Nature and Life : Essays on Deep Ecology and Applied Ethics [1 ed.] 9781527514867, 9781527509207

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Nature and Life

Nature and Life: Essays on Deep Ecology and Applied Ethics By

Md. Munir Hossain Talukder

Nature and Life: Essays on Deep Ecology and Applied Ethics By Md. Munir Hossain Talukder This book first published 2018 Cambridge Scholars Publishing Lady Stephenson Library, Newcastle upon Tyne, NE6 2PA, UK British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Copyright © 2018 by Md. Munir Hossain Talukder Cover photograph by Zaheen A-Rahman Cover designed by Shabnam Akhter & Zaheen A-Rahman All rights for this book reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. ISBN (10): 1-5275-0920-6 ISBN (13): 978-1-5275-0920-7

TABLE OF CONTENTS

Preface ....................................................................................................... vii Holmes Rolston III Acknowledgements .................................................................................... xi Chapter One ................................................................................................. 1 Environmental Crisis and Deep Ecology Chapter Two .............................................................................................. 11 Self-realization: The Basic Norm of Deep Ecology Chapter Three ............................................................................................ 30 Self, Nature, and Cultural Values Chapter Four .............................................................................................. 48 Companionship with Nature: Asian Perspectives Chapter Five .............................................................................................. 65 Intimacy, Admirability, and Virtue: A Critical Analysis of Slote’s View Chapter Six ................................................................................................ 76 Virtue Ethics and the Human–Environment Relationships Chapter Seven............................................................................................ 84 Ethics in Health Care: Inducement Chapter Eight ............................................................................................. 95 The Concept of “Person” in Bioethics Chapter Nine............................................................................................ 102 Patient–Physician Relationship in Bangladesh Chapter Ten ............................................................................................. 123 Informed Consent and the Patients of Bangladesh

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Table of Contents

Chapter Eleven ........................................................................................ 137 Developing a Context-Sensitive Patient–Physician Relationship Model Chapter Twelve ....................................................................................... 150 Multiculturalism and Minority Rights: A Defense of Geo-Cultural Identity Chapter Thirteen ...................................................................................... 172 Is Professional “Ethical Expertise” Possible? Bibliography ............................................................................................ 183 Index ........................................................................................................ 195

PREFACE HOLMES ROLSTON III

Munir Talukder is an environmental philosopher in Bangladesh. Bangladesh is commonly regarded as one of the lesser developing nations, with many in poverty, so those of us in the developed West might not expect an environmental philosopher from that nation to be a deep ecologist. Munir Talukder comes as something of a surprise. But here he is. Bangladesh has been making significant progress fighting poverty, so considering their development goals is timely. Talukder argues for a complete system of environmental values, both intrinsic and instrumental. He takes his inspiration from Arne Naess, Norwegian philosopher in one of the most developed nations on Earth. Nevertheless, Naess found the Western lifestyle, for all its wealth, incomplete and distorted. Naess wrote: “Progress has in all seriousness been measured by the rate of energy consumption and the acquisition and accumulation of material objects. What seems to better the material prerequisites for ‘the good life’ is given priority without asking if life is experienced as good” (See Chapter 1). Westerners had become worried about the standard of living instead of the quality of life. Now it can seem quite rational for a philosopher in a developing nation to wish to listen to a powerful critic of developed nations. However, Bangladesh might be better off seeking a higher quality of life rather than attempting to imitate those Westerners whose search for wealth has actually left them impoverished. The rich countries too are filled with poor people—often economically and often also in this deeper sense of poor. Nor is it only one somewhat eccentric philosopher like Arne Naess who has been asking about the quality of life in developed, over-developed countries. The ethics of development is a live philosophical issue globally. Global inequalities in income increased in the 20th century by orders of magnitude out of proportion to anything experienced before. The distance between the incomes of the richest and poorest country was about 3 to 1 in 1820, 35 to 1 in 1950, 44 to 1 in 1973, and 72 to 1 in 1992 (United Nations

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Preface Development Programme (UNDP), 2000, p.6).

In 2017, this may have reached 100 to 1. Amartya Sen, Nobel Prize winning economist, has been concerned about “focusing on production and prosperity as the essence of progress, treating people as the means through which that productive process is brought about rather than seeing the lives of people as the ultimate concern and treating production and prosperity merely as means to those lives” (Sen, 2004, p.41). The primary objective of development should be the increased enrichment of people’s lives—the quality of their lives, their well-being. Amartya Sen refers to this as people developing their “capabilities”. Talukder finds this already in Naess when he states: “Naess maintains that human beings have the interest of preserving their existence. However, this interest is basically the realization of their ‘inherent potentialities’” (p. 14). Such wisdom about making a life beyond making a living does go back millennia in the West: “A man’s life does not consist in the abundance of his possessions” (Luke 12.15). “Thou shalt not covet” is one of the Ten Commandments (Exodus 20). Talukder is well versed in ancient Greek philosophy. See his insights into how Plato’s ideas of self-development and Aristotle’s anticipation of “biocentric holism” figure into his deep ecology. He is likewise comfortable moving from East to West and back again (See his Chapters 2, 3, and 4). He analyzes the “self–nature relation in both Western and Eastern cultural traditions”. Although the West has exaggerated the differences between humans and nature, Talukder further argues that, both West and East, “the common cultural value ‘identification’ can be demonstrated to build up a harmonious coexistence with nature” (p. 30). In the West, Arne Naess, as we have noted, emphasized a self-realized identification with nature in that, “Deep ecology considers all organisms, plants, and so forth, as a ‘total-field image’. So, deep ecology dissolves the ‘man-in-environment’ concept and establishes a more symbiotic relationship; a relationship which is intrinsically valuable and based on an enlightened principle ‘the equal right to live and blossom’” (pp. 13-14). In the East, “Buddhism persistently emphasizes meditative awareness about the interconnectedness of all life forms” (p. 26). “The Hindus are alive to their environment in which they live. They have respect for the flora and fauna. They believe in the ecological balance of creation” (p. 35). Likewise, the Chinese have a “conception of dynamic, mutually constitutive, internal relatedness” (p. 37). Talukder is fully aware of the tensions and contradictions between East and West (pp. 30-32), but he returns to Naess

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illustrating that there are common values that the West and East share which can be used when seeking ecological harmony (pp. 41ff). I once myself asked the question whether the East can help teach the West how to value nature and, with regard to this, I found Talukder’s analysis of my own worries insightful (pp. 41ff). Seeking such identification and relatedness to our environment, the issue of how much and to whom needs to be clarified. Talukder next worries about a position called “balanced caring” (Chapter 5). Perhaps no one will object to “balanced caring”, but no one will know how to do it without further guidance. Balanced caring, the argument further proceeds, means giving more attention to “intimate caring (our concern for near and dear) and humanitarian caring (our concern for people in general)” (p. 67). One advocate, Michael Slote, claims, “it is morally good to care more for intimates than other people. In fact, caring more for intimates is a moral requirement for virtuous people.” He adds that, “[o]ne can and should care more about some friends or relations than about others” (p. 67). There is an old adage: “charity begins at home.” Slote has modified his account somewhat to allow for supererogation. Those who care for distant others have in a “most praiseworthy way gone beyond the call of duty” (p. 74). This scheme of priorities and duties, of course, leaves caring for the natural world at the bottom of the list, so Talukder needs to refute, even reverse, such priority. “In the reverse account, the caring person is not only caring for those who are closer to their heart but also for those who are less close. In fact, the latter is more favorable. Thus, according to our closeness scale, favoring the environment rather than favoring oneself is a virtuous character trait. Eventually, this account could contribute significantly to the broader moral perspective, such as the relationship between humans and nature” (p. 72). Talukder concludes with his account of “virtue ethics and the human– environment relationships” (Chapter 6). Yes, we may need to recover some old virtues, in both the West and East, but we also need to discover some new virtues: participation in the intrinsic values in nature in an ecological mode. Perhaps readers from the West will think we do not need to go to Bangladesh to learn this. Talukder agrees, since he takes his inspiration from Arne Naess. But readers from both the East and West will be surprised (as we remarked at the beginning) to hear this so forcefully from a keen and insightful Bangladesh philosopher.

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References Sen, Amartya, 2004. “Development as Capability Expansion,” in Sakiko Fukuda-Parr and A. K. Shiva Kumar, eds., Readings in Human Development: Concepts, Measures and Policies for a Development Paradigm, 2nd ed., New Delhi and New York: Oxford University Press. United Nations Development Programme (UNDP), 2000. Human Development Report 2000. Oxford, UK: Oxford University Press.

ACKNOWLEDGEMENTS

Alhamdulillah. I am most grateful to Allah, Rabbil 'alamin for His uncountable mercy and blessings upon us. This book explores some recent thoughts and trends in environmental philosophy and applied ethics. The topics selected here are contemporary and offered in various Masters and PhD programs worldwide. Deep ecology is comparatively a new trend in environmental thinking and it has raised important questions about our current values, beliefs, and attitudes towards nature. It holds that the underlying metaphysics of the human– nature relationship is problematic. Developing an ecological consciousness through identification with nature is a must for deep ecologists. Although the solution they proposed to overcome ecological crisis is not beyond criticism, many environmental organizations and activists find the deep ecological approach worthwhile as a means to maintain a harmonious relationship with nature. Applied ethics attempts to rethink our existing values and virtues in everything from health care to multiculturalism. Unlike traditional ethical theories, applied ethics is devoted to the analysis and examination of moral challenges in our personal, professional, social, cultural, environmental, and even political lives. I remember the struggles as a young researcher because of the scarcity of local resources in environmental philosophy and applied ethics. I therefore feel an obligation to provide some reflections on these fields, and that is why some chapters of the book have focused on the context of Bangladesh. This book is primarily for research students. However, scholars from other levels and disciplines can find alternative ways of thinking here. A lot of people helped me to develop the ideas explored in this book. I am sincerely thankful to my respected teachers, both home and abroad. In particular, I would like to thank my PhD research supervisor, eminent political philosopher, and noted applied ethicist, Emeritus Professor Ten Chin Liew (C. L. Ten), Department of Philosophy, National University of Singapore, Singapore. I would also like to thank Associate Professor Tan Sor Hoon, Associate Professor Cecilia Lim, Department of Philosophy at the National University of Singapore, Singapore; Professor Anders Nordgren, Professor Göran Collste, Centre for Applied Ethics (CTE) at

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Acknowledgements

Linköping University, Sweden; Dr. Mariëtte van den Hoven, Dr. Ineke Bolt, Professor JJM van Delden, Ethics Institute at Utrecht University, the Netherlands; Professor Marcel Verweij, Editor-in-Chief, Public Health Ethics Journal (Oxford); and Professor Fahmina Ahmed, Department of Philosophy at Jahangirnagar University, Bangladesh. These caring mentors taught me philosophical skills, theoretical and applied ethics at various stages of my education and career. I thank renowned historian Professor Sharifuddin Ahmed, Chairman, Department of History and Philosophy, North South University, Bangladesh, for his insightful suggestions about culture, morality, and history. I also thank my esteemed colleagues and enthusiastic students at the Department of Philosophy, Jahangirnagar University and North South University, Bangladesh, for their valuable support in many ways. Finally, this book would not have been published without valuable support and inspiration from Professor Holmes Rolston III, University Distinguished Professor and Professor of Philosophy, Emeritus, Colorado State University, USA, the founding father of environmental ethics and philosophy discipline, and one of my favorite environmental philosophers. His illuminating comments on environmental ethics and philosophy during his visit at NUS and later as my PhD thesis examiner enlightened me. Even though he is very busy, he was kind enough to write the preface of this book. I am extremely thankful to him for this. Each letter, word, and sentence of this book is for the satisfaction of my Rabb (the Creator), Allah, Rabbil 'alamin. May Allah Rahmanur Rahim accept it. Ameen.

Md. Munir Hossain Talukder

CHAPTER ONE ENVIRONMENTAL CRISIS AND DEEP ECOLOGY1

Introduction Environmental crisis is a global phenomenon experienced by every individual in the world. This problem is unique in the sense that it cannot be solved immediately and a broader approach, with the participation of scientists, researchers, environmentalists, academics, religious scholars, social workers, and philosophers, is needed. Several initiatives have tried to find out the root cause of the environmental crisis. For example, conservation biologists are attempting to assess the level of degradation in the sea, ocean, and rainforests, while geographers are measuring climate change in various regions throughout the globe. Environmental historians are helping to uncover people’s attitudes towards preserving nature in both the past and present. After the emergence of ecology as a distinct science, it was believed that this science was sufficient to solve the ecological crisis. Most environmental pollutions are created by chemical contamination or a change in chemical composition and, therefore, ecology is the best option to improve environmental conditions. However, philosophers, such as Arne Naess have claimed that scientific knowledge based on ecology is not enough. Ecology might provide a basis for environmental thought but a much deeper analysis from the philosophical viewpoint is urgently needed. So, what we need to solve this problem is to change the traditionally inherited philosophical mindset. Naess, therefore, explains the environmental crisis from a deeper perspective. This chapter discusses the philosophical underpinnings of the environmental crisis. I will discuss the scientific perspective, philosophical viewpoints, and the initiatives that have been taken so far in order to 1

An earlier version of this chapter was presented at the Faculty Research Project Seminar 2016, Faculty of Arts and Humanities, Jahangirnagar University.

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address the environmental crisis. Finally, I will consider in detail how deep ecology, especially Arne Naess’s ecosophy, has constructed the environmental crisis.

Environmental Crisis—Scientific Viewpoints Environmental crisis was initially primarily a concern for scientists, who warned us about the current situation of the universe. Our Earth is facing a serious natural crisis, which had not been identified before. The development of scientific technology and advancement of scientific knowledge allow us to realize the present environmental status. Scientists are now providing information and suggesting appropriate policies to overcome the environmental crisis. Since the 1970s, numerous scientific research works have contributed to raising awareness about the environmental crisis. The problem is seen as an unprecedented threat to humanity. The UN, through the wing of UNEP, has regularly published a Global Environmental Report for the last few decades. Therefore, the environmental crisis is one of the most pressing problems for scientists. Scientists view environmental crisis as a global phenomenon, which is not limited to any particular region or place and with multiple dimensions to its powers of destruction. The primary concern for them is the destruction of the ecosystem, where all living creatures grow and live. The environmental crisis from the scientific viewpoint can be summarized as “[m]ultiple forms of destruction leading to a possible collapse of the planetary ecosystem that supports life through global warming and other massive disruptions” (Summary of Global Problems and Crises 2016). This ecologically based viewpoint has been illustrated from different perspectives: Firstly, global destruction of forests and phytoplankton in the oceans (these capture carbon dioxide - 59% land, 41% oceans hold moisture and soil, preserve species, moderate the environment and give off oxygen). Secondly, worldwide soil erosion and desertification (the world has lost 1/5 of its arable land in the last decade). Causes: raising beef, lumbering, use of wood for fuel, clear cutting for crops or profit. Thirdly, worldwide burning of fossil fuels, primarily oil and coal, and burning of wood in the third world. Fourthly, harming of forests, lakes, and their ecosystems by acid rain (including Alaska, Canada, Norway, Eastern U.S., Germany, etc.). Fifthly, proliferation of nuclear waste hazards, and massive amounts of other toxic waste. Sixthly, worldwide shrinking of fresh water supplied through pollution and diminishing aquifers. Seventhly, spreading ozone holes resulting from long lasting chlorofluorocarbon gases. Eighthly, massive extinction of species worldwide connected with the above factors.

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Finally, flooding of coastal areas world-wide as the ocean levels rise: displacing hundreds of millions of people and burying a large portion of the world’s prime agricultural lands. (Summary of Global Problems and Crises 2016)

Therefore, the environmental crisis consists of the changing ecosystem; the destruction of soil and land; carbon emissions; acid rain; the production of nuclear waste; water, air, and land pollution; ozone layer depletion; flooding and cyclones. Taylor defines the environmental crisis as a “rapid and dramatic” change in environment conditions. He writes, “I define an Environmental Crisis as a dramatic, unexpected, and irreversible worsening of the environment leading to significant welfare losses” (Taylor 2016). Scientists also describe the environmental crisis as a product of living in an unsustainable environment. Our environment is becoming more and more toxic because of our use of chemicals and radioactive elements; we are also producing a lot of harmful waste. As a result, the atmosphere is becoming warmer which is a threat for present and future human beings, all other living creatures, and other natural entities. A Special Report published by IPCC (Intergovernmental Panel on Climate Change) indicates that there is an increase of global temperature of 1.5 degrees and notes: In its decision on the adoption of the Paris Agreement, the Conference of Parties (COP) to the United Nations Framework Convention on Climate Change (UNFCCC) at its 21st Session in Paris, France (30 November to 11 December 2015), invited the IPCC to provide a special report in 2018 on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways. (IPCC 2016)

The extinction of various species is another indication of the environmental crisis. The International Union for Conservation of Nature (IUCN) has assessed more than 79,800 species for the Red List, among them more than 23,000 are “threatened with extinction”. Their goal is to assess 1,60,000 species by 2020 (IUCN 2016). They also note, ‘103 extinctions [of plant and animal species] have occurred since 1800, indicating an extinction rate 50 times greater than the natural rate’ (‘Confirming’ 2000). (These findings mirror sources of evidence of such extinction.) A 1998 survey of 400 members of the American Institute of Biological Sciences indicated that 70% of the scientists polled believed that ‘the world is now in the midst of the fastest mass extinction of living things in the 4.5 billion-year history of the planet’ (Ayers 1998). Most of

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Chapter One these scientists attributed these losses to human activity (Warrick 1998, A4). (The Environmental Challenges We Face 2016)

Therefore, we can deduce that the environmental crisis, from a scientific viewpoint, is a crisis where human beings face serious challenges to being able to live healthy and comfortable lives. It also means an increase in severe untreatable diseases, animals becoming vulnerable and extinct and a changing ecosystem due to toxic components. As a result, global warming and climate change are visible outcomes of environmental crisis.

Environmental Crisis: Philosophical Viewpoints Philosophers understand the environmental crisis as a problematic relationship between humans and nature. It is a crisis where human beings have failed to establish a harmonious relationship with the environment. The traditional approach of human–nature relationships indicates that there is a hierarchy among the creations, and it is one where human beings are positioned just after the angels. The Creator has nominated human beings as His representative. So, human beings inherited the sole right of domination over nature. This attitude toward nature has made human beings more cruel. Their greedy attitudes have led them to commit violent actions towards the natural elements and, as a result, the natural balance is hampered. For this reason, the life of all living creatures, including human beings, is now under threat. Freya Mathews describes the environmental crisis within the parameters of this relationship: they analysed these attitudes as the expression of human chauvinism, the groundless belief, amounting to nothing more than prejudice, that only human beings mattered, morally speaking; to the extent that anything else mattered at all, according to this attitude, it mattered only because it had some kind of utility or instrumental value for us. This assumption, which came to be known more widely as the assumption of anthropocentrism or human-centredness, was a premise, they argued, not only of the forestry industry, with its narrow-minded reduction of ancient forest to timber resource, but of the entire Western tradition. (2010, 1)

In brief, philosophically the environmental crisis is a crisis of values, perceptions, and beliefs. John H. Fielder states that, The environmental crisis is forcing us to examine some of our basic assumptions about our relationship to nature. It is essential that these philosophical issues become part of the larger public debate on the

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environment, so that our technical and economic options are also seen as choices that reflect certain beliefs and values in a philosophy of life. (1991, 230)

Philosophers observe the environmental crisis from a broader perspective. They do not believe that the environmental crisis is an isolated problem, which any particular initiative can solve and so, instead, they offer different types of approaches in order to overcome it. Some philosophers, for example Norton and Passmore, argue for a solution within the Western framework; this means that they believe the Western normative system is enough to address the environmental crisis and that we just need to formulate effective moral norms and implement them whenever we face a new crisis. We do not need to abandon these norms because they are based on human-centeredness. Human beings have the enormous capacity to correct themselves, as they have done for centuries throughout modern civilization. In contrast, other philosophers, like Leopold and Routley, propose that we need a completely new kind of normative theory to face the global crisis. Anthropocentrism is responsible for severe environmental problems and it cannot be a solution. Rather, we need a new set of moral standards where not only human beings but also other elements of nature, such as land, rivers, and mountains, are considered intrinsically valuable. The Western tradition does not support this value system because it holds that all elements in nature are instrumentally valuable (i.e. they are only valuable in relation to their usefulness for humans).

Environmental Crisis from a Deep Ecological Perspective Deep ecology views the environmental catastrophe, as a crisis of ecological knowledge and erroneous worldviews. Our ecological knowledge is so limited that we believe that some elements in nature are useful and some are not. We are not aware of the full extent of humanity’s enormous potential. Our self-centered behavior has narrowed our abilities. We misunderstand the notion of living a meaningful life and instead privilege artificial luxury over protecting the environment. In addition, focusing on technology has accelerated our environmental crisis. Naess reflects on the environmental crisis in the following way: This discussion of the environmental crisis is motivated by the unrealised potential human beings have for varied experience in and of nature: the crisis contributes or could contribute to open our minds to sources of meaningful life which have largely gone unnoticed or have been

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Chapter One depreciated in our efforts to adapt to the urbanised, techno-industrial megasociety. (1989, 24)

Naess holds that there are several elements responsible for the environmental crisis. Some are philosophical and others are related to the uses of technology but all of them focus on the notion of “progress”. However, the concept of “progress” is not correctly constructed because as Naess argues, Progress has in all seriousness been measured by the rate of energy consumption and the acquisition and accumulation of material objects. What seems to better the material prerequisites for ‘the good life’ is given priority without asking if life is experienced as good. (1989, 24–25)

So, we judge whether we are living a good life or not through our standard of living. A good life does not mean a high standard of living but instead it means living in an emotionally rich and sustainable way. Naess adds, But the taste is the proof of the pudding, and more and more people in the so-called affluent societies are finding that its flavour isn’t worth the stress. ‘I am rich’ as an experience is largely, but not entirely, independent of the conventional prerequisites for the good life. (1989, 25)

Naess observes that we are currently more worried about our standard of living than our quality of life. Our current focus on production and consumption is not correct. Reflecting on the current economic situation, Naess writes, At present, the machine seems to require and to produce a distorted attitude to life. Within such a well-oiled system, a revision of value standards in favour of all-round experiential values, life quality rather than standard of living, must sound like a dangerous proposition. (1989, 25)

So, Naess’s claim is that the environmental crisis is a result of our faulty economy, which is grounded in misunderstood values and standards.

The Roots of Environmental Crisis as Perceived by Deep Ecology Deep ecologists have observed some major causes of the environmental crisis. We have indicated two origins of environmental crisis: one is

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philosophical and the other is the use of harmful technologies in the name of “progress” and “development”. We can also point out some additional roots of the environmental crisis according to a deep ecological perspective: 1. An incorrect focus on production and consumption due to damaging ideologies, practices, and values 2. A lack of appropriate and sufficient ecological knowledge 3. Separation from nature 4. The perception that nature is a resource for human beings Naess concludes that the environmental crisis is an “ecocatastrophe” and argues that, The crisis of life conditions on Earth could help us choose a new path with new criteria for progress, efficiency, and rational action. This positive aspect of our situation has inspired Ecology, Community, and Lifestyle. The environmental crisis could inspire a new renaissance; new social forms for co-existence together with a high level of culturally integrated technology, economic progress (with less interference), and a less restricted experience of life. (Naess 1989, 26)

So, the root cause of the environmental crisis, as argued by deep ecologists, is highly technology-based self-centered lifestyles. Our ignorance about ecology has created more damage in the ecosphere. Scientists often reflect on unusual natural calamities by saying “we do not know”. Therefore, deep ecologists hold that ecological wisdom is necessary in all aspects of life. Our lifestyle has had a serious impact on the environment and if we do not have sufficient ecological wisdom, then it is highly probable that we will behave arrogantly towards the environment. We need progress and economic development, but this progress and development must be consistent with environmental sustainability. Our values may not be merely anthropocentric, but we must also consider other elements of nature as intrinsically valuable. There is no restriction on using natural elements for human purposes, if they are fulfilling basic needs. Human beings destroy the environment mainly to satisfy their greed for unnecessary consumption. Lack of ecological wisdom creates obstacles that prevent humans from integrating with nature. Nature should not be controlled but, instead, enjoyed as it is. Science narrowly focuses on one particular aspect of nature, but nature should be understood on a much broader scale. Nature is not just the means of living as it is inspiring and could help human beings realize their duties and obligations towards other entities. Ecology opens

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new horizons of knowledge for environmental wisdom. The more we identify with nature, the more we can realize the position of human beings within nature. Naess notes, The study of ecosystems makes us conscious of our ignorance. Faced with experts who, after calling attention to a critical situation, emphasise their lack of knowledge and suggest research programmes which may diminish this lack of knowledge. (1989, 27)

In brief, deep ecology maintains that the root of our environmental crisis is philosophical. Our interactions with nature that shape our basic metaphysics regarding the human–nature relation is erroneous; the world view that we construct currently as a standard of living is also incorrect. Deep ecology suggests that our goal should be a rich life that is harmonious with other life forms.

Ecological Wisdom and Ecological Ignorance Ecological wisdom helps us to live a sustainable life. Achieving ecological wisdom should be the goal of all environmental studies. Usually, when we go on vacation to natural resorts our goal is to enjoy natural beauty. However, deep ecologists suggest that we should go to attain ecological wisdom. School children and environmental workers must identify with nature in order to overcome the ecological crisis. Identifying with nature will enable them to understand the ecological balance. If the ecological balance is disrupted, the whole community will face a catastrophe. Ecological ignorance may result in serious damage to the environment. Ecological ignorance shows our limitations in perceiving diverse and rich natural entities. We could ignore the lower plants or species but Naess declares that, So-called simple, lower, or primitive species of plants and animals contribute essentially to the richness and diversity of life. They have value in themselves and are not merely steps toward the so-called higher or rational life forms. (1989, 29)

So, those who create a demarcation between human/other life forms, and plants/other natural entities are ecologically ignorant because the whole universe is linked together. In Naess’s words, it is a “total fieldimage”.

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Conclusion Deep ecologists call for a total change in our lifestyles and our narrow conception of community. There is no doubt that we are facing an environmental crisis because environmental catastrophic events are happening throughout the globe. These include climate change, global warming, rising sea levels, flood, drought, deforestation, desertification, acid rain, and the extinction of various species. Scientists view the environmental crisis as a change in the ecosystem. They have shown us that environmental problems are caused by physical and chemical changes in environmental elements. To overcome these problems, they suggest reducing carbon emissions. However, individual initiatives may not be enough to overcome the current situation. Environmental philosophers point out that the problem lies in our defective human–nature relationship. Our traditional moral theories hold that only human beings are intrinsically valuable, while all other creations are for the use of human beings, which means that they are instrumentally valuable. If we want to overcome the ecological crisis, we should follow well-recognized moral norms towards other natural entities. Deep ecologists find that this approach is inaccurate. We need a new worldview, which holds that other elements in nature are also intrinsically valuable. Since other elements in nature help to maintain the environmental balance, they should have equal value to human beings. Increasing ecological consciousness is the only solution to correct our inappropriate perceptions. Therefore, deep ecologists suggest that we should identify with nature and gain ecological wisdom to overcome the ecological crisis. The more we identify with nature, the more wisdom we will gain. This wisdom will help us to construct a correct worldview and appropriate human–nature relationship.

References Fielder, John H.1991. “Philosophy and the Environmental Crisis.” In Environmental Concerns: An Inter-disciplinary Exercise, edited by J.Aa. Hansen , 229-242. London: Elsevier Science Publishers Ltd. Intergovernmental Panel on Climate Change ( IPCC).2016. http://www.ipcc.ch/report/sr15/ (accessed May 19, 2016) International Union for Conservation of Nature (IUCN).2016. http://support.iucnredlist.org/goal (accessed May 19, 2016) Mathews, Freya. 2010. “Environmental Philosophy.”

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http://www.freyamathews.net/downloads/EnvironmentalPhilosophy.pdf (accessed May 20, 2016) Naess, Arne. 1989. Ecology, Community and Lifestyle: Outline of an Ecosophy. Translated and revised by David Rothenberg. Cambridge: Cambridge University Press. Summary of Global Problems and Crises. 2016. http://www.radford.edu/gmartin/global%20crises.htm (accessed May 17, 2016) Taylor, M. Scott. 2016. “Environmental Crises: Past, Present and Future.” https://www.wto.org/english/res_e/reser_e/gtdw_e/wkshop09_e/taylor _e.pdf (accessed May 18, 2016) The Environmental Challenges We Face . 2016. http://www.albany.edu/faculty/rpy95/webtext/evidence.htm (accessed May 19, 2016)

CHAPTER TWO SELF-REALIZATION: THE BASIC NORM OF DEEP ECOLOGY1

This chapter considers some foundations of self-realization and morality in order to justify Arne Naess’s claim that “Self-realization is morally neutral”. Self-realization, the ultimate goal of Naess’s ecosophy, is the complete and final realization of the maxim “everything is interrelated”. This norm seems to be based on two basic principles: the reduction of ego and the creation of integrity between human and non-human worlds. This chapter argues that the former is an extension of Plato’s idea of selfdevelopment, or self-mastery, while the latter is implicit in Aristotle’s holism. It is important to note that self-realization is morally neutral only if the term “moral” is considered in the Kantian sense. However, Naess reluctantly distinguishes between ethics and morality, which makes his approach less credible. The chapter concludes that Aristotle’s notion of eudaimonia supports Self-realization by qualifying it as a virtue.

Introduction Deep ecology, as an environmental movement, emphasizes Selfrealization, ecological wisdom, and the asking of profound questions. Instead of dominating moral norms, such as the Categorical Imperative, Self-realization is the essence of deep ecology. Arne Naess, the pioneer of this movement, believes that a radical change in our present ideology, attitudes, and values towards the environment can solve the environmental crisis. Environmental philosophers and ethicists also suggest this change and recommend various sets of rules but, in contradiction with their stances, Naess argues for “no moralizing” because he thinks that all we need is “Self-realization”. 1

Previously published as “On Self-Realization—The Ultimate Norm of Arne Naess’s Ecosophy T” SYMPOSION: Theoretical and Applied Inquiries in Philosophy and Social Sciences 3, no. 2 (2016): 219–235.

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Naess uses the term “Self-realization” in a comprehensive sense. His procedure first distinguishes between the two selves: Self (with a capital S) meaning the Indian atman, and self (with a small s) meaning the individual self. The individual self should achieve the universal Self via diminishing the ego or through the “narrow self”; in other words, through realizing the maxim “everything is interrelated”. Naess argues that once the individual attains Self-realization, her behavior “naturally” and “joyfully” follows the norms of environmental ethics. Some important questions then arise: is Self-realization a moral term? Or is it a virtue to which the self needs to become accustomed? Thus, two basic principles—the diminishing of ego and the integrity between the human and the non-human world—constitute Naess’s ultimate norm of Self-realization. By the diminishing of ego, he means the gradual reduction of our hedonistic attitudes and the curtailment of our Western isolated egos. The integrity principle says that everything in this biosphere is internally connected, as all organisms are parts of an integrated whole. That is, if we harm any elements in nature, then eventually we will harm ourselves. I argue that the first principle is an extension of Plato’s self-development, or self-mastery, while the second is an extension of Aristotle’s biocentric holism. The chapter starts with an explanation of the term Self-realization. It then focuses on Plato and Aristotle’s views. After briefly reviewing Gandhi’s non-violence theory and Buddhism, I will support Naess’s claim that Self-realization is a morally neutral phenomenon. At the end, I will show that although Self-realization is, in essence, non-moral, Aristotle’s notion of eudaimonia provides enough ground for it to qualify as a virtue.

Self-realization as the Ultimate Norm of Ecosophy T Self-realization is the norm that connects all life forms through the ultimate principle that “life is fundamentally one”. David Rothenberg has identified three main features of this norm: firstly, Self-realization does not mean self-centeredness because the individual self cannot be isolated from or dissolved into the greater Self. Secondly, Self-realization is a process of expanding oneself to realize that she is a part of nature and others’ interest should be her own interests. Finally, since Self-realization is an active condition, as it is a process or a way of life, nobody can ever reach Self-realization. Like Nirvana in Buddhism, Self-realization is unreachable. Self-realization provides us a direction to move towards the Self (Rothenberg 1986, 9).

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But what does the Self exactly mean in Naess’s ecosophy? What are its special characteristics? In one sense, the Self includes all life forms in the world. That is, it is the symbol of organic oneness. Naess writes, “the Self in question is a symbol of identification with an absolute maximum range of beings” (quoted in Fox 1990, 99). He also adds, “[t]his large comprehensive Self (with a capital ‘S’) embraces all the life forms on the planet” (Naess 1986, 80). However, I think these words do not present his whole idea of the Self. The Self can also be seen as an extended manifestation of the self or, in other words, the universal Self is the mature form of the narrow self. The Self represents unselfishness, totality, and is beyond narrowness. It is unselfish in the sense that it considers the potentiality and the life of other non-human beings. Narrow human dominance dissolves into the Self. So, the Self, in another sense, refers to the wider, broadened, matured, refined, examined, and developed self. If we accept both these characteristics, Self-realization then denotes the realization of the “organic wholeness” as well as some sort of “rectification” of our selves. As I have just mentioned, Self-realization conceives a view of totality that is the ultimate goal of life. To reach this goal one has to go through several stages: T0-self-realisation T1-ego-realisation T2-self-realisation (with lower case s) T3-Self-realisation (with capital S) (Naess 1989, 84–85)

The last stage (T3) should be the ultimate goal. In the Western philosophical tradition, we find only T0, which Naess calls isolated or egoistic. However, T3 is similar to the “Universal Self” or to the “Absolute” in this tradition. Now, how can we reach T3 from T0? In other words, do we need any moral norm to reach T3? According to Naess, we need “inclination” rather than “morality” to get T3, which involves a joyful connection with nature (1989, 86). The norm of Self-realization plays a central role in distinguishing between “shallow” and “deep” ecology. In the shallow ecology movement, Self-realization seems less important because the movement only aims to fight against pollution and protect human beings. By contrast, in deep ecology, Self-realization is extremely crucial. Deep ecology considers all organisms, plants, and so forth, as a “total-field image”. So, deep ecology dissolves the “man-in-environment” concept and establishes a more symbiotic relationship; a relationship which is intrinsically valuable and

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based on an enlightened principle, which is “the equal right to live and blossom” (Naess 1973, 152). Thus, Naess’s Self-realization dismisses any hierarchical chain among human beings, animals, and plants. It favors the principle of integrity in order to draw a normative conclusion. Self-realization, therefore, is neither a purely ecological nor a logical conception. It is an ecosophy of equilibrium and harmony. By means of this norm, Naess argues against the “survival for the fittest” theory. As Darwin’s theory undermines co-existence and cooperational relations in the biosphere and advocates an “either you or me” sentiment, Naess rejects it. As an alternative to the evolutionary thesis, Naess’s maxim is “live and let live” in a class-free society in the whole ecosphere. He writes that “[b]y identifying with greater wholes, we partake in the creation and maintenance of this whole” (Naess 1989, 173). So, the question is, how does the process of identification stem from the notion of “live and let live”? Naess mentions that human beings cannot help animals, plants, other species, and even landscapes, because we can only identify ourselves with them. Identification is a situation that “elicits intense empathy” (Naess 1986, 227). One example of identification is that once Naess saw a dying flea jump into acid. Although he was not able to save the flea from dying, he felt its suffering deeply. Naess says, “[n]aturally, what I felt was a painful sense of compassion and empathy” (1986, 227). Hence, psychologically, Naess realized the similar pain of death and felt deep compassion and empathy by identifying with the flea. Identification means that one is not alienated from others. According to Naess, self-love is a pre-condition for identification. He understands self-love not in an egoistic sense, but rather in the deep and wide sense, that promotes others’ interest. The being’s interest, therefore, makes a bridge to reach Self-realization from self-love. Inspired by Spinoza and William James, Naess maintains that human beings are interested in preserving their existence. However, this interest is basically the realization of their “inherent potentialities”. Naess believes that other animals and plants have the same interests and that only through identification we can realize them (1986, 229). So, existence appears as a necessary condition rather than a sufficient condition for Self-realization. Another point is that the self develops into the ecological Self when human beings realize their own self-interests and have genuine self-love. The ecological Self feels a strong bond with the natural setting around her. She has a deep identification with it and finds herself a part of it. Naess expresses the feelings of the ecological Self in the following ways: “[m]y relation to this place is part of myself”, and “[i]f this place is destroyed

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something in me is destroyed” (1986, 231). Naess seems to say that, unlike the Western philosophical trend, the self is not merely something that exists inside the body and has consciousness as it has a major role in the identification and the realization of our relationship with nature. It contributes significantly to our understanding of how we should live, and how we should treat ourselves as self-interested and self-loving beings. Clearly, Self-realization inspires us to think beyond humanity. That is, we should realize our intimacy with the non-human world. Deep ecologists, Bill Devall and George Sessions, reveal its meaning in the maxim “no one is saved until we are all saved”. Here, the word “one” refers to each and every elements of the ecosphere that contributes to its existence, such as bears, mountains, rivers, and even the microscopic lives in the soil (Devall and Sessions 1985, 222). In the next two successive sections, I argue that the foundation of the Self-realization norm can be found in Plato’s view of self-development and in Aristotle’s holism.

