli policy is more restrictive compared to Germany in the moral and legal balancing of the patient's right to self-determination and the obligations of physicians, for example, when it comes to the omission or termination of medical treatment at the end of life or the implementation of living wills (Schicktanz, Raz, and Shalev, 2010).