By Max Ying Hao Lim

Are contemporary bioethical practices unequivocally, unconditionally and absolutely universal?  Or is the very notion of universality a holdover from a Western-centric colonial ideology seeking to impose ‘best practices’ onto the Global South and other third-world countries? This ‘colonialist’ dilemma is as time-worn as it is fundamental to the modern conception of bioethics, and has stimulated much thought and debate from academics across multiple disciplines over the past 30 or so years – and for good reason, as the implications are enormous. The truth, of course, is somewhere in the middle, and requires a lot of nuanced analysis incorporating the specific contextual factors shaping any particular implementation of ethical norms in clinical practice.

What cannot be denied is that much of the work on ethical standard-setting remains predominantly led by occidental contexts – from the Montgomery principle in the UK which carries landmark status in common law jurisdictions globally, including in places half a world (and culture) away as in Hong Kong and Singapore, to professional standard-setting of ethical norms and behaviours e.g. MRCP(UK) exams where international candidates from mostly former British colonies or mandates are assessed on professional ethical norms set by a British professional body (i.e. RCP). This must not be seen as an outright denial of the validity or applicability of the current ethical practices – there must exist some fundamental truth in how we treat humans which transcends societies and cultures – but it certainly appears, at the very least, hegemonic.

Thus, I argue that the global participation in the sociocultural interpretation of ethical principles in clinical practice is critical to maintaining some semblance of ‘universality’ in modern bioethical principles. The risk in not doing so is the unceremonious shoving of these principles into the ‘colonialist’ corner awaiting ‘decolonisation’ – an undeniable loss to patients, medical practitioners and society at large.

Paper title: Patient autonomy in an East-Asian cultural milieu: a critique of the individualism-collectivism model

Author: Max Ying Hao Lim

Affiliations: Li Ka Shing Faculty of Medicine, The University of Hong Kong

Competing interests: None declared