Plato’s View of Self-development Plato developed Socrates’ idea of “know thyself” in his view of selfdevelopment. Plato did not take “Self-realization” as the ultimate norm and “self” was the central moral source in his thinking. From this perspective, Plato’s view of self-development could be the beginning of the norm of Self-realization. According to Socrates, “the unexamined life is not worth living” (Des Jardins 1997, 212). The inner message of this statement is that the good life must involve a process of self-understanding, self-examination, self-interpretation, and so forth; this is also the aim of Self-realization. In the Republic, Plato’s moral thinking is directed in a similar way because, he believes that, “[w]e are good when reason rules, and bad when we are dominated by our desires” (Taylor 1989, 115). That is, the good man is dominated by reason instead of desires. Arne Naess says that “[t]o identify Self-realization with ego-trips manifests a vast underestimation of the human self” (1986, 234). Devall and Sessions illustrate this idea in the following manner: “Self-realization goes beyond the modern Western self which is defined as an isolated ego striving primarily for hedonistic gratification or for a narrow sense of individual salvation in this life or the next” (1985, 222). Both Plato and Naess argue against allowing our narrow egos or hedonistic desires to dominate. They hold that our reason should dominate our soul and our thoughts, instead of those anthropocentric desires which

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direct human beings to fulfill their needs and wants by any means. Someone could argue here that Plato is more concerned with “self-control”, while Naess is focused on the “diminishing of ego”. Even though to some extent it is acceptable, their ultimate goals both seem to show that egoistic desire should not control a good human being. Morally good human beings have the natural capacity to control or to rectify themselves. Plato’s notion of self-development harmonizes three concepts: unity, calm, and self-possession, which Taylor calls “self-mastery”. To be ruled by reason it is necessary to have the correct understanding or ordering. According to Plato, correct ordering establishes “priorities among our different appetites and activities, distinguishes between necessary and unnecessary desires” (Taylor 1989, 121). Nevertheless, without selfexamination the capacity for correct understanding of appetites, activities, and desires is not possible. As Naess says, without developing capacities, the ultimate goal of Self-realization is not achievable (1986, 233). Broadly, these capacities may include identifying with the non-human world. Beyond this similarity, there are a number of methodological differences between Plato and Naess. Plato did not consider the ‘Self’ in his philosophy as an organic wholeness or an organic oneness. Nor did he take it as an expanded pattern of the self. Plato’s self seems centered on morality, particularly when he distinguishes between the higher part and the lower part of the human soul. The dominance of the higher part implies that we should be ruled by reason. Naess, by contrast, believes that inclination rather than morals can change our behavior. Rationality is a key feature of Platonic philosophy. Plato divides our souls into three aspects based on our mental states and activities. The appetitive part, the spirited part, and the rational part create a harmony, or balance, between our desires and will. However, only the rational part has the ability to know what is best for the individual. Rational desire does not rely on the strength of desires. Reason is thus a condition for self-mastery or self-possession. Naess believes that to act always by reason, or by duty, is a “painful toil”. A process of identification and joy can help us end this painful situation. The concept of identification is completely absent in Plato’s thought. Indeed, with regard to these differences, I believe Plato’s metaphysics and ethics exhibit a way of governing human beings’ behavior that relies on reason, but not necessarily on the moral principles that Kant focuses on. Plato’s vision was to create craftsmen, who can lead their lives by art, beauty, and knowledge, rather than Kantian moral agents. As Carone rightly mentions, “craftsmen of goodness in their own lives” (2005, 123). This noble idea creates a closer link with Naess’s thought.

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In the great Allegory of the Cave, Plato argues that through education we can move from “illusion to wisdom.” Illusion prevents us from attaining the right desires and true happiness, while wisdom is the achievement of real knowledge and correct reason, which allows us to live a good life. Plato says that this improvement is a turn from “darkness to brightness”. Taylor’s response to this analogy reflects the motto of “Selfrealization”. He writes, “[f]or Plato the key issue is what the soul is directed towards...the possible directions of our awareness and desire” (Taylor 1989, 123–124). Similarly, Naess’s norm of Self-realization creates an “awareness” of identification, the diminishment of ego, holistic and harmonious living, joyful co-existence, and the broadening of self to the Self. Thus, we can say that Plato’s view of self-development primarily focuses on self-awareness. This awareness corrects our desire, guides our reason, and clarifies our vision of the good life. As a whole, his account centers on how moral development can be achieved through the rectification of the soul. We have already discussed that Naess’s Self-realization is a process of enlightened self-interest, and of recognizing the potentiality of all elements in the ecosphere. Therefore, although Plato did not use the term “Self-realization”, the norm seems implicit in his view of selfdevelopment.

Aristotle on Biocentric Holism Aristotle blends ethics and biology, and believes that biology should be the essential part of ethics (Des Jardins 1997, 20). Deep ecologist Arne Naess also presents a similar view by mixing ecology and ethics as an alternative to solve the environmental crisis. It is, therefore, not surprising that Naess and Aristotle both share the same integrity principle in order to construct a holistic approach to nature. The integrity principle, as outlined by Aldo Leopold, states that “[a] thing is right when it tends to preserve the integrity, stability, and beauty of the biotic community. It is wrong when it tends otherwise” (quoted in Des Jardins 1997, 176). Thus, integrity also has a moral dimension. Westra develops a more precise version of integrity in an environmental context. She writes that, “the ‘principle of integrity’ is an imperative which must be obeyed before other human moral considerations are taken into account. Just as...the basis for all life is a holistic value” (Westra 1994, 6). So, roughly, the principle of integrity is the (moral) basis of biocentric holism. Now, we have to show how Aristotle’s view conceives of this principle.

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Aristotle’s works, Metaphysics, Physics, De Anima, and Nicomachean Ethics, all reflect on the principle of integrity. All natural objects, according to Aristotle, can be divided into two classes: living and non-living. The living things comprise the “principle of life itself” or “psyche” meaning “soul” (Des Jardins 1997, 21). However, movable things operate using “qualitative potentials”, while “locomotive natures” head towards a “mature state” (akme). In practice, he uses eidos (species or form) as a unified norm for biology, ethics, and metaphysics (Westra 1994, 135). Aristotle’s view of natural integrity is teleological because the aim of all living things is to achieve telos (purpose or function). As Westra argues, this activity involves some sort of “self-maintenance”. Like telos, selfmaintenance then also demonstrates a positive value. Therefore, she claims that the self-maintenance capacity of an organic ecosystem should be considered an “indisputable value” (Westra 1994, 135). Lennox points out similar findings and writes: “[Aristotle] claims to be arguing for the extension of teleology to nature, not, or not merely, to plants and animals. And yet the examples he uses to illustrate the teleology of nature are all organic” (Lennox 2006, 294). Aristotle, therefore, includes human beings, plants, and animals as integrated parts of an organic system. Biocentric holism also appears in his book Progression of Animals: “nature never produces in vain, but always produces the best among the possibilities for the being of each kind of animal” (quoted in Lennox 1985, 72). However, Aristotle differs from Naess in some important points. Firstly, Aristotle holds a teleological view of nature, in that all entities in the natural world have an instrumental value as, according to Aristotle, they are resources for human beings but, at the same time, they have an intrinsic value because their end is to attain excellence. For example, a tree has an instrumental value as human beings may use it for several purposes, but the tree is functioning well and so, in this sense, the tree has an intrinsic value. By contrast, Naess holds that all natural elements are intrinsically valuable; they are valuable for themselves. Thus, their values do not depend on their usefulness. Secondly, unlike Naess, Aristotle holds that only human beings have moral status, which is a strong anthropocentric view towards nature. He writes, “plants exist for the sake of animals...all other animals exist for the sake of man” (quoted in Des Jardins 1997, 91). Since Aristotle believes that only human beings can possess psyche or soul, which is the prime criterion of morality, only they can claim moral standing. Thirdly, as human beings possess the top position in the hierarchy, their interests and needs are very important for Aristotle. In contrast, Naess aims to eliminate such hierarchy and argues

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that human beings have no right to dominate nature. Fourthly, the integrity principle of Aristotle contributes to attain a purpose: that of achieving excellence or functioning well. Later, Thomas Aquinas developed Aristotle’s idea of telos to argue for the existence of God. By contrast, Naess’s holistic view does not have any such purpose. Therefore, in some contexts, Aristotle and Naess’s positions are completely opposed. But, obviously, Aristotle has developed an integrated view: a holistic system of nature. Some environmental thinkers (e.g. Westra) explain the ethical implication of this integrity principle by arguing that nature is intrinsically valuable and even Arne Naess himself writes: “An ecosophy, however, is more like a system of the kind constructed by Aristotle or Spinoza” (1973, 155). So, despite their fundamental differences, both Naess and Aristotle hold that the system of nature is holistic.

Is Self-realization a Moral Phenomenon? Naess’s ecosophy is primarily about the opening up of one’s self to nature through identification. In his view, ecosophy can be taken as an alternative to environmental ethics. That is, when the self perceives everything in this nature as her own part, such a self should naturally be an ethical person. The norm of Self-realization, therefore, is a non-moral phenomenon and the act of Self-realization is morally neutral. Naess himself believes that “inclinations” rather than “morals” could be the solution to the present environmental crisis. So, there seems to be a contrast between Naess’s ecosophy and environmental ethics. Eric Reitan argues that, from the perspectives of Aristotelian virtue ethics and Kantian morality, Self-realization cannot be treated as morally neutral because the value of Self-realization resides in how one identifies with nature. The act of Self-realization, thus, cannot be value neutral. Mathew I. Humphrey supports Naess’s view and claims that Selfrealization should be morally neutral. By highlighting Kant’s notion of respect, he argues that ecosophy T is ontologically prior to any moral law. In this section, I will focus on this debate and argue that Naess seems correct in taking Self-realization as morally neutral. I will briefly discuss Gandhi’s non-violence theory and Buddhism to support my claim. Let us first see how Naess perceives morality.

I. What is morality according to Naess? Naess writes,

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Chapter Two Our self-realization is hindered if the self-realization of others, with whom we identify, is hindered...Thus, everything that can be achieved by altruism—the dutiful, moral consideration for others—can be achieved, and much more, by the process of widening and deepening ourselves. Following Kant, we then act beautifully, but neither morally nor immorally. (1986, 226)

Thus, Naess’s Self-realization is a replacement or an alternative to moralization, but, it is important to note, he never explicitly mentions which sense of morality he is considering. As we know, the concept of morality changes during time and according to different customs; so there are different standards of morality. For example, happiness is the sole criterion of morality to Utilitarians, while for Kantians it is rules, and for Marxists it is the elimination of class. Naess, greatly influenced by Kant, seems to have taken moral rules, or duty, as the hallmark of morality. Naess intends to outline a system of inclination, rather than an ethics of ecological thinking. He emphasizes Kant’s distinction between a moral and a beautiful act, and holds that a beautiful act could be an alternative to duty in an ecological context. His article on this issue is called “Beautiful Action: Its Function in the Ecological Crisis”, and in this he superficially explores the notion of morality. He says, “you do it simply because it is your duty. There is no other motive. Presumably a factual mistake would not spoil the morality of an action – if you have done your duty trying to find out the facts of the case” (Naess 1993, 67). Naess insists that moral acts must follow moral laws. According to him, morality seems like some sort of sacrifice and is fully against our inclinations, because when we obey any moral law we give up our pleasure, joy, and happiness. Like Kant, he believes that moral acts should follow moral laws “at whatever cost”. So, moral acts are against our inclinations. Naess writes, “[i]nspired by Kant...Moral actions are motivated by acceptance of a moral law, and manifest themselves clearly when acting against inclination” (1989, 85). Environmental ethics sometimes suggests that we change our behavior, such as reducing excessive consumption or giving up a luxurious lifestyle, because otherwise Global Warming will continue. A lot of people are inclined to live in luxury so following environmental ethics would be a sacrifice for them. But, if we act correctly towards the environment using inclination and joy, we do not need to follow ethics, or specifically environmental ethics. If people found that it was joyful to live in no luxury at all, then their behavior would naturally follow the norms of environmental ethics. Naess says, “what I am suggesting is the supremacy of environmental ontology and realism over environmental ethics...our

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behavior naturally and beautifully follows strict norms of environmental ethics” (Naess 1986, 236). So, following Kant, morality to Naess is to act according to a duty that is motivated by the moral law. However, eventually, he rejects the concept of morality, as it is too narrow. Narrow in the sense that it does not value beautiful act. Beautiful acts, to him, have to be performed by inclination, not by duty. He writes that, “[m]oralizing is too narrow, too patronizing, and too open” (Naess 1993, 71). In a similar way, he rejects the role of environmental ethics to solve environmental problems.

II. Self-realization, morality, and ethics My observation is that Kant’s distinction between a beautiful act and a moral act, which is the basis of Naess’s claim, cannot establish the norm of Self-realization as morally neutral. One could argue that moral acts are also beautiful acts. For instance, sometimes we act according to duty without distinguishing between duty and beauty. Mothers care for their children with great love not because it is only a moral duty, but because it is joyful. So, a mother’s care could also be a beautiful act. However, Kant constructs his supreme principle of morality beyond inclination. In other words, Kant thinks that inclination is troublesome for morality because it derives from the “propensities of feeling”, not from the will of the moral agent, and conflict between these feelings is likely. Thus, he emphasized duty when he wrote the following: “[f]or the maxim lacks the moral import, namely, that such actions be done from duty, not from inclination” (Kant 1999, 26). His distinction between duty and inclination in morality is crucial. One example may clarify my point. If we imagine there is a war in some part of the world, one feels deep sorrow for the dying people, including children, and is inclined to help them. Naess would say this inclination is much more important than morals. However, Kant believes that anybody who does not have such an inclination, but who is able to save lives has a duty to save them. Kant argues that “an action done from duty must wholly exclude the influence of inclination…objectively the law, and subjectively pure respect for this practical law, and consequently the maxim that I should follow this law” (Kant 1999, 26). Now, what happens if the person who feels deeply over the suffering of the victims helps them to survive without considering it as a duty? According to Kant, since the act was not done from duty, such an act would not be moral, but it would also not be immoral because it is not a violation of any moral law. The act then would be morally neutral. So, I believe that the distinction between

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inclination and duty, rather than that between a beautiful act and a moral act, can establish Self-realization as morally neutral. Beyond this, a serious shortcoming with the deep ecology approach is that it does not distinguish between morality and ethics. According to Bernard Williams, people generally make this mistake when they consider morality in a narrow sense. For example, they may believe that morality stands for obligation without considering that this would be “just one type of ethical consideration” (Williams 1985, 196). They confuse morality with ethics. Williams refers to “morality as a special system, a particular variety of ethical thought” (1985, 174). He also says that “[m]orality is not one determinate set of ethical thoughts” (Williams 1985, 174). For instance, Kant’s conception of morality is based on obligation and duty. Or, more precisely, Kant “claimed that the fundamental principle of morality was a Categorical Imperative” (Williams 1985, 189). However, if one claims that the Categorical Imperative is the only fundamental criterion of morality, Naess maintains this would be a mistake because, for Utilitarians, maximization of welfare or self-interest is the criterion of morality. Ethics, on the other hand, is a much broader concept than morality. Williams claims that “it is possible to use the word ‘ethical’ of any scheme for living that would provide an intelligible answer to Socrates’ question [‘how should one live?’]” (1985, 12). According to him, we should not limit ethics by duty, obligation, responsibility, power, and so forth (Williams 1985, 17). Due to the conflation of morality and ethics, three problems occur within a deep ecological approach. Firstly, it is unclear whether Selfrealization is morally neutral by Kantian morality or Kantian ethics. The principle of Kantian morality is the Categorical Imperative, i.e. the moral law, but moral law itself is not morality. Laws only provide the justification for morality. Secondly, if Self-realization is morally neutral, what type of norm it is? Is it a norm of logic or a norm of beauty, or some other norm? Thirdly, Self-realization focuses only on the development of the self which is, from an ethical point of view, a form of self-centeredness or selfishness. Therefore, we should keep in mind these limitations while commenting on Self-realization. The distinction between inclination and duty, rather than between a beautiful act and a moral act, can establish Self-realization as morally neutral. However, such moral neutrality is possible only if we understand “moral” in the Kantian sense. But Reitan argues that even Kantian morality in a broad sense can allow Self-realization as a moral term.

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III. The debate whether Self-realization is moral or morally neutral According to Reitan, deep ecologists, including Naess, believe Kant’s distinction between a moral act and a beautiful act to be “too narrow” and that too much weight is given to it. Moreover, their narrow understanding “ignores certain other critically important traditions”, such as Aristotelian virtue ethics (Reitan 1996, 413). He claims that if we view Kantian and Aristotelian ethics through a “wider scope”, then Self-realization cannot be an alternative to traditional morality, and, instead fits fully into these traditions (Reitan 1996, 413). Reitan’s argument is based on the process of identification, a core concept in Self-realization. It is a way of realizing interconnectedness (i.e. that plants, animals, and landscapes are our parts) and an understanding that the reduction of narrow ego, as well as the process of identification, involves an “act of will”, which is a “choice” totally related to nature. Self-realization, therefore, must be a rational choice, and not a feeling or an instinct. Reitan maintains that Naess’s “narrow reading” of Kant fails to grasp what moral acts are. According to this reading, acts that are performed by “pure practical reason” without personal feelings, desires, and so forth, are moral acts. However, this does not mean that such acts must be “against one’s inclinations” but instead it refers to an “indifferent” position. He points out that “one of the elements of Kant’s philosophy that is overlooked in the narrow reading is the centrality of respect” (Reitan 1996, 419). He elaborates by arguing that respect obviously involves certain inclinations, such as emotion. So, Kant uses “respect” in the same sense as Naess uses “identification”. Respect cannot be just a physical act. Rather, as Reitan explains, it must be a “mental act” or an “act of will”. In the process of respecting, we recognize and affirm the character as we do in the process of identification. Following Kant, he concludes: it is possible to say that Self-realization is a moral term. In response to Reitan, Humphrey challenges his understanding of the Self-realization thesis and claims that because of several “disanalogies” it would be unconvincing to fit Self-realization into the Kantian notion of respect. Like Naess, he believes Self-realization is, after all, morally neutral. The main problem in Reitan’s analysis, as Humphrey indicates, is the problem of not recognizing “ontological priority”. Kant’s notion of respect can be viewed from two perspectives: first, we should show respect for “the moral law” and second, respecting “rational agents” is a duty. In the first case, there must be a moral law before we show respect for it. Humphrey says, “[t]hus, the moral law has to exist

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before respect can be given to it, and so moral law is ontologically prior to respect for such law” (1999, 77). In the second case, according to Kant, we should never treat rational beings as means but, instead, view them as ends in themselves. Obviously, before respecting them, we must know the nature of rational beings. For Kant, having reason is the criterion to be treated as a rational being. Thus, the sense of morality develops in rational human beings before their conception of respect. Humphrey concludes that Self-realization, or the process of identification, is ontologically prior to any deviation of the moral law, and therefore, Self-realization remains neither moral nor immoral (1999, 77–78). The above analysis shows that it is debatable whether Kant’s distinction between a beautiful act and a moral act can establish Self-realization as a non-moral term. Probably, the difficulty arises for Naess because he takes this distinction seriously, without grasping Kant’s whole idea. But there might be another way to show that Self-realization is morally neutral. Naess’s ultimate norm of Self-realization primarily refers to a system of identification or realizing the Self, which says “life is fundamentally one”. Famous deep ecologist, Warwick Fox, distinguished two different directions in this formulation. First, an axiological direction (or an intrinsic value direction) that says the process of Self-realization is intrinsically valuable or, in other words, “the process of Self-realization is valuable in and of itself” (Fox 1990, 99). Second, a psychological-cosmological direction (or an identification direction) that says all entities are interrelated or, in Fox’s words, “all entities are aspects of a single, unfolding process” (Fox 1990, 99). If we take “Self-realization” in the axiological direction, then Naess’s theory would not add any new ideas because most ecocentric theories, including the Gaia hypothesis, have the same philosophy. But, if we take it in the identification direction, only then can we have a wider, deeper, and total view of the self and clearly, Naess choses this second direction. As Fox writes, “Naess consistently explicates the meaning of his term ‘Selfrealization’ in terms of the psychological-cosmological framework of wide and deep identification” (1990, 99). Since the psychological-cosmological direction does not involve morality or intrinsic value, the term Selfrealization is morally neutral. Both, Gandhi and Buddha, invest the concept of “Self-realization” with similar importance and they both inspired Naess. I will briefly discuss their thoughts in order to strengthen my position.

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Gandhi’s Thoughts Naess’s claim that only the cultivation of our insight (i.e. Selfrealization) has a metaphysical similarity with Gandhi’s non-violence theory. They both believe that if we diminish the dominance of our narrow ego, or self, then we can achieve Self-realization, which is the ultimate norm of ecosophy or Moksha (Liberation). Although Naess and Gandhi have different processes in mind (i.e. identification and non-violence) their goal is the same: achieving Self-realization. Gandhi says, “What I want to achieve—what I have been striving and pining to achieve these thirty years—is Self-realization, to see God face to face, to attain Moksha (Liberation)” (Naess 1986, 233). Gandhi’s non-violent actions opposed the concept of human mastery. His personal lifestyle, such as carrying a goat for milk, as well as living with snakes and scorpions, shows his inclination for non-human beings. He believes that harmonious coexistence and non-violent living could be an alternative to moralization. His non-violent lifestyle recognizes the equal rights of non-human beings. According to Naess, “Gandhi recognized a basic common right to live and blossom: to Self-realization in a wide sense applicable to any being that can be said to have interests or needs” (Naess 1986, 234).

Buddhism In Buddhist thought, Self-realization is also seen as a process of Nirvana (Liberation) without taking it as a moral norm. Naess mentions that Buddhist theories of reverence for life, non-injury, and non-violence make for an intimate relationship with deep ecology. In Buddhism, the non-killing of animals is a fundamental norm. Waldau writes that “[t]here is in Buddhism more sense of kinship with the animal world, a more intimate feeling of community with all that lives...animals are always treated with great sympathy and understanding” (2000, 86). He also mentions “[t]he healthy rapport between plants, animals and humans, underlined by boundless compassion, was the basis of Buddhist life” (Waldau 2000, 86). Naess shares this spirit of Buddhism in his view of Self-realization. One of the teachings of Buddha to his disciples was that human beings should care for all living entities like mothers care for their children. In order to achieve Salvation, this realization is a prime condition. In fact, Buddha thought that true Salvation comes only when we overcome the surroundings of dukkha (dissatisfaction). Trying to fulfill unlimited wants

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and desires is the source of all dissatisfaction. But how can we separate ourselves from dissatisfaction? Buddhism persistently emphasizes meditative awareness about the interconnectedness of all life forms. Buddha’s threefold teachings, or trisiksa, which state that cultivation, meditation, and insight are the roots of enlightenment (Sponberg 1997, 369). These threefold teachings significantly develop the ultimate awareness of realizing the Self. Although Buddha did not hold such activities as joyful, his enlightenment certainly involved a transformation of consciousness from self to the Self. As Sponberg writes, This development of consciousness in Buddhism is expressed practically as an ever greater sense of responsibility to act compassionately for the benefit of all forms of life. (1997, 372)

To conclude this section, I have tried to show that Self-realization may not necessarily be a moral term. Other traditions, for example Buddhism and Gandhism, have considered Self-realization as morally neutral, so I do support Naess’s and Humphrey’s views. However, Reitan is correct when he hints that Self-realization possesses some sort of value. The next section will focus on whether Self-realization can qualify as a virtue.

Is Self-realization a Virtue? Arne Naess has not rejected the possibility of qualifying Selfrealization as a virtue, even though it is morally neutral. We have already discussed how Self-realization demonstrates enlightenment, and may involve some sort of practical wisdom. Joyful co-existence, association with the non-human world, and recognition of their potentialities, are the functional values of Self-realization, which are achieved through longterm practice. Self-realization is, therefore, not an overnight achievement. Additionally, according to Naess, Self-realization is the “ultimate goal of life” (1986a, 237). It is a lifestyle, which has simple means but rich ends (Naess 1986b, 82). These relate Naess’s view to virtue ethics. Virtue ethics, in particular Aristotle’s virtue ethics, are concerned with the characteristics of a person. According to Aristotle, a virtuous person is the one “who does the right thing joyfully and spontaneously out of a firm state of character” (Reitan 1996, 423). Alternatively, a virtuous person does the right thing from the love of virtue, not due to their responsibilities under moral law. Reitan writes that “[t]he ecological Self is one which has acquired a certain kind of virtue” (1996, 424). I should note here that his remark does

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not tell us the name of that virtue. The distinguishing characteristic of an ecological Self is having Self-realization, and so I will argue, using the work of Aristotle and contemporary virtue ethicist, Rosalind Hursthouse, that Self-realization is a certain kind of virtue. Aristotle stated that if “virtues are neither passions nor faculties, all that remains is that they should be states of character” (2003, 17). If virtues are states of character, do they occur in us naturally or arise through practice? Aristotle’s reply is that we can only receive them by adaptation and make them “perfect by habit” (Aristotle 2003, 12). Later, Aristotle says that when someone achieves a virtuous character she has the capacity to act according to the right rule. To Aristotle, “the right rule is that which is in accordance with practical wisdom” (2003, 49). The highest value, according to Aristotle, is eudaimonia which Aristotelian virtue ethicist Hursthouse translates as “human well-being”. She explores the notion of eudaimonia in order to construct an environmental virtue ethics, and argues that eudaimonia can never be grasped within individual happiness, in other words, within human-centeredness. Aristotle’s eudaimonia requires “a complete life” and therefore she maintains that “it is nonsense to call someone eudaimon, however virtuous, if they are being broken on the wheel or surrounded by great disasters” (Hursthouse 2007, 169). The above discussion shows that if we consider Self-realization as a state of character, because it is functional and achievable by habit, then it fulfills the criteria of practical wisdom. Such a piece of practical wisdom inspires us to live a complete life, which realizes the principle “everything hangs together”. Therefore, Aristotle’s own writings and his commentators’ clarifications provide enough ground to consider Self-realization as a measure of excellence in human character, or in other words, a constituent of eudaimonia.

Conclusion Arne Naess’s ecosophy T has Self-realization as its ultimate norm because it holds that all entities in nature are interrelated. Human beings can only achieve this ecological consciousness through the process of identification. Once they identify with nature, they can feel ecological wholeness or, in other words, the interconnectedness of animals, plants, and even landscapes. A deeper, rather than an alienated view of empathy and compassion for other biological entities, is the goal of such realization. I have argued here that Self-realization is an extension of Plato’s view of self-development and Aristotle’s biocentric holism. By exploring Gandhi’s

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non-violence theory and Buddhism, I then defended Naess’s claim that Self-realization is morally neutral, if we take “moral” in the Kantian sense. Finally, it seems to me that Aristotle’s virtue ethics advocates Selfrealization as a virtue.

References Aristotle. 2003. “The Nicomachean Ethics.” In Virtue Ethics, edited by Stephen Darwell, 7–50. Oxford: Blackwell Publishing Company. Carone, Gabriela Roxana. 2005. Plato’s Cosmology and Its Ethical Dimensions. New York: Cambridge University Press. Des Jardins, Joseph. E. 1997. Environmental Ethics: An Introduction to Environmental Philosophy. 2nd ed. Belmont, CA: Wadsworth Publishing Company. Devall, Bill, and George Sessions. (1985) 1998. “Deep Ecology.” In The Environmental Ethics and Policy Book: Philosophy, Ecology, Economics, eds. Donald VanDeVeer and Christine Pierce, 221-226. Belmont, CA: Wadsworth Publishing Company. Fox, Warwick. 1990. “On the Interpretation of Naess’s Central Term ‘Self-realization’.” Trumpeter 7 (2): 98–101. Humphrey, Mathew I. 1999. “Deep Ecology and the Irrelevance of Morality: A Response.” Environmental Ethics 21(1) : 75–79. Hursthouse, Rosalind. 2007. “Environmental Virtue Ethics.” In Working Virtue: Virtue Ethics and Contemporary Moral Problems, eds. Rebecca L. Walker & Philip J. Ivanhoe, 155–171. Oxford: Oxford University Press. Kant, Immanuel. 1999. “The Fundamental Principles of the Metaphysic of Morals.” In Morality and Moral Controversies, edited by John Arthur, 24-33. 5th edn. N.J.: Prentice-Hall, Inc. Lennox, James G. 1985. “Are Aristotelian Species Eternal?.” In Aristotle on Nature and Living Things: Philosophical and Historical Studies, edited by Allan Gotthelf, 67–99. Pennsylvania: Mathesis Publications. Lennox, James H. 2006. “Aristotle’s Biology and Aristotle’s Philosophy.” In A Companion to Ancient Philosophy, eds. Mary Louse Gill and Pierre Pellegrin, 292–315. MA: Blackwell Publishing Ltd. Naess, Arne. (1973) 1995. “The Shallow and the Deep, Long-Range Ecology Movements: A Summary.” In Deep Ecology for the TwentyFirst Century, edited by George Sessions, 151-155. Boston: Shambhala Publications.

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—. (1986a) 1995. “Self-realization: An Ecological Approach to Being in the World.” In Deep Ecology for the Twenty-First Century, edited by George Sessions, 225–239. Boston: Shambhala Publications. —. (1986b) 1995. “The Deep Ecological Movement: Some Philosophical Aspects.” In Deep Ecology for the Twenty-First Century, edited by George Sessions, 68–84. Boston: Shambhala Publications. —. (1989). Ecology, Community and Lifestyle: Outline of an Ecosophy. Translated and revised by David Rothenberg. Cambridge: Cambridge University Press. —. (1993). “Beautiful Action. Its Function in the Ecological Crisis.” Environmental Values 2 (1): 67–71 Reitan, Eric H. 1996. “Deep Ecology and the Irrelevance of Morality.” Environmental Ethics 18 (4): 411–424. Rothenberg, David. (1986) 1989. “Ecosophy T: From Intuition to System.” In Ecology, Community and Life Style: Outline of an Ecosophy, Arne Naess, translated and revised by David Rothenberg, 1– 22. Cambridge: Cambridge University Press. Sponberg, Alan. 1997. “Green Buddhism and the Hierarchy of Compassion.” In Buddhism and Ecology: The Interconnection of Dharma and Deeds, eds. Mary Evelyn Tucker and Duncan Ryuken Williams, 351–376. Cambridge, Massachusetts: Harvard University Press. Taylor, Charles. 1989. Sources of the Self. Cambridge, Massachusetts: Harvard University Press. Waldau, Paul. 2000. “Buddhism and Animal Rights.” In Contemporary Buddhist Ethics, edited by Damien Keown, 81–112. Surrey: Routledge Curzon. Westra, Laura. 1994. An Environmental Proposal for Ethics: The Principle of Integrity. Maryland: Rowman & Littlefield Publishers. Williams, Bernard. 1985. Ethics and the Limits of Philosophy. London: Fontana Press, Collings.

CHAPTER THREE SELF, NATURE, AND CULTURAL VALUES1

Ecological crisis is one of the major worries of the 21st Century. The ecological damage that has already been caused is severe, and many species, including human beings, are facing serious challenges in order to survive. The cross-cultural worldviews could be a promising approach to solve this global problem. Every culture reflects some core values with regard to this, but we do need to recognize and consider them. A comparison between cultures shed more light, since it allows us to learn and rectify our own values. The relationship between self and nature is pre-historical, as it existed before civilization began. However, new knowledge and technology interrupted this relationship and, as a result, catastrophic events occurred. This chapter analyzes the relationship between self and nature in relation to Western and Eastern cultural traditions. It argues that the common cultural value “identification” can be demonstrated to build up a harmonious co-existence with nature.

Introduction Ecological problems, such as global warming, climate change, biodiversity extinction, deforestation, ozone layer depletion, natural disaster, and so forth, have had a major impact on the ecosystem, and as a result species, whether human or non-human, are already under threat. Since our planet is rapidly becoming unfavorable ecologically, scientists, political leaders, academics, policy makers, religious scholars, and even ordinary people, are prioritizing discussing these problems. However, a solution to the ecological crisis may not be merely scientific or technological. For a viable solution, one should know where exactly the problem is. 1

Previously published as “Self, Nature, and Cultural Values” CULTURA: International Journal of Philosophy of Culture and Axiology 7, no. 2 (2010): 81– 99 which has been later translated into Italian as “UNA NUOVA ‘FILOSOFIA’ AMBIENTALE” [A New Environmental ‘Philosophy’] and was published by renowned publisher Mondadori, Milan, Italy in 2012.

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The Western cultural and philosophical tradition, which is anthropocentric, has contributed greatly towards shaping our present attitudes toward nature. Perhaps this attitude is incorrect. Rene Descartes, the founder of modern Western philosophy, divided everything into mind and body. In his view, because nature lacks a mind it has no value except for human use. This view has dominated Western culture for centuries. So, the very early cause of the ecological crisis is rooted in the metaphysics of the self– nature relationship. The first and most influential attempt to correct this metaphysical attitude was made by Norwegian philosopher Arne Naess in 1973, and is widely known as “deep ecology”. According to Naess, through identifying with nature the atomistic individualistic self can become deeper, and such a self is called an “ecological self”. An ecological self, he believes, has a deep feeling that nature is a “part of oneself”. However, his ideas surrounding attaining the ecological self are highly abstract. Two recent environmental philosophers, Eugene C. Hargrove and J. Baird Callicott, believe that Western environmental philosophy is “unsure” about the right attitude to take towards nature. They argue that it is going through a transition period, but that the Asian holistic attitude is very “promising” for a complete reconstruction of the currently incorrect metaphysics. This turn to the East is inspiring. I argue here that “identification”, as a common environmental value, is persistent in both cultures, and deserves special consideration in order to overcome the ecological crisis. Moreover, valuing “identification” can help us to construct a viable relationship with nature so that we can achieve a harmonious coexistence.

