Kirstin Borgerson discusses the current state of bioethics in Canada, and offers her view on whether a distinctly Canadian bioethics is needed.
I pick the bones of what’s been done
and I’ll lick them clean with a cautious tongue
I am far too Canadian
I am far too Canadian
— Spirit of the West / Lyrics by Geoffrey Kelly and John Mann
In The Need for Canadian Bioethics, Carol Collier and Rachel Haliburton argue that “it would be helpful and desirable to develop a more explicitly Canadian form of bioethics.” According to the authors, this need arises because of the overwhelming influence of American bioethics globally and because of the tendency of this literature to assume the American health care context without explicitly recognizing it is doing so.
This tendency is evident in the types of issues discussed (for instance, ethical dilemmas that arise when patients are denied public health insurance), cases referenced (for instance, Roe v. Wade), and in the attention paid to autonomy as “the primary lens through which bioethical issues are examined.” I am sympathetic to this argument, having experienced for myself the challenges of teaching undergraduate classes in bioethics at two Canadian universities (the University of Toronto and Dalhousie University). When I first started teaching, I assigned an American textbook and I often struggled to re-frame a problem or debate in order to make it understandable to my students.
It is possible, however, to overstate the need for Canadian bioethics. In order to avoid this sort of overstatement I would like to offer a couple of friendly amendments to the position outlined by Collier and Haliburton.
From my perspective, and contrary to the impression one might get from the post by Collier and Haliburton, Canadian bioethics is in pretty good health. In 2013 we don’t need to “develop” Canadian bioethics so much as celebrate its continued success and growth. As with assessing the health of individuals, there is no one easy measure of the health of Canadian bioethics so we must look to a variety of imperfect markers. I will consider three.
First, Collier and Haliburton rightly acknowledge that Canada has “a number of internationally-recognized bioethicists;” indeed I think it would be hard to dispute this (particularly in areas like feminist bioethics). I have attended the last three meetings of the International Association of Bioethics (the bi-annual World Congress of Bioethics) and on every occasion both conference organizers and fellow attendees have commented on the strong Canadian presence at the meetings. (Members of one affiliated organization even refer jokingly to the ‘Canadian mafia’). So the international presence of Canadian bioethicists is strong.
A second measure of the health of Canadian bioethics is the number and quality of textbooks with an explicitly Canadian focus. Here we find an array of options, including Kluge’s Readings in Biomedical Ethics: A Canadian Focus (several editions); Fisher’s Biomedical Ethics: A Canadian Focus (2009); Smolkin, Bourgeois, and Findler’s Debating Health Care Ethics (2010); and Weijer, Skelton and Brennan’s Bioethics in Canada (2013). There is also Baylis et al.’s Health Care Ethics in Canada (several editions), the third edition of which I had the pleasure of working on as a co-editor. Contrary to the claim that “Canadian textbooks invariably include American authors and American cases,” the latest edition of Health Care Ethics in Canada contains only Canadian legal cases (sixteen of them) and the final product is a textbook with roughly 75% Canadian content. Since I am confident the editors of other textbooks would make similarly convincing cases for their own collections, I think we can safely declare the ‘textbook’ marker of the health of Canadian bioethics in good shape.
Third, because Canadian textbooks make an effort to draw on Canadian peer-reviewed publications where possible, the overview above also serves as a useful assessment of the healthy and growing state of the research literature. I can attest to the difficulty in choosing the best among many high-quality Canadian articles on a variety of topics including those on classical bioethics issues such as reproductive ethics as well as many on emerging areas of interest such as public health ethics. In sum, on markers of international presence, availability of textbooks, and production of high-quality research articles, Canadian bioethics is doing quite well.
Further, I don’t think we want the Canadian content of bioethics textbooks to hit 100%. There are some well-argued, classic articles in bioethics that have rightly earned a place in most course syllabi and it would seem bizarre to exclude them because of where their authors were born, particularly when the articles are highly conceptual in nature. This brings me to my second general point, which is that ethics doesn’t stop at borders, even if policy sometimes does. As an interdisciplinary field, bioethics includes, among other things, both conceptual and policy-oriented questions. I am writing this blog post from the shores of Lake Geneva, just a few kilometres from the French border. While some attention to Swiss bioethics and the differences between it and bioethics in France might well be needed in some areas (policy-driven areas of bioethics, certainly), it probably would be going too far to say we need distinctively Swiss or French bioethics, with wholly distinct ethical frameworks, modes of analysis, methodologies, questions, cases, and policy recommendations. Likewise with Canadian and American bioethics: we have some key differences, but surely we don’t want to keep re-inventing the wheel every time we cross a border. There is so much we can learn from each other. Parochial bioethics isn’t all that desirable and, in our rush to avoid Americanization, Canadian bioethicists would do well to make sure we don’t end up locking ourselves inside a gated community.
One final point: when we discuss a number of topics (public and private health insurance, for instance) in my bioethics classes, students are always incredibly curious about the systems in other countries. I won’t argue for it here, but I suspect that the best thing for bioethics is a combination of a strong local bioethics and more comparative and collaborative international bioethics. This builds on Collier and Haliburton’s concerns about the differences between the American and Canadian contexts, but is more optimistic about the ability of Canadian bioethics to address those differences, where warranted. It pushes us to be active global citizens who recognize both the unique multicultural nature of our country and our classrooms as well as the shared moral dilemmas arising out of our common humanity.
Kirstin Borgerson, Assistant Professor of Philosophy, Dalhousie University
I fully support the concept and practical need for IMPACT ethics. I love the idea of the conference and mentoring and believe that although it is rooted in Canada it has international appeal. I think the same for textbooks, Bioethics is increasingly global. At the Oxford center for evidence based healthcare colleagues across the globe are in agreement from multiple cultures on bio-ethical principles so it is only adapting them to the system at hand that is needed and perhaps making this process transparent will enable future cohorts to adapt across cultures. The phrase acitive global citizens is key. Thank you for your excellent perspective.