Self and Nature in the Western Traditions How should we perceive nature? What is the relation between nature and us? Are we separate or interrelated with nature? These questions are fundamental to who we are and where have we come from. People in all times and all cultural traditions have been devoted to answering these mysteries, and have attempted to live their lives according to their findings. Therefore, both Eastern and Western cultural traditions have their own historical perceptions of nature. In one sense, these perceptions are completely opposite (e.g. the sacredness of nature), but in other ways, there are some values that are common. Western attitudes toward nature are deeply rooted in the Greco–Roman cultural tradition and Judeo– Christian religious beliefs.

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Since ancient times, Greek cultural tradition has been based on cosmology. Nature was regarded as a realm of gods and goddesses who possessed several human qualities. The Greeks believed in an order of nature that was controlled by various gods and goddesses, such as Zeus, Delphi, and Gaia. It was believed that the people who pleased Gaia, the oldest Mother of all Gods, by their good activities would receive her blessings, but those who are poorly behaved would have to suffer. Some natural places were kept sacred, and hunting was also restricted in Ancient Greece. Even the pre-Socratic philosophers believed that the basic element of this universe was natural objects, such as water, fire, air, or earth. Some thinkers advanced a rational formulation of nature, for example, Nous was the ultimate force of universe according to Anaxagoras. Thus, the preSocratic idea of nature was oneness and cosmological unity. Plato, however, focused on ecological harmony and environmental consciousness. He compared deforestation as a skeleton without flesh. So, in the Laws he suggested some environmental regulations, such as: “[g]oats, which devour small trees, should be watched by keepers (639a); gathering of firewood should be regulated by district foresters (849d); fires must not be allowed to spread (843e)” (Hughes 2009, 356). Aristotle, by contrast, invented a unified principle of nature, known as the Principle of telos (purpose). All living and non-living elements must have a purpose according to the principle of telos. But Aristotle made a classification among natural objects by saying that “plants exist for the sake of animals...all other animals exist for the sake of man...it must be that nature has made all things specifically for the sake of man” (Des Jardins 1997, 91). This view dominates, although he also said in the Metaphysics (107a 17–20) “All things are ordered together somehow, but not all alike––fishes and fowls and plants and the world is not such that one thing has nothing to do with another, but they are connected” (Hughes 2009, 357). So, clearly Aristotle advocated a principle of integrity among human beings, animals, plants, and other living and non-living elements. The Materialist philosophers, like Leucippus, Epicurus, and Democritus, mentioned a purely atomistic mechanical view of nature. Although their view was hedonistic, they believed that human activities caused natural destructions. Later, in the medieval period, philosophy was blended and synthesized with Christian theology. As a result, nature was described in the light of the Bible. In Genesis, God says, Let us make man in our own image, in the likeness of ourselves, and let them be masters of the fish of the sea, the birds of heaven, the cattle, all the wild beasts and all the reptiles that crawl upon the earth (1:26).

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God also says, “Be fruitful, multiply, fill the earth and conquer it. Be masters of the fish of the sea, the birds of heaven and all living animals on the earth (1:28)” (Genesis). Thomas Aquinas applied this sentiment and argues in the Summa Contra Gentiles, book 3, pt.2, We refute the error of those who claim that it is a sin for man to kill brute animals. For animals are ordered to man’s use in the natural course of things, according to divine providence. Consequently, man uses them without any injustice, either by killing them or employing them in any other way. (Des Jardins 1997, 92)

Thus, Aquinas believed that human beings have superiority over all creatures and, for this reason, it is not morally wrong to kill animals for their purposes. However, Attfield claims that Aquinas considered the suffering of animals, and was against their ill treatment, arguing that “Aquinas then turns to the possibility that the feelings of humans and ‘other animals’ constitute a reason for injunctions against ill-treating them, and asserts the naturalness of pity at the sufferings of others, including nonhuman animals” (Attfield 1983, 208). Two important points can be noticed here: first, unlike the ancient period, God and nature are separated, and second, the view that nature is sacred is rejected. These two ideas have a significant impact on modern thinkers, who argue that “Nature was one thing, God quite another. And this agreement, I have been suggesting, was of fundamental importance in determining the attitudes of the West” (Passmore 1980, 11–12). But it seems to me that despite the fact that God and nature are separated the spiritual sign is still there. According to the Old Testament and Christian doctrine, nature was made for the sake of human beings, they gained absolute mastery over nature by God, but this dominion actually represents the superiority of God. Attfield’s observation is that this period centers on “the enhancement of natural beauty or the glory of God” regardless of its “usefulness to humans” (Attfield 1983, 211). The modern period tends to rely more on European Enlightenment and science rather than the concept of a greater authority. The general view during this period was that as human beings have the ability and capacity to control nature, they have the liberty to modify it according to their will. Francis Bacon argued for making human lives comfortable at any cost. He claimed in Religious Meditations, “knowledge itself is power” (Passmore 1980, 18). Rene Descartes adapted Bacon’s view and described human beings as “the masters and possessors of nature” (Passmore 1980, 20). Descartes divided all entities in nature into two categories: minds and bodies. The characteristics of the mind are thinking, feeling, consciousness,

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and sensation, while the characteristics of the body are physical and mechanical. Although Descartes did not deny that plants and animals have lives, he strongly argued against the belief that they have consciousness. So, according to Descartes, everything in nature, apart from human beings, are merely machines or “thoughtless brutes”. Descartes’ mind-body dualism still has a large influence on modern philosophers and has, therefore, shaped their views on nature. He makes a close connection between nature and human beings, even though human beings are seen as mental as well as physical entities: physical because human beings occupy place, and mental because they can manifest their thoughts. This formulation has been described in the following manner: “[a] person is to be identified with his mind, and the Cartesian mind became identified with the human soul” (Pratt 2009, 365). Spinoza dismissed Cartesian mind-body dualism by saying that there is only one substance: God. However, Spinoza’s God is very different from a religious God, because his God manifests the qualities of impersonality, has infinite attributes, and is perceived as being identical with nature. Deus sive Natura: God is Nature and Nature is God for Spinoza. In his understanding of nature, there is no hierarchy; human beings, animals, plants, all are equally valuable because he believed that physical and mental worlds are unified. Spinoza writes that “[e]verything, insofar as it is in itself, endeavours to preserve its own being” (Houle 1997, 420). So, Spinoza’s philosophy emphasizes inter-dependence, interrelation, and oneness. Two great philosophers in this period, John Stuart Mill and Immanuel Kant, revived the superior position of human beings. Mill was concerned about the happiness of human beings, while Kant argued for a principle that treats human or rational beings as an end and never merely as a means. Mill writes, But, it is said, all these things are for wise and good ends... Either it is right that we should kill because nature kills; torture because nature tortures; ruin and devastate because nature does the like; or we ought not to consider at all what nature does, but what it is good to do. (2008, 131)

So, in this statement he is arguing for a wise use of nature. Utility is the ultimate moral principle, according to Mill, as he declares that “I regard utility as the ultimate appeal on all ethical questions; but it must be utility in the largest sense, grounded on the permanent interests of man as a progressive being (p.31)” (Ten 1991, 212). Still Mill’s “Greatest Happiness Principle”, which promoted providing the greatest happiness to the largest number of human beings, is so

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influential that economic policy, state politics, public policy, scientific progress all rely heavily on it. While Kant’s moral laws, instead, allow full autonomy to human beings. He believed that because they are autonomous, humans can and should maximize their utility; this view inspired great numbers of modern people. More and more scientific inventions that enable comfortable living have encouraged human beings to use, modify, and even exploit nature. Therefore, the concept of autonomy and the maximization of human happiness are two main features in the modern period. In the early twentieth century, nature was seen an economic resource: people cut down forests for fuel, they used DDT for pest control, established nuclear power plants, invented the nuclear bomb, constructed bridges and dams, dumped dangerous chemicals into the sea, and completed missile experiments. In return for this economic boom, they received pollution, life-threatening diseases, and natural calamities that include severe earthquakes, devastating floods, and dreadful cyclones. As a result, many animals and plants became extinct and human beings began to feel that climate change had significantly affected their lives.

Self and Nature in the Eastern Traditions In the East, self perceives nature as sacred and it is where all gods and goddesses exist. It became an inspiration for living a spiritual life. Some Eastern cultural values are quite different from the West and may appear mysterious to some Westerners. For example, B. N. Banerjee writes about the Indian culture of worshipping cows; he states that “[i]n Hindu faith the corner stone is devotion, love, non-violence and the supremacy of morality. The Westerners laugh at the Hindus for their worshipping of the cow” (Banerjee 1979, 24). However, he adds that the underlying values are “the glorious manifestation of their love for the animal. The Hindus are alive to their environment in which they live. They have respect for the flora and fauna. They believe in the ecological balance of creation” (Banerjee 1979, 24). Mohanty distinguishes three models of self–nature relationships within an Indian context: the mechanistic model, the teleological model, and the emergent and causal emanation model. He points out some contrasting features of these models on the basis of continuity vs. discontinuity, as well as change vs. permanence. His analysis concludes that “[t]he self, however, is not in nature: it underlines its possibility... ultimately nature is both natural and moral: the two orders coincide. Science then becomes subordinated to the moral and spiritual goals of the self” (Mohanty 1992,

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222). So, Mohanty’s remarks demonstrate that, in this context, the self relates to nature in order to fulfill spiritual and moral goals. In Indian culture, goodness, benevolence, beauty, and harmony, can only be achieved through the contemplation of the proper relationship between self and nature. A. K. Banerjee writes more clearly that “[t]he contemplation of the inner unity of the apparently diversified universe and the essential identity of one’s own self with the Self of the Universe” (Banerjee 1979, 233). How does physical environment relate to Indian culture? Any one familiar with Indian culture and religion can recognize the influence of physical environment on themselves. Undoubtedly, like a few Western countries, the geographical and natural beauty of India is highly glorious, as Shah illustrates: “[s]urrounded on the three sides by the girdle of Ratnakar (ocean) the repository of jewels, wearing the diadem of Himalayas, watered by the holy Ganges, Yamuna...laden with fruit gardens of Kashmir” (Shah 1982, 17). Such fascinating natural beauty will attract anybody, but this attraction for India claims a deeper value: one that is fully bonded with nature. Three ancient books inspire Indian cultural tradition: the Vedic scriptures, the Upanisads, and the Bhagavad Gita. These sacred books explore some major philosophical teachings. For example, the Bhagavad Gita states that Lord Krishna says the true devotee is one who “sees Me in all things, all things in Me (6.30)” (Nelson 2008, 99). In this way, Nelson argues, “Krsna identifies himself with elements of the natural universe: sun, moon, stars, the ocean, the Himalayas, the wind, and the holy Ganges” (Nelson 2008, 99). As a result, the nature itself becomes sacred. Since nature is the body of both gods and goddess, everything in nature becomes purified. Lamb states, natural things, such as fruits, flowers, leaves, grains, nuts, most river waters, and so forth, are inherently pure and can be offered at a temple by almost anyone. They require no ritual purification. Though they are not necessarily sacred in the Western sense of the term. (2008, 345)

So, “sacredness” has a different meaning in Hinduism than the Western traditions discussed. He also mentions that, Though these [the Western traditions] envision the sacred as separate, static, specific, dualistic, and under the interpretative domain of religious authorities, most Hindus view it as ubiquitous, amorphic, contextual, existing on a graded continuum, and not under the exclusive authority of any one. (Lamb 2008, 341)

Indian Culture has the utmost respect not only towards animals but

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also for the whole natural world. The Upanishad discusses self–nature metaphysics and declares that the purification of the inner self (atman) happens by understanding the real nature of the Ultimate Self (Brahman) and this can bring the salvation (Moksa) of human beings. So, self and nature in the Indian tradition manifests a fundamental closeness. Gosling examines this closeness and writes, the Indus civilization or the Aryans who were responsible for the Vedic texts, considerable closeness exists between humans, the natural world and transcendent Reality (God, the gods, the One, etc.)—so much so, for example, that trees are considered to be ‘pervaded by atman’. (2001, 32)

Nature in Chinese is generally translated as ziran which literally means “spontaneous”, or “self so”. Contemporary environmental philosopher Callicott writes, “[p]erhaps the greatest contribution that classical Chinese thought can make to a global deep-ecological awareness lies in this conception of dynamic, mutually constitutive, internal relatedness” (1987, 85). Nature is the central feature of spontaneity, spirituality, and harmony in Chinese cosmology. Chinese metaphysics emphasizes moral improvement of the self by achieving superior qualities. Unlike the Indian tradition, this tradition articulates how the self can be virtuous without relying on religious myths. Confucius and Lao Tzu mentioned several noble qualities, such as tolerance, impartiality, love, benevolence, filial piety, and so forth, which can help us create a harmonious relationship with nature. The goal of Confucian values lies in the development of human nature. To achieve ren, or humanity, one has to improve his or her inner self. Good character through education can turn one into a sage. A sage is more concerned about harmony with nature than anything else. Neville mentions that “[f]or a sage to be ‘sincere’, to be ‘one body with the world’, requires that all the avenues of perception and learning, on the one hand, and of action close at hand and at a distance, on the other, need to be brought into harmony” (2008,7). But this devotion is not easily achievable; in fact, Confucius believed that one had to live to the age of seventy-one before it was attainable. Here, we can reasonably argue that Confucius suggested a continuous and persistent identification of human self with nature. The great Confucian commentator Xunzi in his writings on Tien, or nature, says, “nature endows human beings with biological, emotional, and personal governance systems that are seriously underdetermined” (Nelville 2008, 18). So, the Confucian definition of a good life relies on harmonious contact with nature.

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Daoism, which has a profound influence on Chinese art and landscape painting, views nature as spontaneous and “spontaneity” holds a high value in Daoist culture. Daoist scholar Miller illustrates that “the Dao is to be self-actualizing, creative and spontaneous, so also these values have come to be identified as core-values of the Daoist tradition” (Miller 2003, 140). But how can we understand spontaneity in nature? The Daoist’s response is through the flourishing of Dao. Miller writes that “the flourishing of the Dao came to be understand in reference to a state of creative harmony that emerges between humans, the humans and the earth” (2003, 140). The superior self, in Chinese tradition, is a common human being who is “utterly transfigured and transmuted into a noble character” (Fang 1973, 10). The self cannot be a mere onlooker to the Creator and daily events. Wei-ming also has identified three basic motifs of Chinese cosmology: continuity, wholeness, and dynamism. On the one hand, nature is a “Great Harmony”, while on the other it is dynamic, holistic, and continuous. This proves that great harmony can attain spontaneity. Human beings, who receive the sensory experiences through manifested Ch’i (matter/energy), would then feel that “all things are my companions”, and, therefore, should consider themselves as the filial son and daughter of this cosmos (Wei-ming 1998, 116). Chuang Tzu nicely expresses the self–nature relationship when he says, “[e]verything is its own self; everything is something else’s other...the other arises out of the self, just as the self arises out of the other. This is the theory that self and other give rise to each other” (De Bary, Chan & Watson 1960, 68). One of the disciples of Chuang Tzu once asked him “[h]ow can the mind by means of moral principle (Tao) penetrate things without any limit?” He replied, “[t]he mind is not like a large horizontal door which can be enlarged by force. We must eliminate the obstructions of selfish desires, and then it will be pure and clear and able to know all” (De Bary, Chan & Watson 1960, 498).

Obstacles within the Traditions Lynn White in his very influential paper, “The Historical Roots of Our Ecological Crisis” (1967), has argued that present ecological problems have derived from dominant Western Judeo–Christian attitudes towards nature. He comments, “[e]specially in its Western form, Christianity is the most anthropocentric religion the world has seen” (White 2008, 18). White also believes that Christianity is even more dominant over nature than the Greco–German traditions. As he states, “[o]ur daily habits of action, for

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example, are dominated by an implicit faith in perpetual progress which was unknown either to Greco–Roman antiquity or to the Orient. It is rooted in, and is indefensible apart from, Judeo–Christian theology” (White 2008, 18). In the very first formal book on environmental ethics, Man’s Responsibility for Nature: Ecological Problems and Western Traditions (1980), John Passmore agrees human beings are responsible for many great changes in nature, but still defends the position that Western traditions are sufficient for an appropriate ethical relationship with nature. So, Passmore rejects the need to formulate a new ethics, or ethical principles. Genesis gives human beings superior authority to dominate over nature; however, Passmore corrects White’s view that Genesis also commands them to be caring. In Passmore’s language, And God, according to Genesis, also issued a mandate to mankind: ‘Be fruitful and multiply and replenish the earth and subdue it’ (1:28). So, Genesis tells men not only what they can do, but what they should do, multiply and replenish and subdue the earth. (1980, 6)

Thus, our responsibility for nature is one of a “farm-manager” or “steward” according to Christianity. Passmore argues that the attitude “man is the agent and nature is the machine for his use” is incorrect. Nonetheless, this metaphysical notion neither expresses “the entire Western tradition”, nor does it provide any ground to reject the Western science according to him. He rather identifies two important traditions in the West, Conservationist and Perfectionist, which suggest responsibilities towards nature. Thus, he believes that ecological problems originate not because of Western metaphysics but, instead, because of the “ignorance”, “greediness”, and “short-sightedness” of human beings. In his words, “the major sources of our ecological disasters––apart from ignorance––are greed and shortsightedness” (Passmore 1980, 187). Passmore’s conclusion is, therefore, that the West “leaves more options open than most other societies” and has the seeds to solve ecological problems (1980, 195). But it has to remove the mystical viewpoint, “nature-is-sacred”, because he believes that mysticism cannot be a solution. Rather, the solution should be using the “old-fashioned procedure: thoughtful action”. In the West, the relationship between self and nature is traditionally based on Christianity and science. The self has been seen as a separate entity and master of nature. Science empowers this individualistic attitude. Callicott maintains that Greco–Roman legacy is directly responsible for

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shaping the modern Western worldview. According to him, without any critical and systematic discussion, the Greek philosophers inherited the Judeo-Christian teachings. The Greek atomism, which represents nature as material and mechanical, was “institutionalized” by the Western Industrial Revolution. Descartes’s mind/body dichotomy revived this atomistic/mechanistic view and the self ultimately becomes “essentially and ethically segregated from nature” (Callicott 1987, 119). The Western worldview, as Callicott says, represents “atomistic/mechanistic image of nature inherited from the Greeks, institutionalized in modern classical science and expressed in modern technology” (1987, 118). Thus, almost all environmental philosophers believe that human beings should revise their relationship with nature. Because of serious natural exploitation, the life of both human and non-human species is under extreme threat. As Western ethics separates humans from nature and constructs a value theory based on anthropocentrism, a turn to Eastern holistic environmental thinking is clearly visible. The vision of this major turn has been summarized into a single hope that “Eastern traditions would provide, for these essentially Western ills, an alternative metaphysic and axiology ready-made, as it were, to establish harmony between man and nature” (Callicott 1987, 119). While Asian traditions are very promising for an alternative ecological valuation, Asian philosophers have not yet succeeded in formulating a well-constructed ecological approach. A number of problems are noticed here: firstly, how this tradition, basically religious and idealistic, can fit into pragmatic and scientific analysis of environment, and secondly, like the Western ecological master, the holistic Asian approach invites human beings to be an ecological slave, or, alternatively, it constructs a metaphysical harmony with nature beyond the scope of ethics. According to some Western philosophers, Asian traditions are not specific about the ethics of the human–nature relationship, and more importantly, they do not have any pragmatic answer on how the self should relate to nature. Lynn White, who argues for the reformation of Christian view toward environment, has raised and rejected the Eastern alternative because he believes that such alternative is “very nearly” a Christian view, and its “viability” is “dubious”. A few years later, in 1972, theologian John B. Cobb Jr. ignored the Indian tradition because he felt that “Indians respected human life too little”. Although these critics perceive nature to be sacred, “they [are] too engaged in destructive ecological practices”. In addition, a large human population cannot adopt the “Indian way of life”. Similarly, according to Cobb, China’s notable historical views, including Taoism, “demonstrated ineffectiveness” with regard to preventing

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ecologically destructive practices such as deforestation (Hargrove 1989, xv). John Passmore’s reaction is rather more extreme; he mentions the East as one of the most “dangerous illusions”, totally mystical, and something that will ultimately “destroy” Western science and technology (Hargrove 1989, xvi). However, recent environmental philosopher, Holmes Rolston III, sets out a critical and provocative argument in favor of Easternization. In an important article, “Can the East Help the West to Value Nature?” published in 1987, Rolston writes, “[t]he Eastern views offered are typically both old and religious. The Western problem is recent and (para) scientific” (1987, 172). He is concerned that there is a serious mismatch between the metaphysics and the language of the East and the West. The East speaks using a religious language, which blends poetry with ethics, while the West uses a scientific language that separates religion and ethics. Rolston states that, perhaps the Taoists had worked out details for a life of balance that applied only to bygone Chinese societies...Perhaps the call for more yin is good advice still...But can this be translated into help in making decisions in the modern, industrialized, high-technology West? Can it teach the West what to preserve, where to compromise, and how much to sacrifice of what remains of the shrinking wilderness? (1987, 181)

Thus, Rolston claims that a “considerable reformation” of Eastern thought is a must to help the West.

Recognizing a Common Value Despite these obstacles, Norwegian philosopher Arne Naess has made the first attempt to reconcile Western and Eastern attitudes towards nature. In his groundbreaking thought of deep ecology, Naess outlines an ecosophy named “ecosophy T”. Naess’s ecosophy T has one ultimate norm: “Self-realization”. He writes, “[i]n the premise/conclusion systemization of ecosophy T, ‘Self-realization!’ is designated as the one ultimate premise” (Naess 1995, 215). Naess’s Self-realization is grounded on the maxim “everything is interrelated”. Naess argues that once the individual self attains Self-realization, his or her behavior “naturally” and “joyfully” follows the norms of environmental ethics. According to Naess, identification is the process of Self-realization, thereby understanding that we are the part of a greater “Self”. As he says, “[o]ur Self is that with which we identify” (Naess 2008, 222). One example of identification is that once Naess saw a dying flea that had

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fallen into acid. Although he was not able to save the flea from dying, he felt its suffering. Naess says, “[n]aturally, what I felt was a painful sense of compassion and empathy” (Naess 1995, 227). Once the individual achieves Self-realization through the process of identification it can then develop into the ecological self. Notably, Naess introduced the term “identification” but it is not simple to grasp his concept of identification. However, I would like to discuss some difficulties with his viewpoint. Firstly, Naess recognizes that we have some sort of identification with non-humans who are living beings. He writes, “[o]ur immediate environment, our home (where we belong as children), and the identification with nonhuman living beings, are largely ignored” (Naess 1995, 226). But we definitely do identify with non-living elements. For example, the preSocratic philosophers believed that some natural elements, such as water, air, fire, or earth, could be the fundamental elements of this universe. The same is true for Indian tradition; their conception of five primal elements (Panchabhuta) has a very strong role within Indian culture and philosophy. It is very difficult to ignore a strong bond of identification with these nonliving elements. Secondly, identification is a “process” for Naess. He has taken it as a tool, a method, a way, or a means in order to achieve his ultimate norm of “Self-realization”. He says, “the self sifts the burden of clarification from the term “self” to that of “identification” or rather ‘process of identification’” (Naess 1995, 227). So, identification was not Naess’s end or goal. However, when the Ancient Greeks wanted to please Gaia, the oldest Mother in the Greek traditions, identification was an end for them. The Chinese view of harmony or balance between Heaven, Earth, and Humans, manifests identification as an end, not as a means. Thirdly, Naess writes, “[s]o there must be identification in order for there to be compassion and, among humans, solidarity” (Naess 1995, 227). But Naess quickly rejected “compassion”, “empathy”, or “solidarity”, as the basic idea. Rather, these are medium of identification according to him. However, in the Eastern tradition we find Gandhi and Buddha who have compassion, or empathy, for all living and non-living creatures at the heart of their philosophy. Naess himself mentions, “Gandhi in his ashrams was taken aback that he let snakes, scorpions, and spiders move unhindered into their bedrooms––as animals fulfilling their lives. He even prohibited people from keeping a stock of medicines against poisonous bites” (Naess 1995, 233). Finally, Naess criticizes present conservationist policies since their aim is to protect the environment for the existence of human beings. But Naess believes that the aim should be instead “self-love”. This love surely does

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not mean “selfish love” but, rather, a deeper love for all elements in nature. Through identification, we can achieve this capacity of loving, as Naess writes, “[t]hrough identification, they may come to see that their own interests are served by conservation, through genuine self-love, the love of a widened and deepened self” (1995, 229). So, Naess’s conception of identification is multi-dimensional. Naess values identification in an indirect way, or we could say identification has an instrumental value to him. But I believe that identification has an intrinsic value and a unified sense in both Western and Eastern cultural traditions. Naess was certainly a pioneer in introducing the term, but he only valued it to construct his own ecosophy. However, identification has a strong root as a cultural value, which Naess has ignored.

In What Sense Is “Identification” Common? Identification is an act of identifying superiority. However the word “superiority” could be replaced by any of the following: humanity, harmony, balance, ecological community, ecological virtue, and so forth. In other words, it is an act that makes human beings superior creatures. Identification develops some superior qualities in human beings through which they can realize their position within nature. This sense of “identification” can be found throughout cultural histories. The Greeks identified with nature in order to please Gaia. Gaia was the oldest Mother of all Greek Gods and she only delighted in good activities with nature. Why were the Greeks motivated to demonstrate good interactions with nature? One main reason could be that people identified with Gaia. The Greeks also identified with nature in order to understand the ultimate reality of their universe. For example, Thales said that water is the ultimate reality by observing water everywhere, realizing that water is present in all objects, and identifying with it as a cosmological unity. In the medieval period, the view that nature is sacred and that God exists within nature was rejected. People in this time identified with nature through an instrumental attitude. Alternatively, nature was also seen as a resource for living a happy life. Thus, identification with nature involved mastery and domination of it as the representative of God. Identification can be experienced in two different senses in the modern period. In the first sense, humans identified with nature by maintaining a mind/body dualism. They identified with nature as a superior entity. However, Spinoza’s view “God is Nature and Nature is God” changed this identification into a spiritual direction, which we may, therefore, describe as a second sense of identification. Mill and Kant’s view both represented

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an indirect identification with nature. In this century, identification has received a great deal of attention. Arne Naess’s concept of identification signifies a one-to-one relationship. Such a deep identification entails that nature is a part of our body. This identification is obviously selfless. However, one may also identify with nature as a caretaker. To put it another way, we are created in the image of God and identification with nature means removing our greediness, ignorance, and shortsightedness. Nonetheless, it is not selfless. John Passmore developed this stewardship model of identification. The value of identification is also present in Asian traditions. Indian mythology identifies human beings with nature in the same way that children are identified with their mother. This identification exemplifies reverence and respect for nature. In short, this identification reminds us to “think before you act” because of Karma (action) theory, which says that we should behave well to nature or we will suffer. So, love and sacrifice are the means of identification here. The Samkhya system establishes an identification, which detaches people from misery and provides them with the right knowledge. Identification with different gunas (qualities) in prakrti (nature) helps us to realize spiritual ends. Our identification with nature according to Advaita (non-dual) Vedanta is to achieve transcendental consciousness, to discard Maya or illusion, and to realize the Absolute Self (Brahman). Gandhi’s conception of identification with non-violence or Ahimsa represents an unselfish mind. His goal of identification is in realizing the suffering of others. In Chinese traditions, identification is a way to achieve a superior position without using the creation myth, but without identification with great love or righteousness, the harmony of the soul cannot be achieved. The sage man identifies with virtuous character and becomes noble. Confucius said, “[t]o govern (cheng) is to set things right (cheng). If you begin by setting yourself right, who will dare to deviate from the right? [xii: 17]” (De Bary, Chan, & Watson 1960, 32). Similarly, in Lao Tzu’s view, only our identification with dao can tell us how to act “in accordance with nature”. In the Daodejing he said, The Dao remains in spontaneous nonaction. If rulers and kings can maintain it, They myriad beings will transform by themselves. (Kohn 2004, 20)

Identification appears in Japanese Buddhism to eliminate the apparent distinction between sentient and non-sentient beings. Identification with dharmakaya can achieve Buddhahood. Thus, we have seen that the value of identification is present in both traditions. Selfless identification as well

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as identification by preserving one’s own self has taken place in the Western and Asian traditions.

Conclusion Environmental philosophy holds that the ecological crisis is basically metaphysical and, therefore, a new self–nature metaphysical philosophy is necessary. By analyzing Western and Eastern attitudes toward nature, I have tried to point out common values. Any culture is a fountain of values but we need to recognize, nurture, and consider them in order to improve our attitudes. Nonetheless, it might possible that some values are contradictory and conflict with other cultural values. They might even be unacceptable in a scientific world. However, there are values that are common in all human societies. In addition to this, relying solely on science may not be justified. The human–nature relationship is pre-historical, although new knowledge has shaped and reshaped this relationship throughout time. Our present attitudes and behaviors, which are based on incorrect self–nature metaphysics, are mainly responsible for the ecological crisis. In my view, a promising solution to this faulty self–nature relation is to locate some core values. These values will help us to formulate the right attitude towards nature, and also to develop a harmonious coexistence with non-human elements. I believe that it may not be necessary to establish new values in our old cultural heritage but what is needed is a return to common old values. Identification, as I have discussed, exists in various forms in both Western and Eastern cultural traditions. We should recognize, nurture, and consider this core value to improve our attitude toward nature. But does our improved attitude require self-sacrifice? If so, how much? Minimum? Maximum? Surely, these are questions for further research.

References Attfield, Robin. 1983. “Western Traditions and Environmental Ethics”. In Environmental Philosophy: A Collection of Readings, eds. Robert Elliot and Arran Gare, 201–230. University Park: The Pennsylvania State University Press. Banerjee, Akshaya Kumar. 1967. Discourses On Hindu Spiritual Culture. New Delhi: S.Chand & Co. Banerjee, Brojendra Nath. 1979. Hindu Culture Custom and Ceremony. Delhi: Agam Kala Prakashan.

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Callicott, J. Baird. 1987. “Conceptual Resources for Environmental Ethics in Asian Traditions of Thought: A Propaedeutic.” Philosophy East and West 37(2): 115–130. —. 1994. Earth’s Insights: A Survey of Ecological ethics From the Mediterranean Basin to the Australian Outback. California: University of California Press. Des Jardins, Joseph. E. 1997. Environmental Ethics: An Introduction to Environmental Philosophy. 2nd ed. Belmont, CA: Wadsworth Publishing Company. De Bary, Wm. Theodore, Wing-tsit Chan, and Burton Watson, eds. 1960. Sources of Chinese Tradition, Vol. 1. New York: Columbia University Press. Fang, Thome H. 1973. “A Philosophical Glimpse of Man and Nature in Chinese Culture.” Journal of Chinese Philosophy 1(1) : 3–26. “Genesis”. 2008. Environmental Ethics: Readings in Theory and Application, eds. Louis P. Pojman, Paul Pojman, 12–14. Belmont, CA: Thomson Wadsworth. Gosling, David L. 2001. Religion and Ecology in India and Southeast Asia . London: Routledge. Hargrove, Eugene C. 1989. Forward to Nature in Asian Traditions of Thought: Essays in Environmental Philosophy, eds. J. Baird Callicott and Roger T. Ames, xiii-xxi. Albany: State University of New York Press. Houle, K.L.F.1997. “Spinoza and Ecology.” Environmental Ethics 19(4): 417–432. Hughes, J. Donald. 2009. “Environmental Philosophy: Ancient Philosophy”. In Encyclopedia of Environmental Ethics and Philosophy, eds. J. Baird Callicott and Robert Frodeman, 355–359. MI: Macmillan Reference USA. Kohn, Livia. 2004. Daoism and Chinese Culture. Cambridge, Massachusetts: Three Pines Press. Lamb, Ramdas.“Sacred”. 2008. In Studying Hinduism: Key Concepts and Methods, eds. Sushil Mittal and Gene Thursby, 339–353. New York: Routledge. Mill, John Stuart. “Nature.” 2008. Environmental Ethics: Readings in Theory and Application, eds. Louis P. Pojman and Paul Pojman, 123– 131. Belmont, CA: Thomson Wadsworth. Miller, James. 2003. Daoism: A Short Introduction. Oxford: One world Publications.

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Mohanty, Jitendra Nath. 1992. Reason and Tradition in Indian Thought: An Essay On the Nature of Indian Philosophical Thinking . New York: Oxford University Press. Naess, Arne. 1995. “The Deep Ecology ‘Eight Points’ Revisited.” Deep Ecology for the Twenty-First Century, edited by George Sessions, 213–221. Boston: Shambhala. —. (1986a) 1995. “Self-realization: An Ecological Approach to Being in the World.” In Deep Ecology for the Twenty-First Century, edited by George Sessions, 225–239. Boston: Shambhala Publications. —. (2008). “Ecosophy T: Deep Versus Shallow Ecology.” Environmental Ethics: Readings in Theory and Application, eds. Louis P. Pojman and Paul Pojman, 219–228. CA: Thomson Wadsworth. Nelson, Lance E. 2008. “Ecology.” In Studying Hinduism: Key Concepts and Methods, eds. Sushil Mittal and Gene Thursby, 97–111. New York: Routledge. Neville, Robert Cummings. 2008. Ritual and Deference: Extending Chinese Philosophy in a Comparative Context. Albany: State University of New York Press. Passmore, John. 1980. Man’s Responsibility for Nature: Ethical Problems and Western Traditions. London: Duckworth. Pojman, Louis P., and Paul Pojman, eds. 2008. Environmental Ethics: Readings in Theory and Application. Belmont, CA: Thomson Wadsworth. Pratt, Vernon. 2008. “Environmental Philosophy: Early Modern Philosophy.” In Encyclopedia of Environmental Ethics and Philosophy, eds. J. Baird Callicott and Robert Frodeman, 362–367. MI: Macmillan Reference USA. Rolston III, Holmes. 1987. “Can the East Help the West to Value Nature?.” Philosophy East and West 37(2):172–190. Shah, Giriraj. 1982. Indian Heritage. New Delhi: Abhinav Publications. Ten, C. L. 1991. “Mill’s Defence of Liberty”. In J.S. Mill On Liberty in Focus, eds. John Gray and G.W. Smith, 212–238. New York: Routledge. Weiming, Tu. 1998. “The Continuity of Being: Chinese Vision of Nature.” In Confucianism and Ecology: The Interrelation of Heaven, Earth, and Humans, eds. Mary Evelyn Tucker and Jogn Berthrong, 105– 121.Cambridge, Massachusetts: Harvard University Press. White, Lynn. 2008. “The Historical Roots of Our Ecological Crisis.” In Environmental Ethics: Readings in Theory and Application, eds. Louis P. Pojman and Paul Pojman, 14–21. Belmont, CA: Thomson Wadsworth.

CHAPTER FOUR COMPANIONSHIP WITH NATURE: ASIAN PERSPECTIVES1

What is the meaning of “nature” in Asian cultures? How do Asian people perceive their relationship to nature? What types of environmental ethics do Asian cultures exhibit? This chapter considers these questions in two major Asian traditions: Indian and Chinese. It points out that the concept of nature has played a crucial role in Asian people’s lifestyles, beliefs, and ethical thinking. To them, nature is seen not merely as a means of livelihood, but rather the foundation of harmony, spirituality, and inspiration. This chapter examines whether Asian environmental ethics is anthropocentric or non-anthropocentric. It concludes that, despite some limitations, Asian traditions nourish an alternative environmental ethics, which is compatible with nature, and should be understood as a valuable resource for environmental education.

Introduction Environmental ethics is defined as a branch of ethics that deals with the human–nature relationship from a normative perspective. In other words, environmental ethics provides us some guidelines about how we should relate with nature or how we should behave with nature. Valuing nature is one of the major issues in environmental ethics. Indeed, “how should we value nature?” is the most important question in environmental ethics. When we value nature from the perspective of human beings, i.e. everything in nature is valuable only in relation to the benefit it brings to human beings, this valuation is known as anthropocentric or humancentric environmental ethics. In contrast, when we value nature from the perspective of other natural elements, i.e. everything in nature is equally 1

Previously published as “Companionship with Nature in Asian Traditions: A Resource for Environmental Education” AGATHOS: An International Review of the Humanities and Social Sciences 5, no. 2 (2014): 124–139.

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valuable irrespective of the benefit to human beings, this valuation is known as non-anthropocentric environmental ethics. All cultural traditions reflect their own human–nature relationship and may broadly be categorized as either anthropocentric or non-anthropocentric. Recent environmental philosophers have pointed out that our present attitude toward nature is not appropriate since it endorses a human-centric environmental ethics. Without correcting this dominating attitude towards nature, a harmonious coexistence with non-human natural elements would be challenging. Therefore, they suggest recognizing the “ecological wisdom” found in different cultural traditions. Two famous comparative environmental philosophers, J. Baird Callicott and Roger T. Ames, have already addressed the possibility that Asian cultural traditions may provide important “conceptual resources” for an adequate environmental ethics. However, little attention has been paid to articulating these nonanthropocentric conceptual resources so far. In this chapter, I will discuss the human–nature relationship in Asian cultural traditions. As Asian cultures are diverse and heterogeneous, I focus on two major cultural traditions: Indian and Chinese. Then, I will examine whether Asian cultural traditions subscribe to anthropocentrism or non-anthropocentrism. I argue that Asian traditions reflect a special kind of environmental ethics, which is neither anthropocentric nor nonanthropocentric. This special kind of environmental ethics is most likely place-based and kin-centric. Finally, I evaluate the significance of Asian environmental ethics as an alternative approach in environmental ethical thinking.

Culture, Tradition, and the Human–Nature Relationship Traditions are the customs, practices, rituals, attitudes to life and nature, as well as perceptions of life on this Earth and beyond, that have been followed by mankind for centuries. People generally do not want to break traditions since this can have a negative impact and destroy the existing harmony. Instead of losing traditions, mankind preserves them for generations. Whether this is always correct depends on the available knowledge in the fields of science and technology, literature, arts, philosophy, and value axioms. The most natural way for any tradition to survive is through culture. However, the relationship between nature, culture, and human beings, is not simple. Perhaps, this relationship is much deeper because the culture of cultivation has been seen as the root cause of human–nature separation. Human beings started their dominion over nature in agriculture and

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Toadvine discusses this in a very interesting way: cultivation is the first and essential step toward civilization, the fundamental human manipulation of nature that makes all later technological and social development possible...Agriculture is at the edge—the margin, the barbarian frontier—of culture. (2007, 209) .

Toadvine’s comments clearly show that culture and human civilization have manipulated nature in a most dangerous way. Another important issue implied in Toadvine’s statement is that the culture of cultivation establishes a “boundary” line or a “dividing” line between human and nature. Oelschlaeger calls it “the Great Divide”. He writes, Clearly, boundaries exist. The Great Divide is a deeply entrenched reality. But why? I believe it is possible to seek the origin of the Great Divide in the proclivity of humankind to separate itself from nature. (Oelschlaeger 2007, 4–5)

There is probably no way to ignore the fact that we experience many boundaries in our lives, a fact that is nicely pointed out by Brown, who imagines it as “the shell of an egg, our own skin, or the ecotone where the forest ends and the prairie begins” (Brown 2007, ix). Nonetheless, there are some other boundaries created by human beings themselves such as the technological boundary. Technologies are vital components of our present culture. Technology has separated us from nature because we are only able to use it on other fellow creatures, such as animals and plants. We very often use words like “high tech society”; “technologically advanced societies”; “skilled technology operator”, and “computer technician” to delineate the boundaries. Interestingly, scholars are not sure whether boundaries are realities or mere fictions. Callicott asks: Or are all such putative boundaries between people and nature only obsolete theological and philosophical fictions?—in which case man is a part of nature. (2007, 21)

All theological endeavors may not encourage maintaining boundaries. However, there is some usefulness in maintaining boundaries. For example, conservationists need to know what they should conserve for a harmonious environment. Meanwhile, there are arguments for and against human–nature boundaries. Each cultural tradition exposes a distinct type of human–nature relationship. This is because cultural traditions celebrate and emphasize values that are unique. A key environmental philosopher, Hargrove, writes,

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we can say that the simple fact that seventeenth-and eighteenth-century Europeans knew that people in other parts of the world aesthetically enjoyed nature paved the way for similar values to emerge in Europe. (1989, xviii–xix)

Obviously, Hargrove’s remark does not mean that Europeans lacked an aesthetic sense of nature prior to the seventeenth century. But rather, at that time they started to value nature aesthetically for more than its mere economic value.

Human–Nature Relationships in Asian Cultural Traditions In this section, we will concentrate on some interesting questions. Firstly, what is the meaning of “nature” in Asian cultures? Secondly, what values do Asian cultures reflect? Finally, how do Asian people perceive their relationship to nature? According to Callicott and Ames, “[o]ne clear way that the East can help the West to understand and value nature is...the nature of nature and who we human beings are in relation to it” (1989, 16). Callicott and Ames have rightly hinted that the underlying worldview of any tradition is vital to grasping its teachings and knowledge, which might be helpful for other traditions. In order to understand the Asian worldview, some key ideas need to be discussed. The first and most important among them is the concept of God. Unlike Western traditions, God and nature can be identified in some Asian traditions. God is not perceived as He who created human beings in His “own image” and ordered them to “replenish” and “subdue” nature for their own benefit. Rather, God is the Ultimate Reality who is not separate from nature. Both the other natural elements and human beings all were made by the same primal elements. One who wants to get salvation should maintain a respectful relationship with other fellow members in nature, instead of exploiting them. Indeed, all natural elements are brothers and sisters of human beings and nature is just an extended family. Other cultural traditions in Asia, which do not share this view, hold that human beings must continue to find a balance with nature in order to attain individual, social, and political harmony, even though there they believe that there is no God, or God and nature are not identified. This human–nature relationship can be seen as distinct and unfit for the rationalistic enterprise of the West where philosophy and religion are separate. The reason for the distinctiveness is simple,

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Because philosophy is seen to be relevant to overcoming suffering and improving the quality of human life, there are no rigid distinctions between philosophy and religion in Asian thought. (Koller and Koller 1998, xvii)

This unique blend of nature, religion, life, and philosophy provides an insightful worldview, which may not be purely rational, argumentative, heavily theoretical, and logically sound in the sense of Western traditions. However, Asian modes of thought reflect a different image of human–nature relation (Talukder 2010, 86). While there are considerable differences among Asian cultural traditions, there are also commonalities. The two major traditions in Asia, Indian and Chinese traditions, characterize nature as one single family. Bearing in mind all of these aspects, we will explore Indian and Chinese cultural traditions in detail. Nature as extended family, and how to achieve harmony within this family will be our focus.

I. Indian Culture Deutsch writes, Nature can become value-laden, it seems to me, only from a spiritual perspective which sees nature either as a manifestation of spiritual being or, Advaitic-wise, as an appearance grounded in a spiritual reality. (1989, 264)

As Deutsch observes, nature means spirituality in Indian culture. Everything in nature, including animals, trees, plants, air, rivers, and water, is sacred. The distinction between the material world and the living world hardly appears in these traditions. Chattopadhyaya states that, In the different forms of Indian naturalism, both orthodox and heterodox, there is an intimate relation between the living world, the mental world and the natural world. All forms of life and consciousness are shaped by nature. (2003, 158)

Consciousness cannot only belong to living things; it can be discovered in each and every element in nature, since nature itself is God’s body according to Indian traditions. One notable example of sacredness in nature is the river Ganga (or Ganges). Coward writes, Rivers too are seen to be sacred, especially the Ganges. Hindu mythology describes the Ganges as a great goddess that originates in heaven and flows down to earth giving both food and purification. (2003, 412)

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In Indian culture, the purification of devotees can be obtained by performing certain rituals on the river Ganga. Arati is the most remarkable of these, Devotees perform arati by waving an oil lamp in front of Ganga while standing on the riverbank. The sounds of bells, gongs, drums, and conch shells play a prominent role in the ritual. (Allay 1988, 301)

Note that in the process of purifying, the devotees need to be identified with the river Ganga, and realize their relationship with nature through worship. Numerous rituals are performed in Indian cultural ceremonies. However, most of the ceremonies are inherently related to the reverence for nature. Two natural elements are common in almost all the religio-cultural ceremonies in India: Durbha grass and the Tulsi plant. Banerjee writes, By offering grass as a sacrifice on that day immortality and blessedness for ten ancestors may be secured; and another result is that one’s posterity increases and multiplies like the “durbha” grass itself, which is one of the most prolific members of the vegetation kingdom. (1979, 146)

On the Tulsi plant he comments, The Tulsi plant is found in every Hindu home...Hindu Brahmins consider it to be the wife of Lord Vishnu, and revere it accordingly. ‘Nothing on earth can equal the virtues of Tulsi’; they say. (Banerjee 1979, 146)

Banerjee’s comments indicate that Indian traditions invoke one single message to the whole world, as clearly stated in Koller’s words, the Indian tradition, from Vedic times to the present, views human beings as an integral part of the grand unity of organic existence that extends from the highest gods all the way to the lowliest plant life. (1999, 279)

So, the emphasis is on the “cosmic unity” between all creatures, whether living or nonliving. The Western dualism, mind and body, or living and nonliving, disappears in the Indian worldview. Indian perception of the human–nature relationship is thus simple and perfectly summarized by Dwivedi, every entity and living organism is part of one large extended family system (kutumba) presided over by the eternal Mother Earth, Devi Vasundhara. The development of humanity from creation until now has

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Chapter Four taken place nowhere else but on Earth. Our relationship with Earth, from birth to death, is like that of children and their mother. (Dwivedi 2000, 9)

Therefore, the relationship between humans and nature in Indian cultural traditions is that humans are children and nature is their Mother. In other words, human beings are supposed to maintain a “kinship” relationship with nature. This view is also manifested in several empirical studies. For example, Good says, the empirical evidence for Indian and Sri Lankan Tamils, at any rate, is that most people do not habitually speak about kinship in term of blood, let alone ‘substance’, and may even, as I found, deny its relevance when the question is explicitly put to them. (Good 2000, 326)

Sometimes, indigenous people in rural parts of India establish a kinship relation with natural entities in order to get rid of their sufferings. A woman from the city of Madurai, Southern India, illustrates the wedding ceremony between a young man and a tree in this way: So, we arrange the marriage of that person to a tree, and then we pray that the tree will take on the burdens of that human being and therefore release that person from the suffering. Then the human person is free to marry someone else. Usually it works out that way. (Nagarajan 2000, 457)

So, Indian cultural traditions conceive the human–nature relationship in the same way such that humans relate with their family members. In this worldview, nature is a joint family which is undivided and interrelated. It is worth noting that the Indian concept of a joint family is much broader than the Western one. Banerjee when commenting on this declares that, A joint family means that all the members of the family live together in the same house. The family does not consist of parents and children only. Presumably there is no limit to its size. (1979, 144)

II. Chinese Culture The Chinese culture inherited a kind of cosmology where there is no “Creator” or “God”. Nature itself is not regarded as the Creator. Rather, the Chinese worldview holds that nature is continuous, dynamic, and selfgenerating. All physical elements in nature are denoted “Heaven” and nature is seen as an interaction of Heaven and Earth. All living and nonliving elements in nature are created by an organic process. According to Julia Tao,

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the Chinese have a conception of nature as an organic process, a spontaneously self-generating life force. This life force possesses continuity, wholeness and dynamism. Nature is life-giving, it gives rise to the life, flourishing and development of the myriad creatures. (Tao 2005, 71)

Nature is ever changing, dynamic, and spontaneous, and beyond the control of human beings. Human beings can only interrupt it if they want to control nature. Nature was perfectly balanced when it was first evolved. In order to be wise, or a sage, human beings do not need to worship nature. All they need to do is to cultivate their inner virtues and benevolence. Any act that interrupts natural balance causes the destruction of harmony. So, human beings must practice moral cultivation. Confucius or Kongzi, the most influential thinker in Chinese traditions, recommended moral cultivation to create essential harmony in personal, family, social, and political lives. Cecilia Wee’s insightful comments are worth noting here: Confucius emphasized the moral cultivation of each human being. Such moral cultivation was to be achieved through the practice of rites, and through recognition of the appropriate relations that obtain between oneself and others in society. (Wee 2009, 361)

In fact, moral cultivation makes one the true human being in the Confucian sense. This is reflected in Tucker’s words, “[t]hus to become fully human one must nurture (yang) and preserve (ts’un), namely cultivate, the heavenly principle of one’s mind and heart” (Tucker 2001, 136). In the Doctrine of the Mean (Chung-Yung), the great Confucian scholar Mencius writes, Equilibrium is the great foundation of the world, and harmony its universal path. When equilibrium and harmony are realized to the highest degree, heaven and earth will attain their proper order and all things will flourish. (quoted in Tucker 2001, 136)

Before answering what the best way of achieving harmony is, we should understand the human being. It is important to mention that human beings are not merely rational, social, and political beings in Confucian traditions. Weiming writes, Learning to be human in the Confucian spirit is to engage oneself in a ceaseless, unending process of creative self-transformation...This involves four inseparable dimensions—self, community, nature, and the transcendent. (Weiming 1998, 13–14)

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As Weiming points out, a human being is a transformed being who finds themselves inseparable from their natural community. In another paper, he has illustrated the Confucian vision of human beings more clearly, Actually, we are an integral part of this function; we are ourselves the result of this moving power of Ch’i. Like mountains and rivers, we are legitimate beings in this great transformation. (Weiming 1998, 113)

This cosmic unity is also predictable in the Daoist great book, the Tao Te Ching, “[t]he nameless [wu-ming] is the origin of heaven and earth. The named [yu-ming] is the mother of the Ten Thousand Things [the phenomenal world]” (Girardot 1983, 51). Soon after it says, “[a]ll the Ten Thousand Things are that which were created from the Great Unity; And are transformed by yin and yang” (Girardot 1983, 55). Of course, whether there are ten thousand things in the phenomenal world might be arguable, but the sense is simply that there is a Great Unity and all natural elements are interrelated. The word “mother” obviously indicates a family relationship among them. The Neo-Confucian founding father Zhang Zai summarizes the Confucian vision of nature in some classic words, Heaven is my father and earth is my mother, and even such a small creature as I find an intimate place in their midst. Therefore that which extends throughout the universe...I consider as my nature. (Taylor 1998, 48)

How should one behave with his or her family members? What values are vital in this relationship? It seems to me that one ancient myth from Chinese traditions would be enough to answer these questions. The myth is about “filial piety”, which was first introduced by Confucian thinker Mencius. It is still a basic text for elementary students in China and some other neighboring countries. The central character in the myth is Hibiscus (Shun), a filial son. Although his stepmother and her son wanted to kill Hibiscus through his father (Gu Sou) who ordered him to perform dangerous acts, the life of Hibiscus was saved. The father is characterized here as a metaphorically, but not physically, Blind Man. The word “Blind” signifies his moral blindness since he knowingly wanted to kill his own son to satisfy his wife’s greed for Hibiscus’s property. Despite his life being under threat three times, Hibiscus was absolutely obedient to his father. The moral of the myth is filial duty and it ends with some novel words: “Hibiscus once again served under the Blind Man and he loved his

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younger brother Elephant, and looked after him devotedly” (Birrell 2000, 40). This myth implies that human beings have a duty to cultivate appropriate relationships with their parents, brothers, and sisters. The basis of these relationships is respectful behavior, sympathy, and love for others. Harmony in the family appears as the key concept in Confucian traditions. Slote notices the remarkable psychocultural impact of the Confucian family and says, The result is that the burden of proper conduct weighs heavily upon everyone. If one acts improperly, there is collective loss of face: the child because his or her misconduct is not only personal matter, but reflects upon all. (Slote 1998, 44)

The above analysis implies that the way of achieving harmony is to create an emotional bond to the natural elements. However, it may not mean “following nature”. It simply means humans should act as they act with their family members.

Is Asian Environmental Ethics Anthropocentric or Non-Anthropocentric? Although environmental ethics emerged as a distinct branch of ethical study in the 1970s, more and more sub-divisions have developed. Philosophers have already addressed two sharp distinctions in environmental ethical theories: anthropocentric and non-anthropocentric. Prior to examining which kind of environmental ethics Asian traditions have defended, we must specify what exactly is meant by Asian environmental ethics. Asian environmental ethics refers to those ethical principles that Asian people generally follow in order to relate with nature. Of course, being the largest continent on Earth, Asia is diverse, and as such, a single type of ethics may not be dominant. But, the two cultural traditions that we have discussed are influential and may represent a considerable view of Asian environmental ethics. People’s perceptions of the human–nature relationship are not so different in these two cultures. Perhaps, they follow a comparable kind of environmental ethics. This environmental ethics is similar to some other parts of Asia (e.g. Thailand, Korea, Taiwan, and Nepal) but distinct from traditional subdivisions of anthropocentric and non-anthropocentric ethics in the West, as I will describe below.

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Anthropocentric environmental ethics holds that humans inhabit a special position at the very top of the natural order, just shy of divinity, is the notion of a firm ontological divide between human and nonhuman nature (metaphysical dualism). This divide is expressed by such familiar dualism as culture/nature and mind/body or soul/body. (Keller 2010, 59)

There are different types of anthropocentrism, ontological and epistemological, however, the main idea in anthropocentrism is the ontological division between human beings and the rest of nature. A clear “boundary”, or the “Great Divide”, can be seen in anthropocentric environmental ethics. The ethical principles applicable to human beings should not be applied to other natural elements, according to this view. A clearer version of anthropocentrism from the ontological point of view is presented in the Encyclopedia of Environmental Ethics and Philosophy: “As an ontological view, anthropocentrism refers to the position...in which humans are seen as the center of the universe or the ends of creation” (Minteer 2009, 58). Therefore, non-anthropocentric environmental ethics is the opposite of anthropocentrism, (i.e. it considers nature “as a whole”). Non-anthropocentric environmental ethics does not make any firm ontological division between human beings and the rest of the natural world. Most importantly, nonanthropocentric environmental ethics tends to value nature without providing any “special” status to human beings. If this distinction is correct, then immediately one could say that Asian environmental ethics is anthropocentric. The most vivid example for this claim is Confucian traditions, which are all about the moral cultivation of human beings. How human beings can be a morally distinct species from other species, and how they can lead a harmonious life are the basic questions for Confucius. Indeed, he wants to remove chaos in human societies in order to establish peace and harmony. However, this line of thinking is surely misleading and inconsistent. Confucius scholars believe that the Earth was balanced at the beginning and that human beings must maintain the natural harmony through the balance of li and chi. Once the harmony of nature is destroyed, all institutions will collapse. The deviation of morality is seen as a deviation of balanced nature. Moreover, there is no ontological division between human beings and nature. Those who fail to achieve balance in nature will fail to achieve it in their personal, social, and political lives. In the Analects of Confucius Yu Tzu says,

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Among the functions of propriety (li) the most valuable is that it establishes harmony...It is the guiding principle of all things great and small. If things go amiss, and you, understanding harmony, try to achieve it without regulating it by the rules of propriety, they will still go amiss. (Chan 1973, 21)

So, neither are human beings allowed to regulate nature nor do they have any higher type of propriety (li) than the other natural elements. Instead of continuity in nature, the Confucian traditions maintain an intimate kinship relationship with other fellow members and this needs to be considered. Similarly, others could evidently say that Indian cultures exhibit a nonanthropocentric environmental ethics since everything in nature is included in the Supreme Atman and so all types of divisions disappear. However, the Supreme Atman, or Self, appears as a cosmic hierarchical person since natural elements are seen as different parts of His body and, thus, anthropocentrism cannot be fully avoided in the Indian traditions. But this line of thinking is inappropriate too because, ultimately, Atman, nature, and human beings are identified with single cosmic unity where the kinship relation among them is predominant. Therefore, this analysis leads us to consider that Asian environmental ethics is neither anthropocentric nor non-anthropocentric. We may call it place-based and “kin-centric” because kinship relations not only imply equality or ontological continuity, but they also ensure an emotional bond with place that is in addition to mutual respect. This emotional bond must not be overlooked.

Companionship and Environmental Education Environmental education is a necessity for contemporary cosmopolitan society. An environmentally sustainable neighborhood can bring greater benefits for pursuit of knowledge and creation. Sustainable development is hardly absent in our curriculums, which means that sustainable development is a dominating trend in environmental education. However, a tension has become central to environmental educationists. The tension is that how we can reduce theoretical disagreement between anthropocentrism and nonanthropocentrism. Once reduced, this could then provide a basis for an appropriate worldview to be conceived. In my view, the first thing needed in order to reduce this tension is a metaphysical paradigm shift. Bonnett has suggested this paradigm shift just as a frame of mind,

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Chapter Four Thus, in educational terms, sensing nature as the self-arising and understanding our relationship with it will require a broad and rich curriculum in which a receptive-responsive rather than rational-assertive thinking holds sway. (2004, 138)

In a similar manner, Gottlieb argues for a different path, Many of us in higher education are seeking a different path. We believe that it is possible to connect our bodies and our minds, our intellects and our emotions, our analytical intelligence and our spiritual hopes, a theoretical account of the crisis with an experience of its meaning. (2006, 214–215)

Both of these comments imply that we need a deeper metaphysics in order to overcome the global ecological crisis. This metaphysics is fundamentally different from the established one—where human beings are separate from nature. A sense of companionship with nature demonstrates a higher mental capacity to view nature differently and in a more intimate, emotional, and place-based way. Asian cultural traditions are imbued with thousands-year-old eco-wisdom and a rich history of companionship with nature. The best way to transfer this attitude to other parts of the Earth is through education. However, education has to be realistic rather than idealistic, or merely spiritual. Curry notes, The ideal situation, of course—actually, the most realistic one, properly speaking—would be for education for all and at all levels to cultivate and honour ecological intelligence. (2011, 171)

I admit that there might be a few drawbacks when using Asian environmental wisdom in education. In particular, this might be incompatible with Western attitudes. Contemporary environmental philosopher, Holmes Rolston III, summarizes that, “[t]he Eastern views offered are typically both old and religious. The Western problem is recent and (para) scientific” (Rolston III 1987, 172). His remarks highlight two points: firstly, Asian environmental values are old enough and cannot be incorporated into scientific culture; secondly, Asian environmental principles are based on sacredness in nature, which is a completely religious idea and, as such, scientific culture cannot accept it. However, both of these claims are only partially valid. The first position implies that old values are supposed to be abandoned and scientific values should be promoted. Nonetheless, we always do not follow this view consistently. For example, the concept of neighborhood is an old value but, even today, we consider it to be valuable for a

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harmonious coexistence in the East and in the West. Intimacy is another value, which we practice not just in families, but also in at offices, in groups, and sometimes in the global context. Asian environmental ethics demonstrates a more intimate relationship with natural entities. As the circle of morality is currently expanding, and as it seems consistent rather than contrary to scientific culture, the first claim is inappropriate. The problem is not that Asian environmental values are old but, rather, they have not yet been included in the mainstream ethics. The latter claim holds that sacredness is inseparable from religion or, in other words, religion and sacredness are identified. This is not an appropriate view as well. The reason is that sacredness need not necessarily be a religious concept. Many nonreligious scientists believe in sacred nature (Dawkins 2004, 136). This identification could be seen as similar to an identification of community and human beings. Most of us think that when we talk about community we are talking about human communities. However, community may be applicable to apes, fishes, birds, and, indeed, to all living species. Perhaps, the advancement of science and technology has made us aware to consider this concept beyond the circle of humanity. For instance, often we use the term “biotic community” and “ecological community” which demonstrates this expanded position.

Conclusion The global environmental crisis is not limited to any particular traditions or culture. There is probably no way to overcome the environmental threat, until we value the environment from a broader perspective. This chapter showed how cultural traditions influence the human–nature relationship. It analyzed two major Asian cultural traditions: Indian and Chinese. Although there are considerable differences between them, this chapter argues that both cultural traditions reflect a companionship with nature, which is neither anthropocentric nor non-anthropocentric. This kin-centric environmental ethics maintains an emotional bond with place and respects nature. Nonetheless, more attempts are needed to overcome some of its drawbacks. Then, it could be a strong candidate for a comprehensive environmental ethics. Companionship with nature therefore should be seen as a valuable resource for environmental education.

References Alley, Kelly D. 1988. “Idioms of Degeneracy: Assessing Gangas Purity and Pollution”. In Purifying the Earthly Body of God: Religion and

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Ecology in Hindu India, edited by L.E. Nelson, 297-330. Albany: State University of New York Press. Banerjee, Brojendra Nath. 1979. Hindu Culture Custom and Ceremony. Delhi: Agam Kala Prakashan. Birrell, Anne. 2000. Chinese Myths. Austin: University of Texas Press. Bonnett, Michael. 2004. Retrieving Nature: Education for a PostHumanist Age. Oxford: Blackwell Publishing Ltd. Brown, Charles S. 2007. “An Introduction to the Problem of Boundaries in Ecological Theory and Practice.” In Nature’s Edge: Boundary Explanations in Ecological Theory and Practice, eds. Charles S. Brown and Ted Toadvine, ix-xvi. Albany: State University of New York Press. Callicott, J. Baird, and Roger T. Ames. 1989. “Introduction: The Asian Traditions as Conceptual Resource for Environmental Philosophy.” In Nature in Asian Traditions of Thought: Essays in Environmental Philosophy, eds. J. Baird Callicott and Roger T. Ames,1–21. Albany: State University of New York Press. Callicott, J. Baird. 2007. “Lamarck Redux: Temporal Scale as the Key to the Boundary Between the Human and Natural Worlds.” In Nature’s Edge: Boundary Explanations in Ecological Theory and Practice, eds. Charles S. Brown and Ted Toadvine, 19–39. Albany: State University of New York Press. Chan, Wing-Tsit (trans. and comp.). 1973. A Source Book in Chinese Philosophy. Princeton: Princeton University Press. Chattopadhyaya, D.P. 2003. “Indian Perspectives on Naturalism.” In Nature Across Cultures: View of Nature and the Environment in Nonwestern Cultures, edited by Helaine Selin, 147–159. Dordrecht: Kluwer Academic Publishers. Coward, Harold. 2003. “Hindu Views of Nature and the Environment.” In Nature Across Cultures: View of Nature and the Environment in Nonwestern Cultures, edited by Helaine Selin, 411–419. Dordrecht: Kluwer Academic Publishers. Curry, Patrick. 2011. Ecological Ethics: An Introduction. Cambridge: Polity Press. Dawkins, Richard. 2004. “The Sacred and the Scientist.” In Is Nothing Sacred?, edited by Ben Rogers, 135–137. London: Routledge. Deutsch, Eliot. 1989. “A Metaphysical Grounding for Natural Reverence: East-West.” In Nature in Asian Traditions of Thought: Essays in Environmental Philosophy, eds. J. Baird Callicott, and Roger T. Ames, 259–265. Albany: State University of New York Press.

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Dwivedi, O.P. 2000. “Dharmic Ecology.” In Hinduism and Ecology: The Intersection of Earth, Sky, and Water, edited by Christopher Key Chapple and Mary Evelyn Tucker, 3–22. New Delhi: Oxford University Press. Girardot, N.J. 1983. Myth and Meaning in Early Taoism: The Theme of Chaos (hun-tun). California: University of California Press. Good, Anthony. 2000. “Power and Fertility: Divine Kinship in South India.” In Culture, Creation, and Procreation: Concepts of Kinship in South Asian Perspective, eds. Monika Boeck and Aparna Rao, 323– 333. New York: Berghahn Books. Gottlieb, Roger S. 2006. “Earth 101.” In Teaching Environmental Ethics, edited by Clare Palmer, 213–227. Leiden: Brill Academic Publishers. Hargrove, Eugene C. 1989. “Foreword.” In Nature in Asian Traditions of Thought: Essays in Environmental Philosophy, eds. J. Baird Callicott and Roger T. Ames, xiii-xxi. Albany: State University of New York Press. Keller, David R. ed. 2010. Environmental Ethics: The Big questions. West Sussex: John Wiley & Sons Ltd. Koller, J.M. and P.J. Koller. 1998. Asian Philosophies. New Jersey: Prentice Hall, Upper Saddle River. Koller, John M. 1999. “Humankind and Nature in Indian Philosophy.” In A Companion to World Philosophies, edited by Eliot Deutsch and Ron Bontekoe, 279–289. Massachusetts: Blackwell Publishers Ltd. Minteer, Ben A. 2009. “Anthropocentrism.” In Encyclopedia of Environmental Ethics and Philosophy, eds. J. Baird Callicott and Robert Frodeman, 58–62. Detroit: Macmillan Reference USA. Nagarajan, Vijaya. 2000. “Rituals of Embedded Ecologies: Drawing Kolams, Marrying Trees, and Generating Auspiciousness.” In Hinduism and Ecology: The Intersection of Earth, Sky, and Water, eds. Christopher Key Chapple and Mary Evelyn Tucker, 455–468. New Delhi: Oxford University Press. Oelschlaeger, Max. 2007. “Boundaries and Darwin: Bridging the Great Divide.” In Nature’s Edge: Boundary Explanations in Ecological Theory and Practice, eds. Charles S. Brown and Ted Toadvine, 3–17. Albany: State University of New York Press. Rolston, III, Holmes. 1987. “Can the East Help the West to Value Nature?.” Philosophy East and West 37(2): 172–190. Slote, Walter H. 1998. “Psychocultural Dynamics within the Confucian Family.” In Confucianism and the Family, eds. Walter H. Slote and George A. De Vos, 37–52. Albany: State University of New York Press.

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CHAPTER FIVE INTIMACY, ADMIRABILITY, AND VIRTUE: A CRITICAL ANALYSIS OF SLOTE’S VIEW1

Virtues, according to Michael Slote, are our inner traits or dispositions. Slote defends “balanced caring” as an admirable character trait. He believes that caring more for intimates than others is admirable. A virtuous person attains balanced caring between intimates and others. His account of virtue conceived “balanced caring” as “fundamentally admirable” and it is the basic virtue. All other virtues, such as honesty, kindness, generosity, truthfulness, and so forth, are “derivatively admirable”. This chapter examines Slote’s view and argues that Slote should explore the opposite situation, because his idea of “balanced caring” and “admirability” is vague and misleading. In contrast to his ideas, a reverse formulation that focuses on caring for others more than for intimates is seen as preferable.

Introduction Recent virtue ethicists have devoted themselves to exploring plausible accounts of virtue that are not only morally significant but also actionguiding. Michael Slote, one of the leading figures in contemporary virtue ethics, has developed an agent-based virtue ethics. According to Slote, “balanced caring” is “fundamentally admirable” and it is the only virtue. He distinguishes between two classes of people in this world: one class comprises of intimates, such as our parents, children, friends, spouses, and loved ones; and the other class comprises of all other people, generally referred to as strangers. Slote defends caring for intimates as being something admirable. A caring person would thus accommodate a balanced caring between these two classes. However, his idea of “balanced caring” and “admirability” is very misleading. In contrast to Slote, I 1

Previously published as “Intimacy, Admirability and Virtue: An Examination of Michael Slote’s View” HUMAN AFFAIRS: A Post-Disciplinary Journal for Humanities and Social Sciences 20, no.1 (2010): 43–51.

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believe that the notion of “balance” and the classification of human beings are inappropriate to formulating a credible virtue ethical account. Therefore, my goal is to examine the plausibility of the Slotean account of virtue, and to show that a reverse formulation of the Slotean account is plausible. Some major objections to Slote’s virtue ethics have already been provided by David Copp and David Sobel in their article “Morality and Virtue: An Assessment of Some Recent Work in Virtue Ethics”. Copp and Sobel rightly suggest that caring for strangers is “much more admirable” than caring for intimates (2004, 520). I will take up Copp and Sobel’s suggestion in outlining a reverse formulation of Slote’s view. In section one, I will present some vital features of the Slotean account of virtue. Then in sections two and three respectively, I will argue that Slote should consider the opposite, and that a reverse formulation of the Slotean account of virtue is plausible. Finally, the issue of supererogation will be addressed in section four.

Slote’s Account of Virtue Slote’s virtue ethics is a great turning point in the history of virtue thinking because it develops a non-Aristotelian approach to virtue ethics and reshapes the feminist idea of care ethics. In his Nicomachean Ethics, Aristotle was more concerned about the character of the individuals rather than their motives, or actions. Aristotle believed that the virtuous person would always perform virtuous acts through her wisdom. Slote calls this view “agent-focused”. In contrast, an “agent-based” virtue ethics would consider the agent’s actions or motives of the virtuous act. It attempts to deal with aretaic “ethical characterizations of motives, character traits, or individuals” (Slote 2003, 203). An agent-based virtue ethics “must derive its evaluations of human actions” (Baron, Pettit, and Slote 1997, 206). So, unlike Aristotle, Slote formulates an agent-based virtue ethics, and this is one of the main distinctive features in his virtue ethics. An agent-based virtue ethics emphasizes virtuous motives. Slote distinguishes between “aretaic” and “deontic” virtuous motives or dispositions. He argues that aretaic notions, such as good and excellent, are primary to virtue ethics. By contrast, deontic notions, such as right and obligation, are derivative. Slote claims that deontic notions can be derived from aretaic notions. In his words, “I hope to be able to show you how deontic concepts can be derived from aretaic ones” (Slote 1992, xiv). The fundamental aretaic concept, according to Slote, is “admirability”, which is neutral and capable of deriving deontic concepts. He writes, “The virtue ethics I will be developing will...favor ‘neutral’ aretaic concepts like

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admirability and (a) virtue” (Slote 1992, xvi). In this sense, Slote distinguishes his aretaic account of virtue from other virtue theorists, such as, Plato, Aristotle, Sidgwick and Hursthouse. Finally, and most importantly, in his virtue ethics Slote defends only one virtue, balanced caring. Needless to say, before Slote, feminist ethicists, such as Carol Gilligan, Nel Noddings, Martin L. Hoffman developed care approaches in their writings but none of them consider care as a virtue, nor do they consider its action-guidingness or the notion of “balance”. Moreover, it seems that their ethics of care mainly focuses on responsibility, autonomy, justice, fairness, equality, and rights. For example, Gilligan says, “[s]ince everyone is vulnerable both to oppression and to abandonment, two moral visions—one of justice and one of care— recur in human experience” (2003, 230). Her concept of responsibility establishes a new conception of the interrelation between the self and others (Arnett and Arneson 1999, 163). Nevertheless, these views have had a profound influence on Slote. According to Slote, balanced caring is a “fundamentally admirable” character trait. A virtuous person would balance caring between her intimates and all other human beings. He says, “[t]he view I want to propose emphasizes balance as between intimate caring (our concern for near and dear) and humanitarian caring (our concern for people in general)” (Slote 2001, 66). Caring is a basic form of moral excellence and Slote believes that it is morally good to care more for intimates than other people. In fact, caring more for intimates is a moral requirement for virtuous people. He writes, “[o]ne can and should care more about some friends or relations than about others” (Slote 2001, 66). Obviously, Slote’s structure of caring raises many questions. It seems to me that Slote creates a circle around the individual and their intimates that excludes other human beings. However, virtue seems to be something that goes beyond this circle, to feel the suffering of people promotes welfare for intimates as well as for other human beings. He says more controversially, “a morally good or decent individual will sometimes, indeed often, be doing things for those she loves or cares most about, when she could be doing more good for humanity as a whole” (Slote 2001, 72).

Slote Should Consider the Opposite Three noticeable problems in Slote’s account are: firstly, that the idea of “balanced” and “admiring” is vague; secondly, deontic assessment cannot always be derived from aretaic assessment; and finally, there is a

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problem with classification. I will discuss these problems and argue that Slote should consider exploring the opposite. Firstly, at the heart of the Slotean account of virtue, there are two misleading concepts: “intuition” and “balance”. Slote says that a virtuous person needs to balance her caring between two categories: intimates and strangers. But how is she able to do this? What is the basis of such a balance? Slote does not provide us with a reasonable answer except that of trusting our own intuitions with regard to the “right and wrong action to direct...balanced concern” (Copp and Sobel 2004, 519). Copp and Sobel consider this intuition to be part of the methodology, which allows him to construct the basis of his theory. But I believe that even their attempt is also challenging and possibly unacceptable. A plausible virtue theory must explain its basic principles and it may not depend on mere common sense intuitive plausibility even for the sake of its further construction. The argument is that such a methodology could result in the unreliability of a theory and devalue its action-guidingness. These two criteria—reliability and action-guidingness— seem to be crucial to a virtue ethical theory. For example, if someone believes that honesty is a fundamental virtue then she should say what honesty means to her and how we can achieve it. She may not claim that we all have intuition on what honesty is and then construct her virtue theory. Rather she should clearly state what honesty means to her, for instance, is honesty telling the truth? Or is it giving an unbiased judgment? And so forth. Slote explores his theory by grounding it in a preconceived perspective on intuition. Slote’s concern for intuition becomes more complex once we turn our attention to Copp and Sobel’s points. They correctly noticed that beyond these two categories there is another category, which is the virtuous person “herself”. So, Slote has missed the third category. Now, how can the virtuous person’s intuitions help her to create a balance between these three categories: the intimates, the strangers, and the virtuous person herself? (Copp and Sobel 2004, 523) In addition, there is a crucial point that Copp and Sobel have not mentioned. Slote considers intimates and strangers equally by saying that “our ordinary thinking about the virtuous treats the category of the trait possessor and the category of ‘other people’ (i.e. people other than the trait possessor) as of roughly equal importance” (Slote 1992, 98). Some problems arise here: firstly, Slote is giving equal importance to both categories but arguing that one category, namely, the intimates, is more favorable and considerable. This attempt seems to be inconsistent. Secondly, within the three categories it may not be possible to come up with an “equal” balanced caring because at least one group has to sacrifice

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something. Then a new question arises: who should get least priority—the virtuous person herself, the intimates, or the strangers? Intuitions in Slote’s theory, therefore, do not reasonably enable us to figure out which are admirable character traits. Secondly, as stated previously, the Slotean account is primarily aretaic. It claims that the deontic assessment can be derived from the aretaic assessment. He also argues that admirability is the fundamental aretaic notion and that it is neutral. What is the admirable character trait then? According to Slote, the character trait that admires balanced caring, is an admirable character trait. The complexity in this aretaic to deontic derivation is that we do not know with certainty which character a person has, whether she is an intimate or a stranger. We can only judge whether she is performing immoral acts. Let us take the example of killing, as mentioned by Copp and Sobel. Suppose a man kills a maximum of three strangers to save his child but he would not kill three strangers to save his friend. He considers this to be balanced concern. Now, the problem is whether this balanced concern is as admirable as that which would lead him to kill only one stranger to save his child but he would kill no one to save his friend (Copp and Sobel 2004, 520). Can we derive the deontic assessment of this act from the aretaic assessment of his states of character? The opposite is more acceptable i.e. from the deontic assessment of killing to the aretaic assessment of killer’s character traits. It is also not clear whether admirability is a “neutral” concept because if we admire balanced caring it seems that balanced caring is a positive notion. Finally, in Slote’s theory the definitions regarding what “balanced” concern is and what amount is required to denote balance are very misleading. Moreover, dividing people into two classes is hardly acceptable in a plausible virtue ethical account. A truly virtuous person would not distinguish between intimates and distant acquaintances when caring. Copp and Sobel do not seem to agree with this claim. Although they argue that “it is much more admirable to care for strangers than to care for intimates such as our children and friends” they do not reject this classification either (Copp and Sobel 2004, 520). However, even caring for strangers is better. This type of classification (intimates and strangers) among human beings seems unacceptable to the virtuous person. An example will clarify my point. Imagine that Mr. X is a virtuous person who has two children and they are identical twins. Suppose that one morning, one of his children is playing with another child, whose parents Mr. X does not know at all well. Suddenly these children fall into the swimming pool. Mr. X does not know

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how to swim, and he has only one hand as his other hand was removed last year as a consequence of infection. Moreover, nobody is present who could help Mr. X to save both children. So, Mr. X can save only one child by extending his hand to either one of the two children—his own or the other. To whom should he give his hand? According to Slote, Mr. X should give his hand to his own child and save him without any hesitation. As he is a virtuous person, Mr. X should care for intimates rather than for strangers. One could point out that Slote’s theory is applicable only when “others” is taken as “in sensu composito”, i.e. as a class or category rather than “in sensu diviso” (“each and every other individual”) (Slote 1992, 98). But in our case, we could easily consider Mr. X’s children as a class and someone’s child as another class rather than merely as individuals. According to Copp and Sobel, Mr. X as a virtuous person should give his hand to the other child rather than his own child because caring more for strangers than for intimates is a much more admirable trait. A supporting reason is that his children are twins and to sacrifice one of them would not be a great loss. I believe that both acts would lie in contradiction to virtuousness to some extent. Mr. X cannot willingly let his own child die to save someone’s child though that is relatively better from the virtue ethics point of view. Similarly, he cannot save his own child and let someone else’s child die. Even though he has twins, the emotional attachment and feelings for them are very different. The truly virtuous person, then, would not make a distinction between intimates and strangers. She should not draw a boundary line between the two categories. She should be motivated virtuously to save both the children though only one can be saved. She should not know whether her own or someone else’s child is going to be saved. Her endeavor to save both children is virtuous and morally significant. A further limitation of Slote’s classification is that it does not tell us how the right balance of caring is achievable within the intimate class. For example, what is the right balance of caring between our intimates— parents, children, spouse, brother, sister, friends, and loved ones? Suppose in the previous example, the other child were Mr. X’s youngest brother, then who should be saved—his own child or his brother? So, Slote’s classification creates a central problem for the plausibility of his virtue ethical theory.

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A Reverse Formulation of Slote’s Account of Virtue Copp and Sobel have stated, “Slote takes the virtues to be admirable sates of character. Unfortunately, he provides no substantive criteria of admirability” (Copp and Sobel 2004, 543). They also believe that Slote’s account significantly neglects others’ welfare, which may give us a “bad character”. So, our primary goal in this part is to provide a satisfactory criterion of admirability that also considers others’ welfare. The formulation that I am intend to explore here is roughly that admirable character traits will be defined according to the idea that “closer to heart is less favorable and less close to heart is more favorable”. Unlike Slote, this formulation necessarily omits classifying human beings as intimates or strangers. However, if we frame it in Slote’s language, then we could say that the more intimate they are to us makes them less favorable, while the less intimate are more favorable. Or, alternatively, the more distant they are to us the more favorable and the less distant they are to us, the less favorable. This is clearly in opposition to Slote’s account. We may call it “a reverse formulation”. How can we measure proximity to our heart? What is the underlying principle? Presumably, we could say that the closest person to someone’s heart is herself, followed by her family members, friends, strangers, and the environment (animals, plants and matter), respectively. So, at the top level of the closeness scale is the person itself while at the bottom level is the environment surrounding that person. Consider the following two cases: • •

Case 1—Mr. Y cares for his children the most and spends the maximum amount of money on their welfare. Case 2—Mr. X cares for all the children in this world irrespective of their race, religion, nationality, and spends the maximum amount of money on their welfare without knowing who is getting the money.

Which character trait is more admirable? Caring for one’s own children? Or caring for all children without expecting anything in return? Surely, Case 2 displays more admirable character traits. We do not need here the Slotean vague “intuition” or his confusing notion of “balance”. Our guiding principle “closer to the heart is less favorable and less close to the heart is more favorable” is sufficient with regard to achieving admirable character traits. Our own children belong to the second level on our closeness scale, while all children belong to the fourth level.

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Therefore, to have an admirable character we should favor all children more, and our own children less. One possible limitation of the reverse account could be that the closeness scale may not be the same for all. That is, one person may say that her friend is closer than her family members. Or, she may say that her pet is closer to her heart than her friend. I agree that such closeness is possible. However, that would be rare and exceptional. The regular closeness scale should be the one proposed. In fact, if we favor someone who is our intimate that character trait does not exhibit any virtuous motives or dispositions. All self-centered people would have these character traits. Only the virtuous person will consider that caring more for strangers is a moral excellence. Slote’s classification of the two categories is based on social relationship and kinship bonding. For example, we have a kinship relation with our brother and sister, while with strangers we have no kinship relation but may or may not have a social relation. By contrast, the reverse formulation omits such a social or kinship relation. For instance, we do not have any sort of social or kinship relation with the environment though we should be caring for it. It is justifiable to say that when a person favors someone without expecting any “thanks”, “rewards”, or any sort of “return”, it is much more admirable and virtuous. Slote’s account completely ignores this sentiment. But, as I mentioned earlier, Slote’s account is important for exploring “care” as a virtuous character trait. He also holds that “A caring person might thus see the promotion of caring as the best way to promote what she, as a caring person, is concerned about” (Slote 2003, 219). The reverse, rather than the Slotean account, is compatible with this view. A caring person should promote caring in the way in which she is concerned with it. In the reverse account, the caring person is not only caring for those who are closer to their heart but also for those who are less close. In fact, the latter is more favorable. Thus, according to our closeness scale, favoring the environment rather than favoring oneself is a virtuous character trait. Eventually, this account could contribute significantly to the broader moral perspective, such as the relationship between humans and nature.

Virtue, Empathy and Supererogation In his recent book The Ethics of Care and Empathy, Slote has significantly developed his view to accommodate the issue of supererogation. For instance, instead of “balanced caring” he explores the idea of “empathic caring”

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which successfully rectifies some of the major criticisms mentioned earlier, and also incorporates some sort of obligation to help others. Supererogatory suggests that doing something for distant people is praiseworthy, but it is neither a moral requirement nor the duty of agents. Kawall mentions that, “[a] supererogatory action is often described as one that (in some sense) goes beyond duty or what is morally required” (2009, 180). However, this is not the only sense of supererogation. Blum identifies three different senses of supererogation and one of them is “having greater merit”. He writes, “‘[s]upererogatory’ can mean different things. If supererogatory is taken to imply ‘having greater merit,’ then those who exemplify care would have greater merit than those who merely fulfilled obligations” (Blum 1993, 62–63). So, the important questions are: Is caring more for distant people than intimates supererogatory? If it is, then should the acts of virtuous people, such as Mother Teresa, inspire us as virtues or duties? Slote deals with the first question by referring to Peter Singer who believes that we have an equal obligation to help unknown children just as we should help those we know. This type of empathy is necessarily supererogatory according to Slote. He says, “the person who demonstrates more empathy than most people with fully developed empathy ever show can be said to act in a supererogatory fashion” (Slote 2007, 34). Notice that Slote introduces here the term “fully developed empathy”, and he argues that ordinary people who are naturally self-interested or selfcentred are not fully developed empathetic human beings. Indeed, he rejects the claim that we have equal obligations to those people who are unknown to us. To answer the second question, we may consider other virtue ethicists’ criterion of rightness. In an influential book, On Virtue Ethics, Hursthouse writes, “[a]n action is right if it is what a virtuous agent would characteristically (i.e. acting in character) do in the circumstances” (Hursthouse 1999, 28). However, Slote’s criterion is that, “actions are morally wrong and contrary to moral obligation if, and only if, they reflect or exhibit or express an absence (or lack) of fully developed empathic concern” (Slote 2007, 31). Thus, if we follow Hursthouse’s criterion we have a duty to help distant people because virtuous agents like Mother Teresa helped them more than their intimates. If we fail to follow this, that would be a violation of duty and hence morally wrong. Our reverse formulation is very much compatible with this norm. But it may not be rare that virtuous people sometimes do make mistakes. Slote, however, thinks such types of action (i.e. helping others) should be morally praiseworthy, though not

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virtuous. He states, “we would intuitively regard such a person as having acted supererogatorily, as having in a most praiseworthy way gone beyond the call of duty” (Slote 2007, 34). So, Slote’s view here is much more moderate in comparison to that in his previous work. Slote believes that his concept of empathy is superior to ideas held by other care ethicists on caring for people who are not intimates. Noddings argues, “I am not obliged to care for starving children in Africa, because there is no way for this caring to be completed” (Noddings 2003, 249). However, Slote would say that if we are fully developed empathetic beings then we have an obligation to care for them. Noddings outlines her approach as a “feminine ethic”, which “begins to look a bit mean in contrast to the masculine ethics” (Noddings 2003, 252). Similarly, Gilligan’s groundbreaking work In a Different Voice suggests, “men and women may speak different languages that they assume are the same” (Tong 1993, 81). Nonetheless, these two opposing kinds of morality, masculine and feminine, are, according to Slote, “one-sided and need to be complemented or supplemented” (Slote 2004, 293). He proposes that “a virtue ethics of caring” should be reconstructed as “a virtue ethics of empathic caring”. Since the term empathy has “remarkable explanatory power” in normative ethics, the superiority of emphatic caring is that, unlike care ethics, it can explain a “wider range of moral distinctions” (Slote 2004, 296-298). Nevertheless, Slote still needs to explain why we should be partial to showing our empathy towards distant people.

Conclusion The Slotean account of virtue raises many challenging issues for virtue ethics. Slote’s most unsatisfactory and vague conception is “balanced caring”. Moreover, he relies largely on intuition to achieve “balance”, and there is no plausible guideline as to how we can achieve it except by relying on our intuition. Copp and Sobel indicated that caring for strangers is more virtuous than caring for intimates. I find their indication reasonable and I have argued that a plausible virtue ethical account should take the opposite direction to that adopted by Slote. Contrary to Slote, the reverse formulation, “closer to heart is less favorable and less close is more favorable”, is plausible because it rejects classification and no balance or intuition is required. Moreover, it can provide us with a significant guideline to help us deal with our relationship to the broader moral circle such as the environment. Although Slote’s recent position is much more moderate and somehow accommodates the issue of supererogation, Slote still needs to explore the idea of partial empathy.

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References Aristotle. 2003. “From The Nicomachean Ethics.” In Virtue Ethics, edited by Stephen Darwall, 7–50. Oxford: Blackwell Publishing. Arnett, Ronald C. and Pat Arneson. 1999. Dialogic Civility in a Cynical Age: Community, Hope, and Interpersonal Relationships. Albany: State University of New York Press. Baron, Marcia W., Philip Pettit and Michael A. Slote. 1997. Three Methods of Ethics: A Debate. Oxford: Blackwell Publishers. Blum, Lawrence A. 1993. “Gilligan and Kohlberg: Implications for Moral Theory.” In An Ethic of Care: Feminist and Interdisciplinary Perspectives, edited by Mary Jeanne Larrabee, 49–68. New York: Routledge. Copp, David, and David Sobel. 2004. “Morality and Virtue: An Assessment of Some Recent Work in Virtue Ethics.” Ethics 114(3): 514–554 Gilligan, Carol. 2003. “Moral Orientation and Moral Development.” In Conduct and Character: Readings in Moral Theory, edited by Mark Timmons, 228–237. Ontario: Thomson Wadsworth. Hursthouse, Rosalind. 1999. On Virtue Ethics. New York: Oxford University Press. Kawall, Jason. 2009. “Virtue Theory, Ideal Observers, and The Supererogatory.” Philosophical Studies 146 (2) : 179–196. Noddings, Nel. 2003. “An Ethic of Caring.” In Conduct and Character: Readings in Moral Theory, edited by M. Timmons, 244–255, Ontario: Thomson Wadsworth. Slote, Michael. 1992. From Morality to Virtue. New York: Oxford University Press. —. 2001. Morals from Motives. New York: Oxford University Press. —. “Agent-Based Virtue Ethics.” In Virtue Ethics, edited by Stephen Darwall, 203–226. Oxford: Blackwell Publishing, 2003. —. 2004. “Autonomy and Empathy.” Social Philosophy and Policy 21 (1) : 293–309. —. 2007. The Ethics of Care and Empathy. New York: Routledge. Tong, R. 1993. Feminine and Feminist Ethics. California: Wadsworth Publishing Company.

CHAPTER SIX VIRTUE ETHICS AND THE HUMAN– ENVIRONMENT RELATIONSHIPS1

Environmentalists, scientists and philosophers around the globe have agreed that our current engagement with the environment is inappropriate. Only a radical change in human–environment relationships could save human beings from extinction. What should be the theoretical foundation of this radical change? Should it be Utilitarianism, Kantianism, or virtue ethics? As Utilitarianism and Kantianism suggest practically opposite positions, and ethical principles are not enough to overcoming environmental problems, recent virtue ethicists have defended this radical change by adopting some human virtues such as, practical wisdom, prudence, admirability, compassion, and humility. This chapter is about virtue ethics. It begins with Aristotle’s view on virtue and explains the main features of his virtue ethics. It also discusses the implication of virtue ethics in human–environment relationships with particular reference to the famous virtue ethicist, Rosalind Hursthouse. The chapter ends with identifying some basic limitations of her view.

Introduction The central theme of Aristotle’s Nicomachean Ethics is virtue. To Aristotle, anything that is divisible as excess and defect has a virtue and the virtue is its intermediate or mean. We can get this mean by simple arithmetical calculation. For example, seven is the mean of ten (excess) and four (defect). As a final end, virtue is desirable only for its own sake and not as the means for any other thing. Virtue is the most complete sense of excellence. Although virtue is a pleasant activity, it is not merely a physical pleasure as many animals enjoy. There are two types of virtue: 1

Previously published as “Virtue Ethics and Its Application to HumanEnvironment Relation” Bangladesh Journal of Public Administration 23, no.1 (2014): 143–151.

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intellectual and moral. Intellectual virtue is acquired by teaching whereas moral virtue is a product of habit. So, virtue is not natural i.e. virtue is not something that we receive through luck. Virtue is the perfect form of habit that can be achieved through time and experience. Like arts, virtue requires continuous exercise, or cultivation. We can even produce virtues and destroy them. In order to be virtuous, we need to follow the “right rule”. The right rule is the mean between excessiveness and defectiveness. Virtue will be produced through the mean and destroyed through excess or defect.

Aristotle on Virtue Aristotle holds that our soul comprises three things specifically: states of character, faculties, and passions. Of these, the last two are not virtues while states of character can be considered as virtue. Since passion is a psychological phenomenon, human beings should not be “praised” or “blamed” for their passion. Similarly, faculties cannot determine the goodness or badness of a human being. Virtue is the excellence that makes human beings good for themselves and others. In the same way, the excellence of an ox is good for cultivation, carrying, and other household activities. Moral virtues are the means of passion and action. Correctness, practicality, and success are characteristics of virtue. Virtue is then a choice based on a rational principle. Although the mean may be achieved rationally, in some cases it is difficult to attain. For example, the mean of a circle is hard to find out. The mean is, therefore, attainable by perception rather than reasoning. Intellectual virtues are concerned with contemplation and calculation. Generally, all human beings, including brutes, have some moral qualities such as self-control. However, without reason such qualities are not effective. Reasonable human beings differ in their actions and opinions due to their virtues. According to Aristotle, our soul has two parts: opinion and moral. Opinion comprises “practical wisdom” and “cleverness”, whereas moral comprises “natural virtue” and “virtue in the strict sense”. He believed that although virtues imply practical wisdom all virtues are not a form of practical wisdom. Virtue is what follows the right rule or the rule of mean and this rule functions in association with practical wisdom. Virtues, therefore, involve practical wisdom, correct rules, or a rational principle. Aristotle’s virtue ethics has some basic characteristics.

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Basic Features of Aristotle’s Virtue Ethics Firstly, Aristotle did not ignore the importance of pleasure and pain in his account of virtue. Virtue, to him, is primarily a virtuous activity (Aristotle, 10–11, 15). Human beings as well as animals are capable of feeling pleasure and pain. Full avoidance or control of our emotions is thus impractical. A virtuous person cannot be someone who has no emotion, does not desire pleasure, and avoids pain. However, our entire emotions are not virtuous. To guide our emotions and act virtuously we need practical wisdom. Aristotle rejected passions and faculties, as these are entirely psychological phenomena and accepted only states of character as virtue. Ancient Greek philosophers emphasized the capacity of the soul to be virtuous. But Aristotle’s notion is different in the sense that virtue is acquired and not invented. To him, virtue is a skill of excellence. We cannot invent virtues such as courage without practicing it. Therefore, Aristotle’s account of virtue is pragmatic and not idealistic. Secondly, for Aristotle, the mean is only achieved by perception and never by reasoning (Aristotle, 23), since reasoning sometimes results in excess or defect. For instance, in the battlefield a situation may arise when escaping is the most reasonable act. But Aristotle would say escaping originates from fear, and that is a vice. The mean here is courage, and a virtuous warrior’s practical wisdom would help her in the battlefield to fight until death. Acting in this manner implies that courage directs a warrior’s soul. The soul, as Aristotle said, possesses any truth by the five states (Aristotle, 37); among these are practical and philosophic wisdom, which are both vital for his methodology. Thirdly, According to Aristotle, virtue is achievable only by “repetition” (Aristotle, 12). Repetition is closely related with empirical activities. We may practice again and again to be a courageous person and, eventually, this virtue may belong to us. All common people possess courage with a minimum level, but a virtuous person possesses the practical wisdom of courage, which does not require knowing many rules. Rather she would attain a moral good, courage, through repetitive practice. The rational part of our soul is capable of calculating this virtue by a rational principle. However, this rational principle has to be guided through practical wisdom. In order to calculate the mean, we should have experience about what is excess and what is defect with regard to a particular quality. Fourthly, rationality, or reason, may give us scientific knowledge. This knowledge is usually based on induction and syllogism, though false syllogism is possible to construct. Hence, in Aristotle’s view, virtue is more than that. It is the capacity of choosing human goods on practical

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wisdom. Scientific knowledge cannot be virtuous in this sense. Philosophical wisdom is the most complete form of knowledge that synthesizes intuitive reason and scientific knowledge. Finally, Aristotle’s methodology is not intuitional, in a strict sense, because it considers practice and practical deliberation. Moreover, his conception of virtue combines universals and particulars. For Aristotle, virtue is the state of character that belongs to the soul. Arts, scientific knowledge, and intuitive reason are not virtues, although virtues do involve these qualities. Practical wisdom is the implication of all virtues. Although reason and intuition both are important qualities of mind, they are partially responsible for virtuous acts. Without practical wisdom, no one can be a virtuous person. This practical wisdom requires experience and exercise. Therefore, Aristotle’s methodology of arguing for virtue seems empirical. Nowadays, virtue ethics has major implications in various issues such as human–environment relationships.

Virtue Ethics and the Human–Environment Relationships Rosalind Hursthouse in her book, On Virtue Ethics (1999), has explored that virtue ethics, in spite of Utilitarianism and Kantianism, could be an alternative approach for environmental ethics. For her, since environmental ethics is primarily concerned with defending “the green belief”, environmental virtue ethics is best articulated in virtue ethical terms. She observes we could do this in two ways: firstly, by providing new explanations of old virtues and vices related to the human–nature relationship and secondly, by establishing at least one or two new virtues concerning this relationship (Hursthouse 1999, 156). The former is the “reconfiguration” of some old virtues, such as practical wisdom, proper humility, and vices such as greed and cruelty, while the latter is the development of new virtues, such as “being rightly oriented to nature” (Hursthouse 1999, 158). Utilitarianism and Kantianism hold that human beings have superior value over other creatures, as well as nature. Therefore, in order to satisfy their needs, human beings can dominate nature. Moreover, the continuous survival of the human species is more valuable than others. So, these theories support the green belief merely as a means of human benefit. Nevertheless, by using new understandings of old virtues Hursthouse argues for a radical change of “human-centered” ethics (Hursthouse 1999, 156-158). But the question arises: how can virtue ethics avoid the charge of excessive human-centeredness? According to Hursthouse, a fundamental change in our thinking and feeling, essentially a total involvement of

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human psychology in relation to the natural world, can contribute to overcoming the current limitation of human-centeredness. We should form a united front that is distinctly human in nature so that a radical change occurs (Hursthouse 1999, 160). Using R.W. Hepburn’s idea of the “emotion of wonder”, Hursthouse suggests “respect to wonder” or “being rightly oriented to nature” as new virtues in environmental ethics. Such a character trait disposes us “to feel wonder the right way” (Hursthouse 1999, 161–162). So, the right orientation to nature involves a harmony of reason and emotion in environmental thinking. Hursthouse also puts forward another new virtue namely, “respect for nature”. Although Paul W. Taylor introduced this term, she has provided a new insight into the concept because, for her, respect for nature is not an “ultimate moral attitude” and, instead, is rather “a virtuous character trait”. She argues that Taylor’s view is problematic for three reasons. Firstly, respect for nature as a telos cannot be achieved merely by “adopting an attitude” as it must be an “inculcation” or “training” of our character from childhood (Hursthouse 1999, 163). Secondly, Taylor holds that respect for nature is inherently worthwhile. But the notion of “inherent worth” is highly contentious, because, like human beings, other animals might assign inherent worthiness. Do they differ in degrees? If the answer allows for degrees then human beings would be the most inherently worthwhile. Conversely, if there were no difference in degree then every animate living being would have equal inherent worth (Hursthouse 1999, 164–165). Finally, Taylor’s idea is so narrow that it only includes “biological” organisms although, certainly, inanimate members play a vital role in the natural system. Hursthouse concludes that at present we are lacking relevant virtues to live in accordance with green beliefs, in other words, with eudaimonia. However, by inculcating those virtues and living with “obvious prohibition” we could leave a good earth for future generations (Hursthouse 1999, 170). Notice that Hursthouse’s view is mainly concerned with identifying some old and new virtues regarding environmental ethics. Her arguments have some limitations. Firstly, environmental ethics is the comprehensive study of the human–nature relationship. Moreover, it also discusses the value of non-human elements in nature. Hursthouse, slight differently, holds environmental ethics as “the green belief” which aims for a “fairly radical change” (Hursthouse 1999, 155). Now, what does the word “fairly” mean? Does it mean that we will change our lifestyle and behavior towards nature as long as it is not harmful to any party? Or does it mean that we should do the minimum harm to satisfy our basic needs? Both acts

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are virtuous, as the former is primarily concerned with others’ happiness, while the latter is concerned with one’s own happiness. However, there is a fundamental difference between the two acts. The first implies that other members within nature share the same value, intrinsic or extrinsic, as human beings. But the second implies that human beings possess superiority over other members, which would mean that only human beings have intrinsic value. Hursthouse’s view seems closely related to the second; she argues that human beings have superiority over nature but they do not have absolute power to dominate nature. She also claims that we do not need to impose inherent worth or intrinsic value to nature. In that case, Hursthouse is avoiding the important issue of the value of nonhuman elements. What kind of value do non-humans deserve? Are they valuable as they are useful to human beings? It seems unclear as to exactly what the ethical human–nature relationship means to Hursthouse. Secondly, Hursthouse explores two versions of environmental virtue ethics. The first version says we could “reconfigure” some traditional virtues and vices to bring a change in our “way of thinking, feeling and acting” towards nature (Hursthouse 1999, 160). Therefore, she is arguing for a change of our present character traits. However, this seems implausible for two reasons: not everyone has an absolute understanding of virtue and vice, and we do not yet have an ideal conception of virtuous thinking, feeling, and acting towards nature. The second version says we could introduce some virtues, such as “respect to wonder” and “respect for nature”. Neither one of these two virtues is newly invented as R.W. Hepburn and Paul W. Taylor have previously used these terms; however, they did not claim these as virtues. So, why should we need to treat them as virtues? Virtue is something that is worthwhile and intrinsically valuable; so, for this reason, honesty and generosity are virtues. Hursthouse is silent on the value of nature, although she does argue that it should be respected. The distinction between loving, respecting, and wondering is so narrow in the sense of their interrelation. That is, what we love we have some respect for it. So, without claiming “respect for nature”, or “respect to wonder”, as character traits we could still protect nature. Furthermore, does “respect for nature” as a character trait, realistically solve environmental problems, such as global warming or ozone depletion? Thus, respecting nature, or loving nature, is the same if we do not have a precise action-guiding principle. Finally, Hursthouse argues that through environmental virtue we could make some radical change in our relationship with nature. But she concludes by emphasizing “actions”, “practical reasoning” and “obvious prohibition” to overcome current environmental crisis (Hursthouse 1999,

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170). Where is the role of virtue then? Basically, she tries to synthesize Utilitarian and Kantian views regarding environmental ethics. On one hand, she supports modest “human-centeredness”, while on the other she rejects animate and inanimate distinction in environmental ethics. That is, she values interdependence of different systems in nature, which is nonhuman centeredness. Therefore, Hursthouse does not offer any standard for environmental virtue ethics, except “being rightly oriented to nature” (Hursthouse 1999, 169). Nevertheless, she seems very confused about what “rightly” actually means and the criteria of this rightness. In addition, she uses some metaphorical examples to illustrate “orientation to nature”. It is difficult to grasp what “orientation to nature” means to her. Is it appreciation, adaptation, realization, or some sort of association? Another point is that although Hursthouse sees “respect for nature” as a virtue, she ignores the “preservation of nature”. If we respect nature, then we should preserve it. But then preservation is not a wise use of nature.

Conclusion Virtue ethicists have tried to find a plausible answer to how we should engage with the environment. They do not deny the importance of ethical principles to help solve the environmental problems we are currently facing. However, they hold that ethical principles are not sufficient to fix this global problem. Before formulating any ethical principles, it is important to develop a virtuous character trait. What character traits are virtuous? According to Aristotle, neither excess nor defects are virtuous character traits, but, instead, virtue can be found in a mean of these two extremes. In his view, virtue is achievable through cultivation and practice. Virtue ethics have a different understanding of human–environment relationships. Contemporary virtue ethicist, Rosalind Hursthouse, has claimed that it is necessary to reconfigure some old virtues and at the same time develop some new virtues in order to cultivate an appropriate human– environment relationship. Nevertheless, her theory cannot overcome the charge of human-centeredness. This does not solve the question of whether the environment is intrinsically valuable or instrumentally valuable. In short, she has not provided any action-guiding ethical principle for the preservation of nature. However, she has rightly shown that we should return to some old virtues in order to save the environment.

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References Aristotle. 2003. “From The Nicomachean Ethics.” In Virtue Ethics, edited by Stephen Darwall, 7–50. Oxford: Blackwell Publishing. Copp, David, and David Sobel. 2004. “Morality and Virtue: An Assessment of Some Recent Work in Virtue Ethics.” Ethics 114(3): 514–554 Hepburn, Ronald W. 1984. ‘Wonder’ and Other Essays. Edinburgh: Edinburgh University Press. Hursthouse, Rosalind. 1999 .On Virtue Ethics. New York: Oxford University Press. —. 2012. “Virtue Ethics”. The Stanford Encyclopedia of Philosophy. http://stanford.library.usyd.edu.au/entries/ethics-virtue/ (accessed January 17, 2014.) Slote, Michael. 1992. From Morality to Virtue. New York: Oxford University Press. —. “Agent-Based Virtue Ethics.” (1995) 2003. In Virtue Ethics, edited by Stephen Darwall, 203–226. Oxford: Blackwell Publishing. Taylor, Paul W. 1986. Respect for Nature: A Theory of Environmental Ethics. Princeton, NJ: Princeton University Press.

CHAPTER SEVEN ETHICS IN HEALTH CARE: INDUCEMENT1

Currently, most health researchers or donor organizations consider inducement plays a vital part in promoting research. They propose benefits, such as post-research free medical treatment, food, insurance facilities, or even cash, in order to meet sufficient numbers of subjects. So, inducement may influence one to participate in a research. Is it ethical to offer inducement to human subjects? What are the risks in such practice? What will happen if the donor agencies use subjects by hiding possible risks from them? When can an inducement satisfy ethical criteria? The Council for International Organizations of Medical Sciences (CIOMS), Food and Drug Administration (FDA), and other ethical guidelines hold that inducement is unethical because it involves risks to voluntary informed consent. Supporting this position, a group of ethicists has argued that inducement undermines voluntariness especially when subjects are poor and vulnerable, and thus, is unethical. In contrast to this, others argue that inducement contributes to discover new knowledge, which can improve the miserable condition of the poor. In their view, an inducement maintains all ethical criteria including the subject’s autonomy, and is, therefore, morally permissible. This chapter focuses this debate and analyzes both sides of the argument. It examines whether inducement invalidates informed consent, and concludes that even if inducement does not violate the basic components of informed consent subjects may claim a prima facie right to enjoy research outcomes.

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Previously published as “Ethics in Health Care: Inducement and Human Subjects” AGATHOS: An International Review of the Humanities and Social Sciences 2, no. 1 (2011): 118–129.

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Introduction There can be several reasons for offering inducement in research: it can be necessary to pay to get sufficient subjects, to compensate for subject’s time, for their welfare, or simply to co-operate in overcoming serious health problems. Other incentives can be used as well as money such as treatment, free medicine, and health care services for certain time periods. Now, is it ethical to offer inducement in clinical research? What is the demarcation line between due, or undue, inducement? By quoting CIOMS Guideline 7, some ethicists argue that inducement is unethical because it invalidates informed consent. This is particularly the case when subjects are vulnerable or dependent. According to this guideline, inducement is not only unethical but also harmful because by definition research aims to know what is unknown and, therefore, the result, or risk, from research is also unknown. So, it is unethical to use people in risky jobs by providing few material benefits; in contrast, other ethicists claim that inducement does not invalidate informed consent requirements. As voluntary participants are ethically allowed, there is nothing wrong, according to them, to pay someone for their expenses and time spent. Moreover, it might be difficult to always get voluntary participants, and inducement is not the only determinant for the moral acceptability of a research project. In addition to this, moral acceptability depends on the whole procedure or methodology of research. Taking permission from the Research Ethics Committee is one of these procedures. The ethics committee has the responsibility of monitoring research activities. They will not permit highly risky research that exploits people. So, this means that inducement does not have a negative impact on better judgment and, instead, it aids better judgments. Clearly, there are arguments for and against inducement. I will analyze both types of argument after I have discussed what inducement is and what relationship exists between inducement and informed consent. I will then ague that inducement is ethically acceptable so long as it is not used as a means to obtain informed consent. Inducement is justified because the subject has a prima facie right to enjoy research outcomes.

What is Inducement? When a researcher or donor organization offers money or some sort of benefit for research subjects that added value can be defined as inducement. Inducement is widely used as a synonym of salary, wage,

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incentive, bonus, free health care, free medicine, and even free food. Some ethicists, such as Wilkinson and Moore, even think that inducement could be a “reward” since both parties are gaining something “mutually” in this process. They write, “[a]s a result of offering the reward, the researchers get the subjects they want. As a result of participating, the subjects get the reward they want. Both are better off. No one is worse off” (Wilkinson and Moore 1997, 375–376). However, there are some difficulties when considering inducement as a reward. Since a reward is given to an individual in order to encourage them to provide a better performance in the future by acknowledging their present achievements, it has a motivational function. In a similar way, wages are strongly related to rights. Wage earners may enjoy overtime payments, fixed working hours, and so forth. They also have a responsibility towards the company, or organization, due to their contractual relationship (Grant and Sugerman 2004, 719–720). So, inducement has a variety of different meanings although, generally, it is considered as an offer or an opportunity. While inducement is an offer intending some mutual benefit, it also has a moral significance. In the moral sense, inducement could be due or undue. The amount or the quantity of inducement is the key factor to demarcate between “due” or “undue”. Inducement may be considered as compensation or welfare. Some noticeable features of inducement are: firstly, inducement is offered in order to get sufficient subjects. Secondly, inducement refers to some kind of benefit for the subject, as well as the researcher. Thirdly, inducement is acceptable in so far as it does not change the subject’s behavior significantly. Fourthly, inducement is closer to compensation as opposed to wages or a reward. Finally, inducement is compatible with welfare.

Inducement and Informed Consent Informed consent is an important requirement for any clinical research to be considered as ethical. Since it is not morally acceptable to act against the subject’s wishes and ignore her dignity, informed consent may be defined as her formal or oral voluntary approval to participate in the research. Researchers have an obligation to protect subject’s autonomy and respect human dignity. The CIOMS guidelines connect inducement and informed consent by defining it as: a decision to participate in research made by a competent individual who has received the necessary information; has adequately understood the information; and after considering the information, has arrived at a

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decision without having been subjected to coercion, undue influence, inducement or intimidation (Commentary on CIOMS Guideline 4) (Andanda 2005, 16)

This guideline suggests that informed consent has to be obtained without inducement or coercive offer. However, all inducements may not be ethically problematic because inducements are very common in our everyday lives and we morally permit them. Emanuel states that, “[i]ndeed, inducements are so commonplace and acceptable that our daily lives would be drastically different if they were all prohibited as unethical” (2004, 100). But when is inducement ethically unacceptable? Inducement that dramatically influences people’s judgment, or consent, in order to encourage them to participate in harmful jobs is called “undue inducement” (i.e. unethical inducement). Emanuel, Currie, and Herman identify four “aspects” of undue inducement: 1. an offered good—individuals are offered something that is valuable or desirable in order to do something. 2. excessive offer—the offered good must be so large in excess that it is irresistible in the context. 3. poor judgment—the offer leads individuals to exercise poor judgment in an important decision. 4. risk of serious harm—the individuals’ poor judgment leads to sufficiently high chance that they will experience a harm that seriously contravenes his or her interests. (2005, 336)

According to them, any undue inducement must contain these four aspects. Another important issue related to inducement is “coercion” and this means that the subject has been “threatened” or “pressured” into participating in the research. Wilkinson and Moore state that, “[c]oercion is paradigmatically a case of the denial of autonomy, since it consists in the deliberate imposition of one person’s will on another” (1997, 378). So, coercion necessarily involves physical or mental harm to the subject and this happens when the subject is forced to participate in research against her will. But can inducement be coercive? There is no specific answer to this question as inducement refers to some benefit while coercion refers threat or harm. Grady says, “since the offer of money is not a threat of punishment or harm, but rather an offer, it is hard to see how money as payment for research participation is or could be coercive” (2001, 41). However, some ethicists disagree with him. Emanuel, Currie, and Herman give the example of coercion as “[y]our money or your life” (2005, 336).

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From this discussion, it is clear that inducement and informed consent are intimately connected. Undue inducement and coercive offers are ethically unacceptable, since both of them may invalidate informed consent. In undue inducement, the subject is encouraged to do something out of desperation, while in coercion she is threatened by physical or mental harm. But can inducement invalidate informed consent even if it is neither undue nor coercive? We will review this question in the next section.

Arguments Against Inducement Almost all ethical guidelines and codes discourage inducement. One of the main reasons for this discouragement is that inducement invalidates informed consent. The Council for International Organizations of Medical Sciences says in Guideline 7, Payment in money or in kind to research subjects should not be so large as to persuade them to take undue risks or volunteer against their better judgment. Payments or rewards that undermine a person’s capacity to exercise free choice invalidate consent. (Emanuel, Currie and Herman 2005, 336)

The National Health and Medical Research Council of Australia states that “[v]olunteers may be paid for inconvenience and time spent, but such payment should not be so large as to be an inducement to participate” (Wilkinson and Moore 1997, 373). So, these guidelines emphasize that inducement may be ethically questionable. Three arguments are presented in support of these guidelines. The first argument is that subject may not consider the risk because of the benefits she will receive and so gives her consent; this is not ethical. Ballantyne puts forward this argument in this way, The paternalistic argument against inducements is that...potential participants would be ‘blinded’ by the offer of money and might, therefore, undermine the risks of research, overestimate the benefit of the cash payment or adequately weight the risks. (2006, 7)

Risk is an obvious part of research. Some clinical trials are high risk and may have extreme side effects. For example, Resnik writes, they often are time-consuming, uncomfortable, and painful. Subjects may stay in a medical facility for several days, they may be given a variety of medical test...and they may experience various toxic effects...it is likely

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that most volunteers agree to participate in order to make money. (2001, 54–55)

In this argument, we should at least recognize that there are some risky research trials, which can be uncomfortable and time consuming. But, is the claim justified that people participate voluntarily in research only for benefits? Are they influenced by inducement and then give their consent? Both of the answers to these questions could be ‘No’ because there are many risky jobs in our society where we participate willingly. We are not able to predict all the risks involved in our daily lives; for example, we go to university by bike or by walk through busy and risky highways without knowing when an accident will occur. Take another example given by Resnik: In eastern North Carolina thousands of migrant workers prime, pick, and bundle tobacco every summer when the heat index is well over 100 degree F. This is a job that is arguably much more dangerous, uncomfortable and painful than participating in research. (2001, 55)

Imagine that these workers are not going to be paid for their labor. Will it be better? It seems to me that the answer to this question is ‘no’ because it will not improve the situation, but they will be happy if they were paid a fair wage. The second argument is about better judgment. When inducement is offered it undermines the subject’s better judgment. Prior to participating in any research, a subject should consider what the justifications are for her participation. But if the subjects were offered inducement, they might participate to get the benefits and not consider other factors; this would clearly affect their judgment. Resnik states the argument in the following way, Some writers have argued that we should take steps to protect healthy, poor volunteers from agreeing to participate in research, because they are economically vulnerable and may act against their better judgment. (2001, 55)

This argument also has some limitations. It is possible to argue that making such a claim will devalue human beings’ rationality and create a mistrust surrounding people’s judgments. If we accept that the research subject is competent and able to participate, then we cannot question their judgment. For example, let us assume that a research organization is conducting research on drug addiction and some university students participate in that trial as subjects. We could imagine that these students have some ideas about the drugs, or maybe, they have been provided with

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enough information about the drugs and their effects. Now, can we say that their judgment is not better because of this? There might be many reasons for them to participate in this trial and inducement is only one of them. Resnik himself disagrees with this “better judgment” argument. He says this argument is “overprotective”, and tries to protect people from making their own judgments but as competent people, we will make good as well as bad decisions. We make judgments based on our rationality, competency, autonomy, and liberty. Although it may not possible to always make better judgments, our freedom to make bad decisions or judgments should be equally respected. His second reply is that this argument “overestimates the degree” to which inducement can influence a competent person’s judgment. He says that anyone has the right to refuse to participate in research and that no subject is bound to participate. Inducement may influence our decision but it certainly will not force us to make a bad judgment (Resnik 2001, 55). The third and final argument that this invalidates informed consent is concerned with vulnerable people, especially poor people. It says that vulnerable people (e.g. poor, illiterate, dependent, prisoners, etc.) might participate in research because it is their only option to gain money. They may even not be able to understand what informed consent is. This means that offering inducement to them is unethical. Emanuel, Currie, and Herman put forward this argument in the following way: “[m]any worry that poverty or otherwise compromised circumstances may force people to take an inducement...offers are said to undermine autonomy and voluntariness and therefore, informed consent” (2005, 338). It is an important issue because if subjects are poor, then there is a chance to be exploited. They will also be more eager to get benefits from the researchers anyway. As a result, the researcher could take the opportunity to conduct a risky trial on them. Another point is that it might be easy to use the poor as subjects by paying them an unfair inducement. McNeill very strongly argues against inducement from an “equity” perspective. He says, “[i]t is not equitable that the poor are encouraged to expose themselves to risks of harm, by the offer of a financial inducement, especially when the potential benefit is to others” (McNeill 1997, 395). However, there is no good reason to accept this argument against inducement because even if the subjects are poor and vulnerable it does not imply that they will be unable to make an autonomous decision; they are competent people and agree to participate willingly. Inducement will not decrease their moral status as human beings. Moreover, “equity” or “equality” is a difficult term to pin down as philosophers (e.g. Plato,

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Rawls, etc.) and economists (e.g. Adam Smith, Marx), from ancient times onwards, have struggled to define it. Wilkinson and Moore reject this “equity” argument accordingly. They claim, The equity argument against inducements is the vaguest that we consider. This is partly because, without a great deal of clarifying explanation, the idea of equity is itself vague...here are some of the things that would have to be shown before the equity objection even applies to our position, let alone outweighs the positive reasons for permitting inducements. (Wilkinson and Moore 1999, 116)

From the above discussion, I have tried to show that arguments which claim inducement invalidates informed consent are not fully sound. All three arguments explain some factual events (e.g. risk, economic status, illiteracy, etc.) and then make an unsatisfactory normative conclusion.

Arguments for Inducement Some scholars have claimed that inducement does not invalidate the informed consent requirements. Rather they argue for a reasonable, or acceptable, level of inducement to the subject. They reject the “orthodox argument”, which says that inducement is against research ethics. Although these authors argue for inducement, they agreed that undue inducement and coercion are ethically unacceptable. In this section, I will analyze two important arguments offered by them. Firstly, in our daily lives we often use inducements. Sometimes we offer inducements to our subordinates or we receive inducements as a subordinate. We do it mutually and voluntarily. It does not invalidate our informed consent requirement. This type of transaction is not harmful for each other and is beneficial; everybody is happy. Wilkinson and Moore refer to this situation as “mutually better off”. McNeill gives an example to clarify their argument, he says let us assume that Mr. X is working as a doctor’s receptionist. The doctor pays him overtime which makes both the doctor and the receptionist happy because they are free to make decision and benefited equally (1997, 391). Wilkinson and Moore state, “[p]eople receive inducement all the time...There is no suggestion in the vast majority of these cases that their being paid undermines the voluntary nature of their actions” (1997, 376). So, as we ethically accept these types of inducement in every sphere of our lives, there is no reason to say that inducement in research is unethical. However, I disagree with this analogy because in this example the relationship between the doctor and the receptionist is contractual and a

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contractual relationship is only possible when both parties agree that they will not break or refuse the contract. In a researcher/subject relationship, the subject has the full right to refuse his or her participation at any time. McNeill also disagrees with this analogy. He writes, “I simply disagree on the ground that two are not equivalent and that work is not an appropriate analogy for participating in research” (McNeill 1997, 391). McNeill disagrees for two reasons: firstly, serving as a receptionist and as a research subject are two different types of job. Secondly, he believes that risky work is essential to society. Society needs firemen for the greater benefit of people and, although it is risky, someone has to do this job. It does not justify participation in risky research. Many risky and dangerous jobs are still prohibited in society, but research has some potential benefits. However, participation in risky research is not as necessary to society as the services of firemen (McNeill 1997, 391–392). The second argument against invalidated informed consent is that informed consent protects autonomy and not freedom. Wilkinson and Moore gave an example to explain this argument: imagine the only alternative a person has is to undergo some life saving treatment or they will die, then he or she is not free to choose other alternatives. However, he or she still has the autonomy to accept or refuse the treatment. All the necessary conditions for taking autonomous decision are present here (Wilkinson and Moore 1997, 377). In this analogy, they tried to show that even though the subject is in “desperate need”, inducement does not undermine their autonomy. So, the alternative choice is related to freedom rather than informed consent and informed consent protects the subject’s autonomy not their freedom. In their words, “consent protects autonomy rather than freedom” (1997, 378). To them, “autonomy” and “freedom” are different concepts. Freedom means if we have two or three options then we are free to choose any one of them. By contrast, autonomy is the level of capability a person has to make that decision; for example, we have freedom to either participate or not participate in research. We will be autonomous if no one imposed his or her will on us over which option we choose. Informed consent protects autonomy to ensure that the subject has participated without pressure and she has the capability to make her own decisions.

Should Inducement be Unacceptable? Informed consent is a core requirement in research ethics. The aim of the informed consent requirement is to ensure that the subject has given her consent voluntarily, i.e. there was no pressure or influence used when

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she made her decision. Indeed, informed consent itself has some limitations especially when the subject is poor, illiterate, and dependent. Now, why does inducement not invalidate informed consent? I will use an analogy to answer this question. Let us assume that a university professor conducted research on gene therapy. Some students in her university voluntarily participated in that research and she published her research findings, which were considered the most fundamental contribution to gene therapy. As a result, she was nominated to receive the Nobel Prize for medicine. Do the students have any rights on this Nobel Prize? While I believe that they do not have any rights with regard to the Prize money, they do have a prima facie right over other people in the world to benefit from the research findings. When subjects voluntarily participate in research, it implies that their intension is to benefit humanity. Four basic elements of informed consent are: a. Capacity to consent. b. Full disclosure of relevant information. c. Adequate comprehension of the information by the participant. d. Voluntary decision to participate and withdraw from participation at any stage without prejudice to the participant. (Andanda 2005, 17)

None of these elements will be violated if inducement is offered and, instead, participation with inducement could justify the prima facie right. Subjects could claim to benefit from the research at any time; for example, if they voluntarily participate in AIDS research then they should have priority or greater access (i.e. a prima facie right) to get the newly invented medicine. However, the success of any research is uncertain, and even afterwards there is a market mechanism and this also needs to be considered. So, for this reason the best possible option for researcher is to offer an instant benefit of some sort. The subject has the full autonomy to accept or refuse the offer and that is why inducement may not invalidate informed consent.

Conclusion Some research is risky and people may be under influence to participate in research for inducement, so to protect such types of activities international organizations have developed research ethics in which informed consent is one of the core requirements. Inducement does not necessarily invalidate informed consent. Inducement in research should be allowed only when it is ethical, and neither undue nor coercive.

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References Andanda, Pamela. 2005. “Module Two: Informed Consent.” Developing World Bioethics 5(1): 14–29. Ballantyne, Angela. 2008. “Benefits to Research Subjects in International Trials: Do they Reduce Exploitation or Increase Undue Inducement?.” Developing World Bioethics 8 (3): 178–191. Emanuel, Ezekiel J. 2004. “Ending Concerns About Undue Inducement.” Journal of Law, Medicine & Ethics 32(1): 100–105. Emanuel, Ezekiel, Xolani E. Currie, Allen Herman. 2005. “Undue inducement in clinical research in developing countries: is it a worry?” The Lancet 336 (9482):336–340. Grant, Ruth W., Jeremy Sugerman. 2004. “Ethics in Human Subjects Research: Do Incentives Matter?.” Journal of Medicine and Philosophy 29 (6):717–738. Grady, Christine. 2001. “Money for Research Participation: Does It Jeopardize Informed Consent.” The American Journal of Bioethics 1(2):40-44. McNeill, Paul. 1997. “Paying People to Participate in Research: Why Not?. ” Bioethics 11(5): 390–396. Resnik, David B. 2001. “Research Participation and Financial Inducements.” The American Journal of Bioethics 1(2): 54–56. Wilkinson, Martin, Andrew Moore. 1997. “Inducement in Research.” Bioethics 11(5): 373–389. —. 1999. “Inducement Revisited.” Bioethics 13(2):114–130.

CHAPTER EIGHT THE CONCEPT OF “PERSON” IN BIOETHICS1

Recent bioethical debates on abortion, euthanasia, brain death, prenatal screening, and animal experimentation have complicated the concept of “personhood”. Due to the revolutionary developments in the biomedical technologies, a growing concern over this topic is unsurprising. A human being, even in a PVS state, is rarely distinguished from a person in the religious sense and some bioethicists share this view. However, others do not share the same concept of personhood. This chapter discusses some major views on the concept of “personhood” and their implications in various bioethical problems. It argues that the capacity to use complex brain functions could be a significant criterion to be considered as a person.

Introduction Since the last decade, the concept of “personhood” is one of the central issues in bioethical discussions. The philosophical resolution of many controversies, such as abortion, euthanasia, brain death, prenatal screening, animal experimentation, and so forth, is closely related to the concept of personhood. But who is a person? What are the criteria of personhood? What does being a “person” mean? These are the fundamental questions of personhood. Ethicists who support the conservative view hold that any human being is a person from the moment of conception. That is, only human beings at any stage of their biological developments are persons. There is no distinction between a person and a human being according to this view. Contrary to their stance, supporters of the liberal view believe that personhood deserves some special criteria such as, self-awareness, selfmotivation, rationality, and consciousness. So, some human beings are not 1

Previously published as “The Concept of ‘Person’ and Its Implication in Bioethics” Eubios Journal of Asian and International Bioethics 20, no. 5 (2010): 157–160.

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persons. However, certain animals, for example, dolphins, whales, and primates, according to this rule, are clearly persons. If we accept the latter view then several bioethical discussions, such as animal rights, animal experimentation, as well as responsibilities toward PVS patients, become extremely complex. I begin by discussing different views on “personhood”, and then I will briefly explore the implication of these views on recent bioethical issues. At the end, my own position of personhood will be presented. I have divided the views on the concept of personhood into two sides, the conservative and the liberal. 1. The conservative view: This view is mainly based on religious ideas. Almost all religions have a similar concept of personhood. The Roman Catholic Church’s position is a prominent example of the conservative view. According to this view, the human being is a person from the moment of conception. He or she should be respected and treated as a person from conception. He or she has full moral rights as a person does. Don Marquis’ view is close to Catholic position (cf. Warren 2001, 127). 2. The liberal view: Early in the last century, the terms “human” and “person” were used in the same sense. Generally, these appear interchangeably in discussions. However, many philosophers in the latter half of that century drew a sharp distinction between humans and persons. It is specially found in the writings of Michael Tooley, Peter Singer, and Mary Anne Warren. They all discuss the meaning of personhood, its rights, when it begins, what are its characteristics, and so forth. There are significant differences in their opinions on the criteria of personhood. However, Tooley identifies 17 properties common among contemporary bioethicists. The criteria form a long list and it is possible to include more categories. So, it might be better to identify the significant characteristics of a person. According to some ethicists (e.g. Tooley), the significant criteria of personhood include self-consciousness, rational thought, being a moral agent, non-momentary interests, simple consciousness, and so forth (Tooley 2001, 120). I will now discuss Tooley, Warren and Singer’s liberal view of personhood. Tooley’s view: Tooley separates the concept of personhood into two different meanings: biological and mental. Biologically, all human beings are Homo sapiens and persons. In the latter meaning, some entities that are not human beings (e.g. gods, angels, whales, dolphins, and primates) are also persons. Tooley clarifies the concept of persons by considering the wrongness of killing. He tries to answer whether personhood is a

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necessary condition, or a sufficient condition, for moral status. There are some entities that are non-persons but have the same moral status as a person. For example, the potential person is not the same entity as a person but possesses all the qualities to become a person in the course of time. But how can the moral status of some entities (e.g. anencephalic human babies), which are neither persons nor potential persons, be measured? Tooley finds the boundaries of personhood are controversial. He identifies other issues regarding personhood, for example, All-or-Nothing issues. Do all persons, potential persons, and qua persons possess the same moral status? Or, does the degree of their qualities matter? The dominant view is that personhood does not depend on degrees. Tooley holds that without a systematic moral theory, resolving the personhood issue is difficult. Therefore, Tooley’s position is that capacity for thought could plausibly be the most significant criteria for personhood (2001, 120–121). Warren’s view: Warren defines two meanings for the term “human”: human in a genetic sense and human in a moral sense. In a genetic sense, any member of our species is a human being and no member of another species could be a human being. In contrast, moral sense makes a distinction among human beings and, therefore, some human beings are not persons in this sense. Her concept of personhood involves consciousness capacity (particularly the capacity to feel pain), capacity of reasoning, self-motivated activity, capacity to communicate, self-concepts, self-awareness activity, and so forth. Like Tooley, Warren criticizes the “potential person” argument (2001, 130). In my view, to some extent, Tooley’s arguments are more acceptable. I agree that there are a lot of uncertainties from conception to birth in the mother’s womb. Anything may happen before the human fetus meets the criteria of personhood. But as soon as it becomes viable, the fetus achieves some important qualities, such as brain function, psychological, mental and social relationships with the mother, and so forth. In fact, at this stage, the relationship between fetus and mother is almost the same as an adult child. So, the fetus receives its mother’s love, feelings, and emotions due to its characteristics at the time of viability. These unique qualities of the fetus could be sufficient for personhood. Singer’s view: Peter Singer generally defines persons as rational and self-aware beings. He strongly criticizes speciesism. Tooley also says that species membership is not itself morally significant (cf. Tooley 2001, 123– 124). However, I believe that this philosophical stance is incorrect as speciesism is not a barrier to achieving a moral status. Rather, one’s species is important for identification. If a human being and a rat are transgenically bred, then we do not know the species of that new entity, let

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alone its moral status. So, one’s species is important for claiming moral status. It is also possible to establish this thesis from contemporary animal ethics. Philosophers like Singer, Cavalieri, and Orlans, argue that great apes (humans, chimpanzees, and gorillas), at least, possess moral status. According to them, great apes are persons as they have psychological, social, and rational similarities to human beings (cf. Orlans 2001, 409). It is not acceptable that they are just arguing for the moral status of one special species (apes), but not for protozoa, or other lower species. Although they are against speciesism, I still consider it to be a double standard. On the one hand, they are criticizing speciesism, while on the other they are claiming moral status for a certain species. So, the argument against speciesism is circular.

Implications of the Concept of Person for Various Bioethical Issues The concept of personhood has various implications for bioethical issues. Moral considerations of many bioethical issues depend on how “personhood” is defined. The concept of personhood is a crucial concern for the debate on abortion, euthanasia, brain death, responsibility to anencephalic children, and the moral rights of animals. I will focus on these issues.

Abortion The traditional argument regarding abortion is that it is wrong to kill a person. A human fetus is a person; therefore, it is wrong to kill a human fetus. The moral permissibility of abortion relies on the second premise. Some ethicists make a sharp distinction between the terms “human” and “person”. They offer some necessary criteria for personhood. On the basis of these criteria they argue that the fetus, even a newborn child, does not qualify as a person and therefore abortion, specifically late abortions, are morally acceptable. Some ethicists argue that a fetus at the viability or pain reaction stage has consciousness, which provides it with the ability to feel pain and this is sufficient reason to consider a fetus as a person. So, a viable fetus has full moral status as a person and, therefore, abortion is morally wrong at this stage. The conservative ethicists argue that the human fetus has potentiality from the moment of conception. Therefore, there is no difference between a fully developed human being and a zygote. Abortion is wrong at any stage from conception to birth. Hence, three positions could be identified regarding the moral status of human

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embryo and fetus. These are: Radical Gradualism, Moderate Gradualism and Absolutism. These three positions basically demarcate three different conceptions of personhood. Thus, defining the correct conception of personhood could settle the moral as well as the legal status of abortions.

Euthanasia The term “euthanasia” means “allow to die”. Euthanasia can be understood in two different ways. If a physician administers “a lethal injection” to a terminally ill patient, from the point of view that it is better for the patient to die, then this act is euthanasia. Another form of euthanasia is withdrawing treatment, withholding treatment, deep sedation, and so forth. Voluntary euthanasia is performed after an informed request is made by a competent patient. But several situations may occur where non-voluntary euthanasia becomes necessary. For example, an individual might be in a persistent vegetative state (PVS), an irreversibly deep coma, or have Alzheimer’s disease, and as a result is incapable of having consciousness, thought, feeling, and recall memory. The moral decision for non-voluntary euthanasia involves personal identity.

Brain death The traditional criterion for death is when the heart and lungs have ceased to function. After a person’s breathing has stopped, within a few minutes the cognitive brain function ceases. However, the development of life-sustaining technology and modern medicine can continue a person’s functions artificially. For this reason, a wide range of ethical questions emerge that redefine death. Death is now defined based on the function of the brain. There are two views on the brain death issue, both of which relate to the concept of personhood. First, the whole brain death, which means when the brain ceases integrating and coordinating functions, including psychological functions like consciousness, thought, and feeling. Second, higher brain death means that the cerebrum is fully damaged, although respiration and heartbeat function continues. Is such a patient a person? Bioethicists have different views in answering this question (cf. McMahan 2001, 250–254).

Personhood and Brain function The concept of personhood is a classic problem that has been discussed in many fields. Today, it is not limited to philosophical discussions,

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academic journals, or newspapers as, rather, it is about the ethics of killing and letting someone die. Immanuel Kant places emphasis on rationality and believes that it is the sole criterion of personhood. However, John Locke considered a person to be a thinking intellectual being with the capabilities of consciousness, reason, and reflection. This conception of personhood is wide and includes any species (e.g. animal) that has these capabilities. After Locke and Kant, many criteria of personhood have been proposed. My primary focus is on complex brain functions. The human brain function is more complex than that of animals. In addition, the distinction among humans at different stages of their development is the capacity to use complex brain functions. A fully developed human being is more able to use its brain function, but, in contrast, a viable fetus is less capable of using its brain function. Self-awareness, thoughts, ability to feel pain, and so forth are all proposed criteria within brain function. But the capability of using brain function is not the same for all creatures; therefore, this is my sole criterion for personhood. Now, using this criteria I will examine the three basic arguments: fetuses have no personhood; marginal people, such as infants, have no personhood; some non-human animals do have personhood. Embryos and fetuses develop gradually and there is a significant point in this process when viability occurs (week 24). At this point, fetus brain function is fully developed with the ability to feel pain, as well as the ability to survive outside the womb. The only limitation is that fetus could not fully use these complex brain functions. The capacity to use complex brain function is gradual for the fetus, and also for fully developed human beings. So, both possess active, unique, complex brain function and, in this sense, the viable fetus is a person. In my opinion, marginal peoples (infants, newborns) are also persons. However, the anencephalic and PVS patients are not persons because they do not have even the minimum capacity to use complex brain function. But they are semi-persons, by which I mean they have not full rights as a person, although they do have a right to receive care. We may also have personal and social relations with them. In the case of animals, we may compare the capability of a human fetus to animals and deduce that some non-human animals are persons but such type of analogy is a categorical mistake. Animals have consciousness, but they do not have consciousness of rights and duties. They have feelings, but are unable to provide justification for those feelings. Moreover, I think they lack the capacity to use complex brain functions like human beings. So, animals are not persons, but they are semi-persons.

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Conclusion The issue of the criteria of personhood is still unsolved. It is very difficult to identify all the criteria for personhood, although we may characterize a person as a being with higher mental capabilities.

References McMahan, Jeff. 2001. “Brain Death, Cortical Death and Persistent Vegetative State.” In A Companion to Bioethics, eds. Helga Kuhse and Peter Singer, 250–260. Oxford: Blackwell Publishing Ltd. Orlans, F. Barbara. 2001. “History and Ethical Regulation of Animal Experimentation: An International Perspective.” In A Companion to Bioethics, eds. Helga Kuhse and Peter Singer, 399–410. Oxford: Blackwell Publishing Ltd. Tooley, Michael. 2001. “Personhood.” In A Companion to Bioethics, eds. Helga Kuhse and Peter Singer, 117–126. Oxford: Blackwell Publishing Ltd. Warren, Mary Anne. 2001. “Abortion.” In A Companion to Bioethics, eds. Helga Kuhse and Peter Singer, 127–134. Oxford: Blackwell Publishing Ltd.

CHAPTER NINE PATIENT–PHYSICIAN RELATIONSHIP IN BANGLADESH1

Since the Greek Hippocratic Oath (5th century B.C.), the principles of an ideal patient–physician relationship model have had a high priority, and recently this has become a growing concern for bioethics. The questions being asked are whether a single model is appropriate for both Western and developing societies? Do scarcity, illiteracy, and cultural values matter at all for the patient–physician relationship? If so, which model could be appropriate for a country, like Bangladesh, that has a large population and a low level of literacy? This chapter focuses on these questions and analyzes various patient–physician relationship models. After examining them from the Bangladesh perspective, it argues that paternalism alongside other models have failed to be considered satisfactory. Perhaps an alternative model that is committed to care and, at the same time, respectful to patients’ autonomy might be appropriate.

Introduction The patient–physician relationship is one of the major issues in Bangladesh healthcare. It touches everyone’s lives from villages to the capital city, Dhaka. The relationship is rather complex in Bangladesh because physicians claim that it is not possible to maintain an ideal relationship with patients, since they have to provide services for a huge population within a limited timeframe. For instance, writing on patient expectations, two renowned physicians in Bangladesh point out that, “[a]pparently there are many expectations which can only be met if a doctor is a missionary...He is a professional rather than a missionary” (Absar and Rahman, 8).

1

Previously published as “On Patient-Physician Relationships: A Bangladesh Perspective” Asian Bioethics Review 3, no. 2 (2011):65–84.

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In contrast, patients claim that physicians are not only careless but they also often ignore patients’ rights. For example, an in-depth study conducted in Dhaka Medical College and Hospital (DMCH), the country’s main center for public health services, reports that 43% of outpatients were dissatisfied due to an “absence of doctors on time, careless treatment and presence of other people (such as medical representatives) during treatment” and 48% of inpatients mentioned “irregular visits by the doctors” (Akter and Islam 2006, 1). So the question is: What is the appropriate model of a patient–physician relationship for a developing country with a large population and high illiteracy rate, such as Bangladesh? Should we follow the same models proposed for the Western societies? Are illiteracy, scarcity, and cultural differences morally significant when we consider the patient–physician relationship? In the 1990s, the American Medical Association laid out some fundamental elements of the patient–physician relationship, where they stated that not only the physicians’ obligations but also the patients’ rights (such as the right to information, and involvement in the decision-making process) should be made the highest priority (1990, 3133). Nowadays, the basis of the patient–physician relationship is more patient-centric rather than physician-centric. As a result, the traditional paternalistic model of “Doctor knows best” has been replaced by new models. However, each and every model has attempted to answer some fundamental questions about the authority of the physician, patients’ rights, and their autonomy. I will discuss the patient–physician practice in Bangladesh after providing a brief overview of the country’s healthcare system. Then, I will explain recent patient–physician relationship models that are influential in Western societies. Finally, I will examine whether any of these models are appropriate for Bangladesh.

An Overview of the Healthcare System in Bangladesh Bangladesh is a small country with a large population in the South Asian region. The country became independent by a War of Liberation in 1971. Most of the population is Muslim (88%), although a considerable number of citizens are Hindus (10%), Christians (1%), and Buddhists (1%). Although Bangladesh has a good tradition of religious harmony, a rich cultural heritage, and an international reputation for micro credit innovation, the country faces many problems, such as massive corruption in all sectors, poverty, political instability, and a low literacy rate. According to the Human Development Report, United Nations Development Programme, UNDP 2009, it ranks 112th in the Human

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Poverty Index (HPI-1) among 135 developing countries in the world. About 40% of the population lives below the national poverty line. Bangladesh has a life expectancy at birth of 66.7 (F) and 64.7 (M), adult illiteracy rate 46.5%, and GDP per capita of US$423. Total Health Expenditure (THE) of Bangladesh per capita is about US$10 and per capita public expenditure on health is US$3 (UNDP 2009). Nonetheless, the millennium goal of the country is “health for all” and for citizens to have the constitutional right to receive healthcare. The health sector in Bangladesh can be divided into two categories: education and service. The country has a well-equipped medical university and hospital, 18 government medical colleges, 41 private medical colleges, 11 private dental colleges, and 39 private institutes of health technology. There are 589 government hospitals in the health sector and the number of non-government hospitals is 2,271 (Health Bulletin 2009, 11 & 45). Three types of healthcare services, namely public, private, and NGO, are available in Bangladesh. Public healthcare services are based in medical college hospitals, postgraduate hospitals, specialized hospitals, district hospitals, Maternal and Child Welfare Centre, Upazila Health Complex, Union Health Centre, and community clinics. Private hospital services are mainly based in the capital city and they provide expensive, modern facilities, while NGOs and the government serve the rural area. Most people, especially the poor, are dependent on government services for healthcare and only a few can afford private facilities. Apart from this allopathic scheme, homeopathic and traditional herbal treatments are also popular in Bangladesh (Banglapedia 2006). There is a government homeopathic as well as an Ayurvedic medical college hospital in the country. According to the Ministry of Health and Family Welfare, Bangladesh, there are 49,994 registered physicians and 3,481 registered dental surgeons for the whole population (more than 124 million) (Health Bulletin 2009, 15). UNDP report mentions that only 26 physicians are available for every 1,00,000 people, while the population living below US$1.25 per day is 49.6%, and the population living below US$2 per day is 81.3% (UNDP 2009, 2007/2008). Clearly, this data shows a very poor physician/patient ratio and this has a significant impact on the patient–physician relationship. Dealing with too many patients and the prevalence of conflict of interest has serious negative consequences. In some cases, one can even doubt whether a patient–physician relationship is actually present in treatment decisions.

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The Patient–Physician Practice in Bangladesh The patient–physician relationship in Bangladesh is very negative. Physicians’ negligence, carelessness, absence from duty, lack of attention and time, irresponsibility, incorrect treatment, unwillingness to provide information, and business attitude are frequent problems in Bangladesh (Akhter and Islam 2006, TIB 2008, Begum 2001). Recently, after having visited one notable physician’s office in Dhaka, a medical student reflected: The patient is frequently barred from giving information s/he wanted to tell. But patients are not cars or televisions, which can be fixed with a tune-up. They are living human beings whose humanity must be respected if treatment is to succeed. (Hubbard 2010)

The role of the physician in Bangladesh is multi-dimensional. A senior physician is often a teacher in medical college, an executive of the hospital, and a private practitioner. Most physicians work as medical officers and private practitioners. In addition, physicians work in diagnostic centers or receive commissions from them and this means that they have competing interests. Indirectly, they are also affiliated with pharmaceutical companies to help the marketing of medicine, i.e. they prescribe medicine to their patients and get a percentage of the cost from the company (Knox 2009, TIB 2008). All these issues have a major influence on the patient–physician relationship. As Bangladesh is a highly populated country, each physician has to deal with many patients every day. However, people do not visit physicians until they are really sick. When rural people feel sick, they usually take medicine from the nearby pharmacy or village doctor without consulting a registered physician. The pharmacist and village doctor have limited training in medicine and so they can only give them medicine, as they understand the disease. Both free consultations and an intimate social relationship, help villagers to make decisions. When there is no improvement, or the illness rapidly gets worse, they have to attend the local government hospital. At this stage, two things are important for the patient: one is cost and the other is the decision-making process. Since the patient’s condition is serious and he does not have the ability to undergo costly treatment, it becomes apparent that he is clearly suffering from a psychological weakness. Patients are fully dependent on the decisions that their physicians make. The decision-making process is strongly paternalistic and questionable. Initially, the physician hears about the disease from the

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patient or the family and within a few minutes he makes some sort of diagnosis and a decision. In the case of surgery, the physician asks the family whether they are financially able to meet the costs. If all the treatment in the local hospital fails, the physician sends patients to the capital city’s government hospital. In the capital city, physicians are even busier and involved in many jobs, such as private practice, consultation in private hospitals, and so on, which are all in addition to their service in government hospitals. Nevertheless, they know that the patients have been suffering for a long time without making any improvement. Meanwhile, the patient has spent a significant amount of money, which has possibly been collected by selling household goods, or through loans from relatives. At this stage, the patient is desperate and surrenders himself to the physician. As a result, the patient–physician relationship becomes very paternalistic. However, in a situation where people are vulnerable (economically, physically, and emotionally), care with sympathy, communication, active and proper treatment, sufficient health information, and so forth is required instead; this can rarely be found in healthcare practices in Bangladesh.

Some Common Problems with the Patient–Physician Relationship in Bangladesh I have already mentioned that Bangladesh has a high shortage of physicians. Naturally, a physician has to deal with too many patients. This limitation is partially responsible for the vulnerability of patients in their relationship with their physicians. However, the main causes are physicians’ negligence and absence from duty, greediness for money, carelessness, unaccountability, conflict of interest, medical malpractice, and so forth. I would now like to discuss some common problems with the patient– physician relationship in Bangladesh. Firstly, a good percentage of physicians are absent from their jobs, despite the fact they receive a salary from the government; this is because they are involved in other businesses and, therefore, most physicians allocate very little consultation time for the patient. The government and international organizations have discussed this situation in several reports. One of these reports HNPSP 2003 states: Absenteeism of health care providers is a major concern; consultation time is very short (2–3 minutes), with almost no privacy ... Most of the time, providers are busy with other activities, including private business. (quoted in Andaleeb, Siddique and Khandakar 2007a, 255)

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The HNPSP APR 2009 recognizes that some improvement has been achieved, but it also emphasized the accountability and behavioral pattern of the physicians: when health professionals have better understanding of the lives and concerns of poor people, they are more willing to change their behaviour towards them and provide services which make poor people feel welcome. (HNPSP 2009, 61)

Secondly, Nahar also identified the fact that physicians demonstrate a lack of care and good behavior towards their patients. She writes: There is wide concern about the attitude and behavior of doctors. Patients want a professional approach, careful observation, polite and humane and easy communication with physicians. Unfortunately this is far from the behavior usually experienced. (quoted in Andaleeb, Siddique and Khandakar 2007a, 255)

Thirdly, Begum critically examines the correlation of illiteracy, poverty, and physicians’ accountability in the Bangladesh context. She writes: Hence, lack of education among the people makes the process of gratifying the self-interest of the health-care professionals easier. They make money through financially rewarding private practice, neglecting their duties at various medical hospitals and clinics, both in the private and the statefunded sector. The accountability for such negligence is almost absent as the patients are either not aware of their rights or are not powerful enough to raise their voices against such unethical practices. (Begum 2001, 51–52)

Furthermore, by referring to an incident published in The Independent, a national daily newspaper, Begum gives a clear and common scenario of unaccountability, negligence, and medical malpractice in Bangladesh. She says: Absence of any accountability for medical malpractice is another poverty related fact, which hinders the realization of a morally viable society. Recently in Dhaka, the capital of Bangladesh, a surgeon, Dr. Habibur Rahman, took out the healthy kidney of Rubel, a 16-year-old boy, instead of the non-functional one. The doctor admitted his mistake casually and called it a “medical mistake”. Due to this ‘medical mistake’ the boy eventually died in another hospital...The parents of the boy had already spent all their resources on the treatment that was meant to save their son. They had no money left to sue the doctor...negligence. (Begum 2001, 54)

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Finally, Andaleeb, Siddique, and Khandakar have specified some additional negative qualities in physicians, which seriously influence the patient–physician relationship. They write: Particularly disturbing is their lack of empathy, casual demeanor, aggressive pursuit of monetary gains, palpable incompetence and occasionally, their disregard for human suffering that patients endure without being able to voice concerns. (2007a, 254)

These remarks show that beyond the low physician–patient ratio, there are other crucial reasons that make the patient–physician relationship difficult. These include overpopulation, illiteracy, and poverty, all of which are responsible for placing the physician in a stronger position in the hierarchy; these factors eventually result in unaccountability, irresponsibility, distrust, medical malpractice, and so forth. The examples mentioned here may even indicate that there is no appropriate patient– physician relationship in Bangladesh, and this malpractice needs to be strongly criticized. We certainly agree with these conclusions, but we also want to take it one step further because, in general, there is still another dominant picture underlying the healthcare practice. This dominant picture needs to be uncovered because when we know what it is then we can make adjustments to this model in order to improve the ethical quality of the patient–physician relationship in Bangladesh.

Patient–Physician Relationship Models In the last century, scholars have proposed various models for patient– physician relationship; for instance, Robert Veatch (1972) explores four models, Childress and Siegler (1984) five models and a few years later, Pellegrino and Thomasma (1988) suggested the beneficence model. Finally, Emanuel and Emanuel (1992) offer four models: paternalistic, informative, interpretive, and deliberative, although they do favor the deliberative relationship as the ideal model. All these models have significantly contributed towards identifying the basic principles of the patient–physician relationship.

Paternalistic Model The paternalistic model states that a patient should receive the best possible treatment from the physician for his health, even if he does not know what is good for him. Gerald Dworkin defines paternalism:

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By paternalism I understand roughly the interference with a person’s liberty of action justified by reasons referring to the welfare, good, happiness, needs, interests or values of the person being coerced. (quoted in Häyry 1991, 51)

Firstly, the above definition indicates that paternalism violates, or at least interferes, with a patient’s autonomy. Secondly, paternalistic behavior has to be justified by some positive phenomena such as the patient’s “good” or their “welfare”. Thirdly, paternalism holds that coercion is morally permissible. In the paternalistic model, it is the physician’s responsibility to diagnose, identify the cause of disease, and reduce the patient’s suffering by using his skills and knowledge. It means that a physician acts as the patient’s guardian and his inner morality provides him with strength to take any initiative for the well-being of the patient. One important thing to note, with this model, is that a physician will encourage the patient to give consent and, if necessary, the physician can authoritatively inform the patient about their treatment. Veatch’s “priestly model” is similar to this model. The priestly model gives the physicians full authority to make their own moral judgments for the benefit of the patient. This model views the physician as a priest or a moral expert. The basic moral principle of this model in Veatch’s words is to “[b]enefit and do no harm to the patient” (Veatch 1972, 57–58). The priestly model can be seen as an alternative of the traditional “fatherhood” conception in the patient–physician relationship. The physician is a symbolic father while the patient is an innocent child. In a paternalistic model, it is not mandatory for a physician to disclose all the information, or for a patient to agree with all the treatment decisions made by the physician, because the physician’s aim is for the health and well-being of the patient (Emanuel and Emanuel 1992, 2221–2222). Each model has advantages as well as disadvantages. Paternalism is a very old and influential model for the patient–physician relationship. Almost all medical codes, including the Hippocratic Oath and the American Medical Association codes, were paternalistic until the mid-20th century. Paternalism is based on higher order moral qualities and states that physicians are “morally obliged” to act for a “patient’s benefit”. Paternalism recommends a physician’s superior position because he knows the patient’s best interests. A physician has a moral permissibility to ignore the patient’s wishes and even use coercion; therefore, paternalism is defensible in emergencies. The following are two of the main criticisms against paternalism:

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(a) Paternalism undermines the patient’s autonomy and respect. Modern ethicists (Buchanon, Childress) argue that the paternalistic model is incompatible with a patient’s autonomy and respect. Buchanan writes: There are two main types of arguments against paternalism. First are the arguments that rely upon a theory of moral rights rooted in a conception of personal autonomy...Second are the arguments that meet the paternalist on his own ground and then attempt to cut it from beneath him by showing that his arguments are defective. (1981, 214)

The first argument is the problematic theoretical foundation of paternalism, while the second argument is concerned with the defective application generally favored by paternalist medical practitioners. (b) Patients can disagree with their physicians about their best interests and best treatment options, and the paternalistic model can, therefore, be an unsatisfactory solution to such disagreements. After all, why should the physician always be right? For example, Childress and Siegler mention that the physician might consider cigarette smoking as a disease, but the patient could understand it as merely a bad habit. This disagreement may also arise with the contradiction of other values, such as religious values, because, for instance, for a Jehovah’s Witness the patient’s heavenly salvation is more important than a blood transfusion, while for a physician, saving lives is more important than salvation (1984, 18). Emanuel and Emanuel write that, “it is no longer tenable to assume that the physician and patient espouse similar values and views of what constitutes a benefit” (1992, 2224). Thus, there is no satisfactory solution to these disagreements within the paternalistic model because the physician claims absolute authority over health decisions.

Informative Model The informative model is more patient-centric. That is, the physicians provide all the information about a disease and offer different available treatments to the patients; then, it is up to the patient to make the best decision. After the decision has been made, the physician executes the treatment. Patients receive information about possible risks and benefits associated with the treatment, existing uncertainties and limitations, the possibility of achieving a cure from different types of treatment, and so forth. So, the patient’s obligation is to select the best treatment, while the physician’s obligation is to offer correct, up-to-date, truthful information, his areas of competency as well as his limitations. In addition, the physician should provide information about the possible cost of treatment.

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In this model, we may compare the physician’s role with an expert technician who is available to serve according to the will of consumers (Emanuel and Emanuel 1992, 2221–2222). Veatch calls this model the “Engineering model”. In the engineering model, the physician is seen as an “applied scientist”. His role is to cure the patient’s disease in the way that a plumber repairs something. The physician will be “factual” rather than a value-owner. Moreover, the physician will inform the patient of all facts and offer to choose the best option. The physician has an obligation to act for the patient’s will even if he believes otherwise (Veatch 1972, 57). In the informative model, the patient’s autonomy is respected more strongly than in any other model. The patient is fully free to make decisions about his treatment. Moreover, he is well informed about the risks and probable benefits. As a result, the patient has the opportunity to make plans about his own treatment. Still, these advantages of the informative model do not qualify it as an ideal patient–physician model since, in this model, a physician’s influence is very minor. A physician has a moral responsibility to advise, in a neutral way, the best treatment for the patient. He will not only inform the patient of the condition of the disease and available treatment but also suggest the best option to recover from the disease. A good physician will help the patient to come up with a suitable decision. Lelie and Verweij reject the informative model for two reasons. Firstly, “it obliges the physician to provide the patient with value-free information” (2003, 25). Why is valuefree information problematic? It is because value-free information is impossible, particularly when a physician intends to give information to treat their patients. Secondly, “the informative model cannot function as an ideal for the relationship between doctor and patient...it simplifies and impoverishes the physician-patient relationship” (Lelie and Verweij 2003, 25). The authors have provided four reasons why the informative model damages the relationship. Firstly, this model discourages the physician from having an “empathetic attitude” towards the patients. Secondly, in its literal sense, the physician may not interfere with the patient’s opinion or preference. Thirdly, this model does not allow the physician to discuss his experience, which would sometimes be helpful for the patient. Fourthly, the focus is on providing information and, therefore, “neglects” that fact that sometimes the patient’s choices need to change during different stages of treatment (Lelie and Verweij 2003, 25–26).

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Interpretive Model In the interpretive model, a physician’s role is comparatively active. That is, an interpretive physician will provide correct, appropriate, and true information to the patient, in order to help them come up with a decision; these roles are similar to the informative physician. Furthermore, interpretive physicians passively take part in the decision-making process. They explain all the possible treatment options, including risks and benefits, and suggest which option should be chosen. They provide justification for the best suitable option that is most compatible with the patient’s values and needs. So, the physician’s role in the interpretive model is similar to that of counselor or an adviser. Emanuel and Emanuel compare the physician’s role in the interpretive model with cabinet ministers who give advice to the head of state by providing information, explanations, and suggestions (1992, 2221–2222). Veatch calls this model a “collegial model” because it seeks a balance between autonomy and influence. In this model, the physician and the patient are colleagues and they have a common goal to eliminate illness and suffering. Their relationship is based on trust, confidence, and fellow feelings. No one stands in a superior position and respect, autonomy, and values are seen from an equal as well as “harmonious” perspective (Veatch 1972, 58–59). The interpretive model focuses on the “explanation”, or “elucidation”, of different healthcare values. Individual understanding of relevant healthcare, mutual understanding of treatment procedures, and the resolution of healthcare conflicts make this model more attractive. Nevertheless, the interpretive model also has some limitations. Primarily, the physician’s preferences or values might influence the patient’s choices. The physician has to deal with different types of patients and their values will also differ. Sometimes, it may be difficult for a physician to advise in an impartial way. In particular, the physician may not properly analyze either the patient’s values, or other relevant values, in the limited consultation time. As a result, there is a chance that the physician may impose his own values on the patient and this will open the door to paternalism. As Emanuel and Emanuel say, “[s]uch circumstances may push the interpretive model towards the paternalistic model in actual practice” (1992, 2224)

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Deliberative Model The fourth model is the deliberative model, which emphasizes the moral deliberation of the patient’s values. Like the previous two models, a deliberative physician will provide all information about the patient’s condition, explain the most suitable health-related values, and then help to the patient decide on the best treatment among the different options. In addition, the physician will engage in a dialogue with the patient in order to clarify which values are preferable. The physician is able to deliberate with patients that all values are not morally significant, or related to their disease and treatment. So, the physician’s aim is moral persuasion and not coercion. After the dialogue, the patient will select the best option for treatment on the basis of important moral values. In this model, the patient gains the capability of judging different values, their importance, and application in clinical treatment. Therefore, the physician’s role in this model is that of a teacher, or even a friend (Emanuel and Emanuel 1992, 2222). Emanuel and Emanuel claim that the deliberative model is the most preferable and suitable model for Western societies. In addition, this model could be regarded both “descriptively” and “prescriptively” as the ideal patient–physician relationship model. The authors offer six points for their claim. We will consider some of their points here. Firstly, in the deliberative model, the patient’s autonomy is recognized as the ideal conception of autonomy and one that requires “critical assessment”. Secondly, an ideal physician will make his recommendation consistent with cultural, social, and literary values. Thirdly, although, like a teacher or friend, a deliberative physician will try to “persuade” the patient; it is not in a paternalistic manner (Emanuel and Emanuel 1992, 2225–2226). Like other models, the deliberative model also has some limitations. Firstly, Emanuel and Emanuel claim that the physician’s role in the deliberative model is like a teacher or a friend; however, “teacher” and “friend” are two separate types of relationship. A teacher, as mentor or coach, helps students to become wiser, while a friend deserves an intimate relationship where certain values are central, and those values can be shared. Secondly, this model emphasizes the importance of moral deliberation and by this Emanuel and Emanuel mean that the patient and the physician carefully discuss which values are significant for a particular treatment and why these values are worthier than other morally relevant values before making any decisions (1992, 2222). This procedure can be time consuming. Therefore, we can say that each model has both advantages and limitations. Indeed, a particular model may not be appropriate for all

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circumstances. I have presented a general picture of the patient–physician relationship in Bangladesh and I will now examine which model fits best.

Which Model Seems Appropriate to the Bangladeshi Perspective? (i) Physicians as priests, parents, or guardians; patients as children. Physicians perform the role of priests, or parents, in the paternalistic or priestly model. There is a long tradition of using this model in Bangladesh and this is because “strong paternalism” is rooted in the country’s social and cultural structures. However, “[s]trong paternalism consists of overriding the competent wishes and choices of another” (Pellegrino and Thomasma 1998, 7). Hui writes, “in its strong form, physicians authoritatively order patients to assent (with coercion if necessary)” (2005, 222). In strong paternalism, withholding information, telling lies, and even coercion, are morally permissible. The main objection against paternalism is that it undermines a patient’s autonomy. Many physicians in Bangladesh use these negative aspects of paternalism rather than its other focus on the best interests of the patient. They exercise their full power to dominate or override the patient’s interest. Patients allow physicians, in good faith, to make whatever decision they think is best for them, while some physicians take advantage of this faith. Each year, a good number of patients die, or become disabled for life, as a result of a physician making the wrong decision or providing inappropriate treatment. So, the overall consequence of strong paternalism in Bangladesh is extremely dangerous. (ii) Physicians as teachers; patients as pupils. In the deliberative model, physicians act as teachers and patients as pupils. Although Emanuel and Emanuel argue that this model is the best patient–physician relationship, it may not be appropriate for Bangladesh because, in this model, it costs physicians a lot of time and patients a lot of money. The authors also mention this point: Most important, we must recognize that developing a deliberative physician-patient relationship requires a considerable amount of time. We must develop a health care financing system that properly reimburses— rather than penalizes—physicians for taking the time to discuss values with their patients. (Emanuel and Emanuel 1992, 2226)

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In addition to the inadequate healthcare financing system in Bangladesh, many patients are illiterate, so they may not be able to correctly follow the moral deliberation of physicians. (iii) Physicians as expert technicians or rational contractors; patients as consumers. In the informative model, the physician’s role is that of an expert technician, or contractor, while the patient is the consumer. This model is too formal and, in Bangladesh, this model would be particularly challenging owing to insufficient physicians and very lowincome patients. However, this type of contract could work if the parties involved obey moral rules and the legal system was free. This model is blooming in the private health sector of Bangladesh. However, the informative model could be more dangerous in Bangladesh because some physicians may give exaggerated information in order to attract more patients for treatment. There is also a chance that patients will misunderstand the information. Information is obviously helpful for both the patient and physician, but it should not form the basis of their relationship. Moreover, as a great number of patients are illiterate, they may not be able to use information properly. (iv) Physicians as advisers or counselors or friends; patients as identifiers. In the interpretive model, physicians are counselors and patients are identifiers. Counseling is essential for patients and, undoubtedly, health counseling is needed for Bangladeshi patients. An interpretive physician will interpret the disease condition, (i.e., provide information to the patients). However, the part of this model that is most suitable for the Bangladesh context is the fact that a physician may interpret a patient’s condition in a biased way and impose his own values on the patient. Who will ensure that the particular interpretation is correct? Who will take the responsibility if a patient is misguided? What moral law will guide physicians? These are the most crucial questions. Bangladesh actually needs more morally enlightened and committed counselorphysicians, who will be guided by their own moral principles, so that patients can benefit from caring treatment.

Corruption and the Patient–Physician Relationship Model Corruption is one of the major problems Bangladesh faces. According to the Corruption Perceptions Index (CPI) 2010 from Transparency International, a Berlin-based global organization against corruption, Bangladesh ranks 12th from the bottom and is, therefore, extremely corrupt

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(TIB 2010). Their Bangladesh chapter, “Transparency International Bangladesh (TIB)”, mentions three main types of corruption in the healthcare system: harassment and bribery, private business by government physicians, and expensive pathological tests, in a countrywide household survey 2007 (TIB 2008). As stated in the present healthcare policy of Bangladesh, patients are not required to pay a consultation fee in a government hospital, but the report found that “doctors in hospitals take money from patients for writing the prescription” (TIB 2008, 28). Moreover, without taking proper care, patients were “advised to visit the private chamber/clinic of the doctor” (TIB 2008, 28). In the case of pathological tests, “patients had to incur more costs for the same services that had been available in public health centers...for their private gains” (TIB 2008, 30). Thus, corruption is not only making the whole system vulnerable but also creating serious mistrust within the patient–physician relationship. This has significantly contributed to the build-up of an improper relationship throughout both urban and rural areas. It seems that a good number of physicians are rarely committed to their patients. But why are they so reluctant to perform their duties? What are the dissatisfactions that push them to corruption? Research conducted by Dr. MM Rahman et al. identifies some crucial reasons for these issues. The first is about the physician’s present dissatisfactory status and they argue that, “[a]lmost 77% doctors were not satisfied with their present status as they were more interested [in their job] post-graduation. Besides that, outdoor doctors also had complaints [over] poor salary, high work load...and health policy” (Rahman MM et al. 2007, 569). It is noticeable that many physicians want to pursue postgraduate studies in order to gain “financial solvency and better social status” rather than professional improvement. In addition to improper health policy, “corruption in management and employee’s union” was also mentioned. Another cause is related to the physicians’ MBBS curriculum where very little emphasis is given to humanities subjects (such as medical ethics, psychology, etc.). Finally, “[l]ack of other man power (nurses and other staff), deficiency of enough equipment, small number of facilities for training” (Rahman MM et al. 2007, 570) were also reported. So, the analysis shows that corruption and scarcity both are fundamentally connected to patient–physician relationship models. However, these problems are not new in Bangladesh, and in the last few years, the country had been fighting against them. Recent governments have achieved a slow, yet positive result because, while Bangladesh was considered to be the most corrupted country in the world for five years

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from 2001 to 2005, according to the CPI, a nationwide policy program, HNPSP, was implemented in 2003 (TIB 2010). Currently, its position has improved to 12th as previously mentioned. There is no doubt that as long as corruption persists, none of the models will function. Nonetheless, eliminating corruption is a long-time mission in comparison to creating an adequate health policy, balanced medical curriculum, increased postgraduate opportunities and training, a separate salary structure for physicians, and so forth. We have to take these facts into consideration in order to offer an ideal model. Apart from corruption, an ideal model for Bangladesh would be to consider illiteracy, scarcity, and culture. Do the discussed models consider illiteracy, scarcity, and cultural aspects? “Physicians as guardians” is the model that is commonly practiced in a developing country like Bangladesh. Nevertheless, the impact of paternalism in Bangladesh is terrible, as we have presented in the previous sections. In Bangladesh, patients tend to depend upon their families and sometimes they even play a part, with the physician in the medical decision-making process. The remaining three roles of a physician (teachers, contractors or technicians, and counselors) do not enable such values. In addition, an illiterate person may not be able to follow contract information, and so forth. They expect care, advice and sympathy from the physician rather than an overly formal relationship. Physicians that act as mere advisers or counselors are impractical in a very low-income society. Furthermore, a certain level of knowledge may be required to understand the physician. From the above discussion, we can say that no model on its own fits for Bangladesh. If corruption could be controlled at an acceptable level, then a few of them (particularly the paternalistic model) might have a positive impact. Still, a balance between a patient’s autonomy and a physician’s influence is required. If we order the four models on the basis of a patient’s autonomy, then the informative model will be placed in the highest position and the paternalistic model will be in the lowest. Conversely, if we order them on the basis of physician’s autonomy and beneficence, then the ordering will be reversed (Hui 2005, 223). So, both of these two models are extreme. The other two models, i.e., deliberative and interpretive, are relatively mild but lack an acceptable guiding moral principle. An appropriate model for Bangladesh should balance both patient’s autonomy and physician’s influence.

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Quality of Care and the Alternative Model It is highly remarkable that most Bangladeshi patients, regardless of whether they are rich or poor, rely, to the best of their ability, upon local healthcare facilities. Moreover, they are hardly dissatisfied with the skills and education of the physicians. Local patients basically want an empathetic attitude, commitment for care and cure, effective communication, and humane behavior from their physicians, which are all crucial parts of medical treatment. For these patients from an overpopulated developing country with a low literacy rate, these are as vital as medicine. It is no longer acceptable for 43% of health professionals from Bangladesh to neglect patients, and for “patients needing a prescription from the doctor...[to be] coerced [into] attend[ing] a private diagnostic centre of the doctor’s choice” (Knox 2009, 129). Similarly, “the lack of empathy of the service providers, their generally callous and causal demeanor, their aggressive pursuit of monetary gains” is also not acceptable at all (Andaleeb, Siddique and Khandakar 2007b, 264). So, there is a clear link between the quality of care and patient satisfaction with the patient–physician relationship and this should be addressed in the developing world context. In their excellent paper, Andaleeb, Siddique and Khandakar have identified a framework of quality healthcare for Bangladesh that comprises both service and other factors. The service factors are reliability, responsiveness, assurance, tangibles, communication, empathy, and process features, while the additional factors are cost and availability/access. According to the authors, these components should be given attention in order to increase patient satisfaction, improve the healthcare system, and to ensure quality healthcare (Andaleeb, Siddique and Khandakar 2007b, 265–266). I believe that these factors deserve our consideration. I am arguing for an alternative model that involves care and respect for autonomy and which is context-sensitive and includes the major components (e.g. reliability, responsiveness, assurance, communication, empathy, etc.) of quality healthcare. This alternative model might work better because it considers care that respects a patient’s autonomy. In the alternative model, physicians would treat their patients as a “care seeker”, rather than a “client” or “customer”. Equally, patients would perceive their physicians as “caregivers”—a term already coined by two insightful physicians from Bangladesh (Nuruzzaman and Al-Mahmood 2009, 4). In my view, when a physician considers himself or herself a “caregiver” instead of a doctor, professional, adviser, expert or specialist, it significantly changes his or her attitudes towards patients.

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In practice, the alternative model would be compatible with some core socio-cultural values (e.g. collective medical decision-making, relational autonomy, etc.) and, therefore, has the strong possibility of fulfilling common patient desires. Overall, the model will change physicians’ attitudes and practices towards their patients. Perhaps some basic structures are also needed for any model to function properly, such as adequate policies, fair implementation, sufficient ethical subjects and practices in medical curriculum, and, most importantly, making use of alternative healthcare providers (e.g. village doctors, paramedics, pharmacists, etc.) to reduce the workload of physicians. For example, Shehrin S. Mahmood et al. argued that in the Bangladesh, “[t]hese Village Doctors, if trained in proper management of common ailments, can be a potential source of quality health care for the villagers” (2010, 8). Moreover, they insisted that, “[t]he Village Doctors could also contribute...by making proper and timely referrals to qualified physicians” (Mahmood et al. 2010, 9). At the policy level, HNPSP 2009 APR has emphasized that “all health care providers need to be trained on the clients’ rights, and their duties and responsibilities in line with the Medical Code of Conduct and Professional Ethics” (HNPSP 2009, 62). A similar suggestion came from Redwanur Rahman who writes that, “[e]thical conduct needs to be promoted by the professionals themselves, their organizations, medical schools, and the government” (Rahman 2007, 204). Therefore, an alternative model based on “caring” as a sole ethical criterion could be the most effective guiding principle for Bangladeshi physicians. However, we do also need to combine quality of care, the concept of autonomy, informed consent, and socio-cultural values by asking some important questions, such as: how do patients perceive their autonomy in Bangladesh? To what extent are they interested in questioning physicians’ decisions? Are patients fully autonomous? Are they capable of making their own decisions? There is ample evidence that strong paternalism is not an ideal model for Bangladesh, and, therefore, a revision of the underlying ethical principle of the patient–physician relationship is urgently needed.

Conclusion The patient–physician relationship is an important issue within medical ethics. Since ancient times, all medical codes and guidelines have attempted to identify the basic principles of an ideal patient–physician relationship. However, there seems to be no ideal model applicable to all cultures and all societies. The development of biological as well as

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medical sciences, medical technology, moral thinking, and social values, should be taken into consideration while analyzing any such relationship. I have discussed the most recent and widely accepted Emanuel and Emanuel’s four models of the patient–physician relationship. Even though each individual model has some advantages for any society, it requires a different value system, advanced socioeconomic conditions, sufficient healthcare infrastructure, minimum levels of patient literacy and physician/patient ratios, and so on. Most of these requirements are absent in developing countries like Bangladesh. Despite some good arguments for paternalism in such socioeconomic conditions, overall paternalism leads to negative outcomes in Bangladesh. Thus, none of the models are fully appropriate for Bangladesh. Perhaps an alternative model that is committed to care and is respectful of patients’ autonomy might be more appropriate. But what does this alternative model look like? Surely, this is a topic for further research.

References Absar, Md Nurul, M Hamidur Rahman. 2008. “Expectation of Patients From Doctors.” Journal of Bangladesh College of Physicians and Surgeons 26 (1): 3–9. Akter, Taslima and Shahidul Islam. 2006. Dhaka Medical College Hospital: A Diagnostic Study - Executive Summary, 1–4. http://www.ti-bangladesh.org/research/ES_DMCH.pdf (accessed 2 November 2010). Andaleeb, Syed Saad, Nazlee Siddique, and Shahjahan Khandakar .2007a. “Doctors’ Service Orientation in Public, Private, and Foreign Hospitals.” International Journal of Health Care 20(3): 253–63. Andaleeb, Syed Saad, Nazlee Siddique, and Shahjahan Khandakar .2007b. “Patient Satisfaction with Health Services in Bangladesh.” Health Policy and Planning 22 (4): 263–273. Bangladesh Health, Nutrition and Population Sector Programme (HNPSP) .2009. Annual Programme Review (APR), 2: 1–254. http://hnpinfobangladesh.com/docs/di_205_Technical%20Reports%20 Final%2011.05.2009.pdf (accessed 3 November 2010). Banglapedia: National Encyclopedia of Bangladesh. 2006. “Traditional Medicine”. http://en.banglapedia.org/index.php?title=Traditional_Medicine (accessed 2 November 2010) Begum, Hasna. 2001. “Poverty and Health Ethics in Developing Countries.” Bioethics 15(1): 50–56.

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Buchanan, Allen. 1981. “Medical Paternalism”. In Medicine and Moral Philosophy: A Philosophy and Public Affairs Reader, eds. Marshal Cohen, Thomas Nagel, and Thomas Scanlon, 214–34. Princeton: Princeton University Press. Childress, James F. and Mark Siegler .1984. “Metaphors and Models of Doctor-Patient Relationships: Their Implications for Autonomy.” Theoretical Medicine and Bioethics 5 (1):17–30. Emanuel, Ezekiel J., and Linda L. Emanuel .1992. “Four Models of the Physician-Patient Relationship.” The Journal of the American Medical Association 267(16): 2221–2226. Häyry, Heta.1991. The Limits of Medical Paternalism. London: Routledge. Hubbard, Richard. 2010. “Improving Doctor-Patient Relationship”. The Daily Star, April 10, 2010. http://www.thedailystar.net/news-detail133701 Hui, EC. 2005. “The Centrality of Patient-Physician Relationship to Medical Professionalism: An Ethical Evaluation of Some Contemporary Models.” Hong Kong Medical Journal 11(3): 222–223. Knox, Colin. 2009. “Dealing With Sectoral Corruption in Bangladesh: Developing Citizen Involvement.” Public Administration and Development 29 (2): 117–132. Lelie, Annique, and Marcel Verweij. 2003. “Futility Without A Dichotomy: Towards an Ideal Physician-Patient Relationship.” Bioethics 17(1): 21– 31. Mahmood, Shehrin S., Mohammad Iqbal, SMA Hanifi, Tania Wahed, Abbas Bhuiya. 2010. “Are ‘Village Doctors’ in Bangladesh a Curse or a Blessing?.” BMC International Health and Human Rights 10(18): 1– 10. Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh. 2009. Health Bulletin. http://www.dghs.gov.bd/ and http://www.mohfw.gov.bd/ (accessed 2 November 2010) Nahar, L. 2002. “Improving the Health Services”. The Daily Star, May 16, 2002. http://www.thedailystar.net/ Nuruzzaman, M. and Abu Kholdun Al-Mahmood . 2009. “Medical Services Without Medical Ethics: Sailing the Ship Without Compass.” Bangladesh Journal of Medical Science 8 (1–2): 4. Pellegrino, Edmund D. and David C. Thomasma . 1988. For the Patient’s Good. The Reconstruction of Beneficence in Health Care. New York: Oxford University Press.

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Rahman, MM, S Rahman, N Begum, AKM Asduzzaman, M Shahjahan, A Firoz, MS Metul. 2007. “Client Expectation From Doctors: ExpectationReality Gap.” Kathmandu University Medical Journal 5(4): 566–73. Rahman, Redwanur. 2007. “The State, the Private Health Care Sector and Regulation in Bangladesh.” The Asia Pacific Journal of Public Administration 29(2): 191–206. The American Medical Association (AMA). 1990. “Fundamental Elements of the Patient-Physician Relationship.” The Journal of the American Medical Association 264 (24): 3133. http://jamanetwork.com/journals/jama/article-abstract/384425 (accessed 3 November 2010) The World Bank Report. 2005. Bangladesh Development Series-Paper no. 5, “Targeting Resources for the Poor in Bangladesh”. http://siteresources.worldbank.org/BANGLADESHEXTN/Resources/F INAL-printversion_Paper-5.pdf (accessed 22 April 2008) Transparency International Bangladesh. 2008. National Household Survey 2007 on Corruption in Bangladesh, 1–67. http://www.ti-bangladesh.org/research/HHSurvey07full180608[2].pdf (accessed 3 November 2010). Transparency International. 2010. Corruption Perceptions Index Report. http://www.transparency.org/policy_research/surveys_indices/cpi/2010 /press#report (accessed 3 November 2010). UNDP. 2009 and 2007/2008. Human Development Reports. http://hdr.undp.org/en/reports/ (accessed 2 November 2010) Veatch, Robert M. 1972 (1986). “Models for Ethical Medicine in a Revolutionary Age.” In Biomedical Ethics, eds. Thomas A. Mappes and Jane S. Zembaty, 2nd edition, 46–59. New York: McGraw-Hill Book Company.

CHAPTER TEN INFORMED CONSENT AND THE PATIENTS OF BANGLADESH1

In medical practice, informed consent plays a vital role when making ethical decisions. In recent years, informed consent also appears to be a key issue in biomedical discussions. Several definitions of informed consent have already been proposed. However, the socio-economic conditions of different countries are not the same. Many countries differ culturally as well as with regard to their literacy rates. So, a unified concept of informed consent might not be justified for all contexts. This chapter discusses the importance of informed consent, different views regarding informed consent, and the limitations of applying one single idea of informed consent in every context. It argues that the most plausible concept of informed consent achievable for developing countries, like Bangladesh, is based on care ethics. The chapter concludes that informed consent could be a “natural outcome” and not be a barrier to a positive patient–physician relationship if the idea is understood through the perspective of care ethics.

Introduction Informed consent is a core component in treatment decisions. It also explicitly expresses the nature of the patient–physician relationship. Different ethicists propose different conceptions of informed consent and the most widely used, with regard to biomedical issues, are Faden, Beauchamp, and Childress’s views. Indeed, other care ethicists, such as O’Neill, Dodds, Mackenzie, and Stoljar, have criticized their ideas. In this chapter, we will discuss the importance of informed consent, different views regarding informed consent, and its limitations. We will also examine which plan is achievable in the Bangladeshi context. It seems 1

Previously published as “Informed Consent and the Patients of Bangladesh” European Journal of Bioethics 7/1, no. 13 (2016):19–31.

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strange that there is a tendency to use one dominant concept of informed consent in many different contexts and I will carefully examine this trend. At the end of the chapter, the idea of relational autonomy will be justified from the Bangladeshi perspective.

Why is Informed Consent Important in the Patient–Physician Relationship? Informed consent is a worldwide well-known medical or ethical notion. Informed consent is important because firstly, it has a legal position and many health laws have included this notion as a vital clause. Secondly, almost all medical codes and guidelines have incorporated this requirement in order to protect the patient or the human subject from harm. In the patient– physician relationship, an informed consent procedure is essential for treatment because this protects the patient’s rights. The practice and requirements of informed consent ensure the patient’s autonomy to make decisions about their treatment and it also helps to limit medical paternalism. Capron has indicated two basic justification of informed consent: “protection from harm” and the “protection of autonomy”. (Beauchamp and Childress 1983, 67). Any medical intervention or clinical research must fulfill the crucial requirement of informed consent in order to be considered as ethical. Medical treatment may involve risk, and benefit as well. Before starting treatment, the physician has an obligation to inform the patient of the underlying risks and probable benefits of the proposed course of action. Informed consent might serve as a way of providing information about the treatment. Sometimes informed consent procedures may help the patient to decide that they would prefer to undergo alternative diagnostic or medical interventions. According to Childress, informed consent gives the physician a special right and it is the patient who transfers this right to the physician. He writes that, “[c]onsent is one possible ground for special rights that are created, or transferred, by transactions between parties. These rights are special because they depend on relationships” (Childress 1982, 79). Therefore, informed consent provides not only “approval” but also a contract that cements the patient’s “rights”. Another important facet of informed consent is that it is a legal document and can be used for judicial purposes. As Schermer writes, “[t]he doctrine of informed consent, however, is not only...a product of medical ethics. It developed within the framework of law and medical practice...and directed by legal and practical considerations” (Schermer 2001, 40).

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Schermer has pointed out four important factors that informed consent provides. Firstly, informed consent is a “means” of gaining patient’s autonomy. Secondly, it could be an “expression” of respect for the patient’s autonomy. Thirdly, informed consent promotes the well-being of the patient. Finally, it enables “rationality” and “self determination” (Schermer 2001, 40–41). Therefore, we may conclude that informed consent is important in order to protect the patient’s autonomy, it helps to promote the patient’s rationality and self-determination, it provides treatment information and guards legally, as well as ethically, against coercion.

Different Concepts of Informed Consent There is an ongoing debate about the meaning and procedure of informed consent. Some ethicists (e.g. Beauchamp and Childress) argue that informed consent protects the patient’s autonomy and respect for persons; while others (e.g. O’Neill) hold that informed consent prevents us from coercion, although they also point out that genuine informed consent is impossible to gain. Recently, care ethicists argue that the traditional conception of informed consent and autonomy are too individualistic. In this section, I will first explain different concepts of informed consent and their limitations. In the next section, I then examine these conceptions in the current Bangladesh context. I. Faden, Beauchamp and Childress: Faden and Beauchamp, in their book A History and Theory of Informed Consent (1986), develop the notion of informed consent as an ethical and legal principle. In addition, they have presented the “conceptual” foundation of informed consent as an “ethical requirement”. Faden and Beauchamp separate two senses of informed consent. In the first sense, informed consent is an “action” by which a patient or subject declares his or her “autonomous authorization” while in the second sense, informed consent is an institutional or legal “effective procedure” rather than autonomous authorization. The goal of informed consent, in the former sense, is to fulfill moral requirements, whereas in the latter sense it refers to satisfying legal or institutional demands (Schermer 2001, 41). Faden and Beauchamp hold that an autonomous action must have to satisfy three basic criteria: “1. intentionality, 2. with understanding, and 3. without controlling influences” (Schermer 2001, 42). Intentionally means, “to be willing as a conscious agent” and, therefore, an autonomous patient will perform an action willingly, as well as consciously. Actions that

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happen accidentally or suddenly may not be considered as an intentional action. Some authors (e.g. Schremer) hesitate to accept intentionality as necessary for informed consent because, for them, when we give our consent it implies that we do so intentionally (Schermer 2001, 43). Their second criteria of, “understanding” means “a patient must understand both the fact that he is giving an authorization as well as all the material information pertaining to the treatment or procedure he is authorizing” (Schermer 2001, 43). The importance of understanding is that the patient has to realize he or she is giving the authority to allow the intervention. The third criterion is about the voluntary actions. If something is voluntary, it ensures that the action has been performed without any influence or coercion (Schermer, 2001, 46). According to Beauchamp and Childress, the three basic components of competence are: “capacity to understand”, “deliberate” and “decide” (Beauchamp and Childress 2001, 72). They write that, “a person is usually considered competent if able to understand a therapeutic or research procedure, to deliberate regarding its major risks and benefits, and to make a decision in light of this deliberation” (Beauchamp and Childress 2001, 72). The authors hold that competence and autonomy are closely related. An autonomous person is competent and able to give his or her consent. An autonomous person should have the capacity to make decisions, understand the (material) facts involved with the treatment procedures, and be able to use the information to make his or her own judgment. “Disclosure” refers to the physician’s obligations, while “understanding” refers to the patient’s obligation. Disclosure is a legal procedure, which involves providing necessary information. Beauchamp and Childress write, “[d]isclosure, like treatment, is a task that belongs to physicians because of their professional expertise and commitment to the patient’s welfare” (Beauchamp and Childress 2001, 82). Understanding involves reasoning and communicating in order to authorize treatment. It is associated with the patient’s knowledge, reasoning ability, and projection. Understanding includes the ability to analyze, use, and evaluate information regarding treatment. The minimum requirement for understanding is that, “[p]atients...should understand at least what a health care professional...believes a patient...needs to understand in order to authorize an intervention. Diagnoses, prognoses, the nature and purpose of the intervention, alternatives, risks and benefits, and recommendations are typically essential” (Beauchamp and Childress, 2001, 88–89). Finally, “voluntariness” implies an absence of others’ influence. Voluntariness could have two senses, as Beauchamp and Childress mention, one is narrow and the other is broad. In the broad sense, voluntariness has

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a similar meaning to autonomy while, in a narrow sense, voluntariness is about restricting any influence. Beauchamp and Childress state that, “a person acts voluntarily to the degree that he or she wills the action without being under the control of another’s influence” (Beauchamp and Childress 2001, 93). Although Faden, Beauchamp and Childress present a systematic and standard analysis of informed consent, their views have been criticized strongly by some authors. O’Neill, Dodds, Mackenzie, Stoljar are prominent examples of these critics. I will now analyze their views. II. O’Neill: O’Neill argues that the present frameworks and procedures used to gain informed consent are misleading. The authors who claim that the informed consent requirements, deemed to be sufficient to protect patient’s autonomy, are actually overly demanding. There are many cases where it is not possible to obtain informed consent. She holds that current informed consent frameworks have significant limitations and that we should incorporate, as well as relax, some of the existing constraints. Although she is doubtful about the necessity of formal informed consent, she does not reject its strength. Yet, she argues that consent frameworks need to be redesigned. She writes, “[g]iven that informed consent is problematic for so many patients, it can hardly be necessary for medical treatment” (O’Neill 2002, 40). According to O’Neill, informed consent is meaningful only when both parties participate “willingly” and they are “aware” of the main theme of consent. They should have a clear idea about how the contract will work. O’Neill says that informed consent creates greater “difficulty” in medicine than in its usual use in daily life. She identifies four limitations in informed consent requirements (O’Neill 2003, 4–5). Firstly, incompetent people cannot give their consent. She writes, “[w]e cannot give informed consent when we are very young or very ill, mentally impaired, demented or unconscious, or merely frail or confused” (O’Neill 2003, 4). Secondly, informed consent is incompatible when constructing a unified public health policy. Since public policy is a unified framework, it is not possible to set a policy by taking consent from each and every person. Thirdly, the patient has to disclose a great deal of related family and genealogical information without obtaining consent from family members. Fourthly, people who are “vulnerable” or “prisoners” are unable to “refuse” when they are being asked to give consent. According to O’Neill, consent should be made as simple as possible. The consent form should obviously not be “overwhelmed” with detail because some patients want too little, while others want too much

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information. So, the patient should be able to choose how much information he or she needs to give consent (O’Neill 2003, 6). She states that, “[t]his balance can perhaps be achieved by giving them a limited amount of accurate and relevant information and providing user friendly ways for them” (O’Neill 2003, 6). III. Care ethics: Furthermore, care ethicists have also criticized the traditional approach. Dodds identifies some limitations of autonomy-based informed consent practice. Firstly, giving the physician a responsibility to gain informed consent by providing information is an “overturn” of paternalism. Since the physician is the only person who holds the power to give adequate information about the possible treatment, it needs to be less about paternalism and more about disclosing information. Secondly, through the informed consent requirement, bioethics has isolated the notion of autonomy from its wider meanings. This is similar to how free speech is isolated and protected by law; although, by protecting free speech without protecting freedom, is like protecting the head but not the body. Thirdly, isolating informed consent implies that the physician’s ethical concern is only to obtain the patient’s consent and not to participate in the decision-making process. Therefore, there are some vital issues between providing information and gaining consent, such as how does the physician present the information to the patient, and in what language? These questions are often ignored (Dodds 2000, 213–214). According to care ethicists (like Dodds), the traditional concept of informed consent is too individualistic. Since this framework ignores the patient’s social bonds and the inner power of relationships. The patient who is supposed to give consent will not be removed from this context as they form a small part of society as a whole. Traditional informed consent does not truly reflect the patient’s values, thoughts, or perceptions about the treatment. At best, informed consent could be merely a choice (Dodds 2000, 216–217). Feminist bioethics proposes three constituents, or procedures, namely “choice”, “control”, and “care” in order to develop an alternative theory of autonomy and informed consent. A choice will not be made separately and, instead, the physician will listen the patient’s desires and wants in order to provide the information that they need. The physician will then help them to decide. For women, this means they have the choice to control their reproductive capabilities. Care implies a caring relationship in an interconnected socio-cultural context. Hence, the feminist stance on autonomy and informed consent argues that these are not isolated individual choices,

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but instead form a caring interrelationship between the patient, physician, society, and culture (Dodds 2000, 218–222). So, in a care ethics approach, informed consent is not just a formal document, or protector of autonomy. Informed consent is more than that, as it allows the physician to help the patient to understand in a sympathetic and empathetic manner to understand the necessary information needed in order to obtain the patient’s consent. Using this approach, informed consent becomes the product of an empathetic relationship, rather a contract. As Rosenberg and Towars write, “[t]he relationship should be reshaped...patient care that combines the biomedical analysis of disease with an empathic understanding of the patient’s illness experience. Truly informed consent is viewed as a natural outcome of the application of this more comprehensive framework” (Rosenberg and Towar 1986, 181). As we have seen the traditional conception of autonomy-based informed consent is too individualistic and problematic. Therefore, care ethicists propose a richer conception of autonomy where the self is embedded as well as differentiated. This new understanding of autonomy is shaped as “relational autonomy”, which gives more value to interconnectedness, dependent relationships, as well as providing human qualities such as love, care, empathy, sympathy and so forth. Mackenzie and Stoljar define “relational autonomy” as, The term “relational autonomy”...is rather an umbrella term, designating a range related perspectives...a shared conviction, the conviction that persons are socially embedded and that agents’ identities are formed within the context of social relationships and shaped by a complex of intersecting social determinants, such as race, class, gender, and ethnicity. (Mackenzie and Stolzar 2000, 4)

Firstly, relational autonomy involves a holistic approach and individuals are not isolated from their circumstances or society. This means it is a shared connection between individuals, society, and culture; this indicates that we should treat the person as a “socially embedded” individual. The individual will not be identified as a rootless separate member and, instead, a deep-rooted “social relationship” identifies the individual. Therefore, the main claim of relational autonomy is that the agent can protect his or her autonomy within their social context and relationships with others because it is difficult for the agent to be isolated from all social identity. Secondly, relational autonomy is against all sorts of oppression and could be defined as an identifier of “agent’s social location”. As McLeod and Sherwin indicate, relational autonomy could be “defined and pursued in a social context and that social context significantly influences the

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opportunities an agent has to develop or express autonomy skills” (McLeod and Sherwin 2000, 259–260). Thirdly, relational autonomy involves the capacity to function as it refers to the “well-being of person”. Brison states that relational autonomy “is one kind of relational account of autonomy that holds that an agent’s autonomy is dependent on her having an adequate capability to function” (Brison 2000, 282–283).

Which Concept of Informed Consent is Possible to Gain in Bangladesh? In Bangladesh, the current means to get and respect informed consent is a painful process. One of the major areas where informed consent plays a crucial role is in the patient–physician relationship. Unfortunately, in most cases, there exists an unhealthy relationship between the patient and physician in Bangladesh. Elsewhere, I have discussed the patient– physician relationship within the Bangladeshi context in detail and I have argued that As a result, the patient–physician relationship turns out to be very paternalistic. However, in a situation where people are vulnerable (economically, physically, and emotionally), that would instead require care with sympathy, communication, active and proper treatment, sufficient health information, and so on; this can rarely be found in healthcare practices in Bangladesh. (Talukder 2011, 68)

I concluded that an alternative model that is committed to care for and respect the patient’s autonomy is more appropriate for Bangladesh. Recently, a context-sensitive patient–physician relationship model in the Bangladeshi context has been outlined indicating that patients do not enjoy the privilege of informed consent in Bangladesh (Talukder 2016). Many of these patients are poor and, therefore, they do not get a chance to go to or visit doctors at District hospitals, and so, because of several limitations (such as poor income, illiteracy, distance) they often go instead to either village doctors or to different hospitals, which may be unhygienic and have poor facilities. However, it is often seen that in these hospitals patients are poorly treated, unqualified staff perform operations and prescribe medicines, and physicians are inhospitable and uncooperative. In this environment, informed consent becomes only a signature to provide legal protection if the patient dies or is harmed. In district hospitals, when patients, after long hours of waiting, do finally get an appointment with the doctor they often find that they are

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very busy. It is clear that many doctors are reluctant to get informed consent, even if they are not busy. It seems that physicians wish to keep their patients in the dark, which can lead to a frantic, agonizing, and unethical state of worry and mental stress because their health condition has not been properly explained to them. Sometimes patients are just told through the doctors’ assistants that they have to undergo a certain treatment or operation. This causes mental stress to the patient in the sense that they want to know why the doctor recommends that particular solution, what the other possible solutions are, what are the benefits, the risks and so on. When the patient does not get the answers to these questions, they tend to become increasingly suspicious and tense, which causes mental stress. The main aim of this kind of physician is to earn “black market” money through encouraging repeated visits to private clinics, or diagnostic centers, that they are affiliated with in order to receive more payments. This means that in addition to a lack of respect of a patient’s autonomy, unfair business practices are also taking place. Informed consent only exists as the patient’s signature on a piece of paper and has no meaning behind this basic requirement. However, physicians’ business attitudes are not the only drawbacks in informed consent practice; insufficient knowledge and low levels of understanding of informed consent issues from physicians also play a part. A study conducted on Bangladeshi physicians about their knowledge of informed consent shows that “although the majority of the physicians were conscious about informed consent, a large number of them did not possess sufficient knowledge about basic elements and fundamental characteristics of informed consent” (Hossain et al. 2005, 25). So, the study suggests the need “to include more details of research ethics in the syllabus of undergraduate and postgraduate medical courses, particularly in developing countries” (Hossain et al. 2005, 25). It implies that a lack of ethics courses in the medical curriculum is another point worthy of consideration. A good knowledge in ethics and updated medical declarations will create confidence, greater responsibility, and inspiration among physicians, which will enable successful communication with vulnerable patients. After conducting research on pregnant women in rural Bangladesh and Sweden, Lynöe et al. commented that “[t]he vulnerability of potential research subjects demands that researchers take seriously their responsibility to ensure the rights of the participants” (Lynöe et al. 2001, 461). The research shows that although illiteracy, poor income, low patient– physician ratios, and so forth exist in developing countries, subjects are also vulnerable in developed countries. Only a caring and responsible

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physician or researcher can help to ensure an effective informed consent procedure. Now, we could realize that some of the vital requirements of genuine informed consent are not possible to fulfill for an uneducated, poor patient. Although they have the capacity to make choices, and have some understanding of the treatment, these are not enough to give consent. Moreover, in order to understand written disclosure they have to seek someone’s help, which often falls to the physician to provide this. This sort of dependency might violate the criteria of “voluntariness”. Therefore, it might be impossible to gain genuine informed consent from an illiterate, poor patient in Bangladesh. O’Neill’s understanding of informed consent seems more pragmatic in the Bangladesh context than that of Faden, Beauchamp, and Childress. Yet the question is: who will provide the information to the illiterate patient and how? The notion of informed consent as presented by care ethics seems more compatible in the Bangladesh context, since poor and illiterate patients’ autonomy may not be viewed as individualistic. Therefore, health workers and physicians should gain informed consent in a much more relational way.

Justification of “Relational Autonomy” (From a Care Ethics Perspective) in Bangladesh Respecting patient autonomy and obtaining informed consent is a great challenge in developing countries like Bangladesh because, for several reasons, the risk of exploitation is much higher here. One way of protecting the patient’s autonomy and their rights could be to consider community and family bonding, cultural embeddedness, social values, linguistic heritage, collaborative partnerships, and so forth. Emanuel et al. argue that in developing countries the process of informed consent is complex, hence special concentration should be given to language and social traditions, as well as cultural and family practices. They suggested five benchmarks for obtaining informed consent. The second of these benchmarks says, disclosure of information should be sensitive to the local context. It should be done using the local language, culturally appropriate idioms, and analogies that the prospective participants can understand. This obviously entails a need for collaborative partnership. (Emanuel et al. 2004, 934)

This “partnership” includes physician, patient, medical staff, the patient’s family members and researchers; it must be based, in my view, on the common value of caring.

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Campbell points out the same issues and argues that there are complexities and barriers to obtaining informed consent in developing countries. However, in order to facilitate informed consent in developing countries he suggests: Rather than assuming the inability of some people to grasp western biomedical concepts, researchers need to realize that understanding suffers in both developed and developing settings and that the real focus should be on adapting the universal paradigms of research to local cultural norms, ideas, and literacy levels. (Campbell 2013, 3)

So, it follows that we should consider western biomedical norms, such as autonomy and informed consent in relation to local cultural and social values, socio-economic conditions, literacy levels and the level of patient understanding. Bhutta observes that, in developing countries, we should not just focus on a formal informed consent practices and that we should, instead, look beyond it. One of the main roles of researchers or physicians in the wider understanding of informed consent is to be caring and compassionate. He writes, This may only be possible in an environment where human rights are respected and the fundamental principles of justice govern the design and conduct of research. While the role of a caring and compassionate researcher is fundamental to conducting appropriate research in developing countries, the following permutations of the process and regulations may make it both easier and more ethical. (Bhutta 2004, 775)

Bhutta’s permutations include the change of focus in informed consent, implementing innovative materials, providing alternative means of documentation, and involving senior community members. He suggests using a partnership model to obtain true informed consent in developing countries, when he states that “[w]hile ethics review committees can help in oversight, only an active and transparent partnership between research sponsors, investigators and the community can make this happen” (Bhutta 2004, 776). In a partnership model, where caring as a means of transparency is the common value, obtaining informed consent will be seen as more than a procedure. Only then, informed consent can become an outcome of mutual respect, instead of just a procedure. The eminent physicians of Bangladesh also indicate a need for a partnership model that is based on care ethics. They believe that physicians should be considered as “care givers” and patients as “care seekers”; they recommend that, “[t]he civil society, the political parties,

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patients (care seekers), the doctor (care givers) community all have to play important role in this matter” (Islam and Jhora 2012, 55). Therefore, we can assume that genuine informed consent may not be possible to obtain in developing countries, including Bangladesh. We support care ethicists’ criticism of traditional autonomy and informed consent, and their arguments for a richer understanding of autonomy, and specifically “relational autonomy”, from a care ethics perspective. But what is the advantage of the “relational autonomy” concept? The main advantage is that relational autonomy considers patient rights as well as the physician’s obligation to care. It seems that for patients, autonomy and informed consent are secondary choices, while care is the primary concern. Caring, like paternalism, does not undermine patient rights as these are nourished through sympathy, care, and understanding relationships. Could relational autonomy be useful for the Bangladesh context? In order to answer this question we need to consider some important factors: firstly, although not all patients are poor and illiterate in Bangladesh, the reality is that most of them are plagued by these conditions. The patients are so helpless and they are unable to bear their medical expenses. When they become ill they have to face many problems, such as inadequate medicine, overdependence on the physician because they lack the ability to read or write, scarcity of beds in hospitals, and so they become ill not only physically but also psychologically. All these things can be seen as great obstacles to making autonomous decisions. How can we believe that a patient who is isolated in this way will be able to understand the meaning of disclosure or treatment procedures, have a reasonable standard of competence, deliberation, and decision making abilities, and that their decisions will be voluntary? Secondly, patients are embedded within culture and family and so it is a brutal fact that many poor patients who are forced to lie on the floor of the hospital and suffer from negligent practices only recover because they receive sympathetic, responsible, loving-care from family members. Therefore, families serve the patient by providing invaluable labor, care, and support and, therefore, the patient is unlikely to be interested in making decisions without family input. Thirdly, patients expect sympathy and care even if they are receiving insufficient treatment. Finally, patients want to see their physician as a trustworthy sympathetic person and the only one who can treat, inform, and advise them. When considering these factors alongside the relevant socio-cultural status, relational autonomy is justified for the Bangladesh context.

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Conclusion To summarize, after discussing different conceptions of informed consent and their importance within the patient–physician relationship, I think that the care ethics approach provides the most plausible framework that is achievable in the context of Bangladesh. I have argued that the relational conception of autonomy from a care ethics perspective is more compatible with the typical illiterate and poor patient in Bangladesh. If we incorporate relational autonomy, rather than traditional individualistic autonomy, then this will provide a more pragmatic and pertinent approach. Informed consent in this sense is a “natural outcome” of the patient– physician relationship and this supports the fact that patient illiteracy might not be a barrier for providing consent.

References Beauchamp, Tom L., and James F. Childress.1983. Principles of Biomedical Ethics. 2nd ed. New York: Oxford University Press. —. 2001. Principles of Biomedical Ethics. 5th ed. New York: Oxford University Press. Bhutta, Zulfiqar A. 2004. “Beyond Informed Consent.” Bulletin of the World Health Organization 82 (10): 771–778. Brison, Susan J. 2000. “Relational Autonomy and Freedom of Expression.” In Relational Autonomy. Feminist Perspectives on Autonomy, Agency, and the Social Self, eds. Catriona Mackenzie and Natalie Stoljar, 280–299. New York: Oxford University Press. Campbell, Ben. 2013. “Informed Consent in Developing Countries: Myth or Reality?.” https://www.dartmouth.edu/~ethics/docs/Campbell_informedconsent.pdf Childress, James F. 1982. Who Should Decide? Paternalism in Health Care. New York: Oxford University Press. Dodds, Susan. 2000. “Choice and Control in Feminist Bioethics.” In Relational Autonomy. Feminist Perspectives on Autonomy, Agency, and the Social Self, eds. Catriona Mackenzie and Natalie Stoljar, 213– 235. New York: Oxford University Press. Emanuel, Ezekiel J., David Wendler, Jack Killen, Christine Grady. 2004. “What Makes Clinical Research in Developing Countries Ethical? The Benchmarks of Ethical Research.” The Journal of Infectious Diseases 189 (5):930–937. Hossain, M Mahmud, M Al Mamun, K Selim Anwar and M Saidur Rahman. 2008. “Informed Consent in Health Research: Current State

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of Knowledge among Physicians in Bangladesh”, 22–25. Asia Pacific Perspectives on Medical Ethics. Bangkok: UNESCO Asia Pacific Regional Bureau for Education. Islam, MS, and ST Jhora. 2012. “Physician-Patient Relationship: The Present Situation and Our Responsibilities.” Bangladesh Medical Journal 41 (1):55–58. Lynöe, Niels, Ziauddin Hyder, Mustaque Chowdhury and Lotta Ekström. 2001. “Obtaining Informed Consent in Bangladesh.” The New England Journal of Medicine 344 (6):460–461. Mackenzie, Catriona, and Natalie Stoljar, eds. 2000. Relational Autonomy. Feminist Perspectives on Autonomy, Agency, and the Social Self. New York: Oxford University Press. Manning, Rita C. 2001. “A Care Approach.” In A Companion to Bioethics, eds. Helga Kuhse and Peter Singer, 98–105. Oxford: Blackwell Publishing Ltd. McLeod, Carolyn, and Susan Sherwin. 2000. “Relational Autonomy, SelfTrust, and Healthcare for Patients Who are Oppressed.” In Relational Autonomy. Feminist Perspectives on Autonomy, Agency, and the Social Self, eds. Catriona Mackenzie and Natalie Stoljar, 259–279. New York: Oxford University Press. O’Neill, Onora. 2002. Autonomy and Trust in Bioethics. Cambridge: Cambridge University Press. —. 2003. “Some Limits of Informed Consent.” Journal of Medical Ethics 29: 4–7. Rosenburg, James E. and Bernard Towers. 1986. “The Practice of Empathy as a Prerequisite for Informed Consent.” Theoretical Medicine 7: 181– 194. Schermer, Maartje. 2011. The Different Faces of Autonomy. A Study on Patient Autonomy in Ethical Theory and Hospital Practice. Ridderkerk: Ridderprint B.V. Talukder, Md. Munir Hossain. 2001. “On Patient-Physician Relationships: A Bangladesh Perspective.” Asian Bioethics Review 3(2): 65–84. —. 2016. “Developing a Context-Sensitive Patient-Physician Relationship Model for Health Care in Bangladesh.” Eubios Journal of Asian and International Bioethics 26 (3): 95–101.

CHAPTER ELEVEN DEVELOPING A CONTEXT-SENSITIVE PATIENT–PHYSICIAN RELATIONSHIP MODEL1

Bangladesh has a complex system of patient–physician relationships and there is no single established model. Several points have indicated that it is necessary to develop a new model. A framework of ideal contextsensitive patient–physician relationships for Bangladesh is explored in this chapter. It argues that an ideal model should not just be based on moral jargon but, rather, it should also seriously consider the context. A balance between the ideal and the reality is vital. So, illiteracy, scarcity, and cultural differences are both morally and practically relevant. This chapter concludes that care ethics provides the moral basis of an ideal patient– physician relationship model, because people from Bangladesh, perceive autonomy as relational rather than individual.

Introduction I have previously discussed different patient–physician relationship models within the Bangladesh context (Talukder 2011), arguing that there are considerable reasons to build a new patient–physician model for the country. Some of these reasons are: firstly, no model pays enough attention to the role of the family in making medical decisions. The family can be understood as the main providers of care because individuals depend on family members when they are ill, as well as for other social reasons. So, family members have a right to help the patient make decisions about their healthcare and, in this way, the family’s role is morally relevant. Secondly, there are immoral consequences from the strong paternalism in Bangladesh. Thirdly, some physicians devalue moral 1

Previously published as “Developing a Context-Sensitive Patient–Physician Relationship Model for Health Care in Bangladesh” Eubios Journal of Asian and International Bioethics 26, no.3 (2016):95–101.

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attitudes and are desperate for money. Finally, many patients are not satisfied with the current patient–physician relationship. Therefore, we need a new type of relationship that is effective in solving current problems and is compatible with the context. In this chapter, I will explore what type of patient–physician relationship suits the Bangladesh context when we account for the facts of illiteracy, scarcity, and cultural differences. I will try to find out why illiteracy, scarcity, and cultural differences are ethically relevant concepts. In addition, I will consider how these three conditions influence the context-sensitive ideal. It is necessary to mention that some key aspects of the patient–physician relationship are crucial when building a contextsensitive ideal. In my previous discussions, I have pointed out that Emanuel and Emanuel have emphasized four key components as vital. From my point of view, six conceptions (trust and beneficence, the patient–physician communication, decision-making authority, the role of the physician, the patient’s autonomy and ability to resolve conflicting values) need to be stressed when analyzing an ideal relationship for the current Bangladesh context. I will order these six aspects in terms of necessity and importance for the current Bangladesh patient–physician relationship. This analysis collectively presents an idea of realistic, as well as ideal, relationships. The status of this context-sensitive relationship is pragmatic and possible to achieve in the Bangladesh context. These factors will cover the minimum requirements in order to create a balance between the ideal and the reality. Finally, I will discuss relevant ethical theories so that I can provide a moral foundation for this ideal relationship.

Aspects of a Context-Sensitive Ideal Patient–Physician Relationship in the Current Bangladesh Context a. Trust and beneficence: Trust and beneficence are two valuable elements of an ideal patient–physician relationship in Bangladesh. Achieving the patient’s trust should be one of the goals of a physician. Trust can only be achieved when all the criteria for effective communication has been satisfied. That is, the patient will trust the physician when she is careful, does not harm, maximizes the patient’s benefits, is sympathetic, selfless, skillful, benevolent, respects the patient’s rights and autonomy, and communicates and so forth. In an illiterate society, trust needs to form the basis of an ideal relationship since disadvantaged people have to be able to trust their physician. They consider their disadvantages as a serious issue and must be able to trust the

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physician to do what is in their best interests. The patient–physician relationship is ultimately a bond of trust. As Beauchamp and Childress write, “relationships between health care professionals and their patients...ultimately depend on trust, and...rules of veracity is essential to foster trust” (Beauchamp and Childress 2001, 284). Beneficence is the other major foundation for an ideal relationship. Pellegrino and Thomasma hold beneficence as the “guiding principle” of the patient–physician relationship. Indeed, they propose a new term, namely “beneficence-in-trust”, that incorporates other moral principles. What does “beneficence-in-trust” mean? Pellegrino and Thomasma write, “[b]y beneficence-in-trust we mean that physicians and patients hold ‘in trust’...the goal of acting in the best interests of one another in the relationship” (Pellegrino and Thomasma 1988, 54). b. Patient–physician communication: Communication gaps, or miscommunication, are serious issues in Bangladesh. In order to correctly understand the patient’s problem, collect necessary information, and to be able to discuss the disease and possible treatments, a considerable amount of time is required. Indeed, as stated in the introduction, Bangladesh has a large population and scarcity is a major problem. So, the physician may not be able to allocate enough time for their patients. Effective communication eventually results in patient’s satisfaction and allows for a more significant relationship. Sometimes effective communication is as important as medicine. Travaline et al. write that, “[i]n fact, research has shown that effective patient–physician communication can improve a patient’s health as quantifiably as many drugs” (2005, 13). So, effective communication is a skill that should be included in an ideal patient–physician. Now, what are the conditions or criteria of effective communication? According to the Accreditation Council for Graduate Medical Education, effective communication skills have five elements: 1. listening effectively 2. eliciting information using effective questioning skills; 3. providing information using effective explanatory skills; 4. counseling and educating patients; and 5. making informed decisions based on patient information and preference. (Travaline et al. 2005, 15)

Bangladeshi patients often cannot reach the physician on time because of the scarcity of transport and medical resources. Illiteracy is another barrier for effective communication. It is also not possible for a physician to provide a lot of time for consultations with patients. However, considering the context, an ideal mode of communication could be providing information in an easy language for the patient. This would

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create an environment where the patient feels free to disclose confidential information about the disease. As a whole, the patient is more likely to feel fully satisfied following communication. c. Decision-making authority: Medical decision-making is a complex issue. We are uncertain about the future risks and have to depend on the present available information. Our knowledge, wisdom, and experience help us to make the most prudent decision for ourselves. However, when there is a question of life and death, and it becomes necessary to take a risk for future benefits, the decision is even more crucial. Who should make the decisions in the patient–physician relationship? As we know, most of the patients in Bangladesh are illiterate and poor. Are illiterate and poor people capable of making healthcare decisions? Are they competent enough when they have not received any formal education? Is the family’s participation in the decision-making process morally acceptable? These questions need to be answered. A common and immediate argument could be that uneducated, illiterate people are unable to understand, communicate, and use information, therefore, the physician should decide for them; paternalism is appropriate for this class of patient. Yet, Luna has rejected this argument as unsound and shows that illiterate people are not too incompetent to make medical decisions. She analyzes three of the reasons for this argument, which are, as follows: communication with illiterate people is “impossible” hence they are incompetent; illiterate people are unable to use the information and so they are unable to understand; even if illiterate people are competent, they might have some additional “difficulties” such as psychological and mental blocks that inhibit understanding and proper communication. According to Luna, the first interpretation is unfair as it denies that illiterate people possess basic human values. The second interpretation is mistaken because it confuses information and understanding; just because illiterate people cannot read and write does not mean that they lack the “cognitive faculties” to understand. The third interpretation is plausible, but it might also be applicable to literate people. Therefore, Luna concludes that if the physician uses more “time and effort” to translate health problems into an easy language, illiterate people will be able to make their own decisions (Luna 1995, 286–289). Luna’s conclusion is not fully acceptable. It is difficult to agree with her that there is no difference between the educated patient and the uneducated patient when making medical decisions and that illiteracy does not matter. An educated patient may able to decide by using information, risk-benefit analysis, and so forth, but this might not be easy for an illiterate patient. An illiterate patient could choose one of the available

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options, but their choice may not be justified rationally. Ideally, the patient should have the authority over their right to decide, as he or she is the owner of his or her body. Nevertheless, when illiteracy is an issue, the patient may not able to decide alone without any discussion. As Clarke et al. write, Our experience indicates that many patients do not want to decide alone, however; they prefer family or friends to be involved and they want advice from a spouse, son or daughter before they make the final decision. (Clarke et al., 2004, 16)

So, it may not be pragmatic to say that the illiterate patient has the absolute authority to decide. We have to consider the limitations of their reasoning, low cognitive ability, and so forth. There is nothing wrong if the physician or the family helps them to decide. Another feature needs to be considered is cultural circumstances. In Bangladeshi culture, the patient’s family members, or relatives attending him or her, have an influence on the final decision. Generally, the physician informs the relatives of the patient’s condition, risks, and benefits if asked. Although the patient may not participate in this discussion, the family conveys the information. So, the role of the family is crucial. In an ideal relationship, the patient will directly participate into the physician’s interpretation, explanation, or suggestion and may seek family members or intimates’ advice before making the final decision. d. The role of the physician: Different ethicists propose different roles as ideals for physicians. Emanuel and Emanuel propose the ideal role of a physician as a moral deliberator, while Veatch likens it to a contractor. But we cannot apply their ideals in the Bangladesh context, as most of the patients are illiterate, poor, and want family involvement in medical decision-making. The illiterate and poor patient has a chance to be treated paternalistically and sometimes the physician could abuse them for their poverty and ignorance. When considering this practical situation, in our ideal model the physician’s role may not be confined only to medical procedures. Giving proper treatment, providing correct and true information, building a trustful and cordial relationship, counseling health care values, interpreting and discussing the patient’s condition with passion, sympathy, and respecting patient rights are the basic roles of a physician. Although in a disadvantaged society, when important decisions are to be made the doctor feels justified in overriding the patient’s wishes. The doctor may subscribe to the view that patients do not have sufficient knowledge to make good decisions

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This traditional attitude should be changed. Hui argues for an interpretive model, instead of the traditional paternalistic model in the Chinese tradition by saying that, A Chinese PPR [Patient–Physician Relationship]...fits well in the “Priestly”/“Paternalistic” models that are incompatible with modern medical codes...educating and enabling their patients to properly exercise their right of autonomy so that...outcomes can be achieved through the ideal “interpretive”/ “collegial” PPR model. (Hui 2005, 223)

So, we could suggest that instead of taking the easy way out, the physician should make an effort to build a caring relationship with their patients and allow the time to explain their health care rights and values. e. The patient’s autonomy: The concept “autonomy” originates from the Greek words “autos”, meaning “self”, and “nomos”, meaning “rule”. So, the literal meaning of the word “autonomy” is “self-rule”. When applied to individual autonomy it refers the right to choose, the right to liberty, the right to privacy, and so on (Beauchamp and Childress, 2001, 57–58). Autonomy is a fundamental requirement for an ethical patient–physician relationship. Acknowledging a patient’s autonomy implies that the patient is capable of making their own decisions, that they are able to choose or refuse any treatment, are conscious of health care values, and so forth. According to Childress, autonomy has two important features: “acting freely” and “deliberating rationally”. Acting freely refers to acting without coercion, or influence, from others. An autonomous act is free and voluntary. However, deliberating rationally means the deliberation of “imaginative” rational action (Childress 1982, 62). Now the questions are: who is an autonomous person? Can poor and illiterate patients fulfill the criteria of autonomous personhood? Is autonomy ideal or relational? According to Beauchamp and Childress, an autonomous person is able to act freely and he or she has a “self-chosen plan”, while a person lacks autonomy when he or she is unable to act according to their self-chosen plan and when they are “controlled” by someone. They hold that “autonomous choice” is the basic criterion to be treated as autonomous (Beauchamp and Childress 2001, 58). Poor and illiterate patients may not have self-governing capacity in a standard sense and so they are unable to draw conclusions using sound reasoning or analytical skills. Still, they are able to make a choice for themselves because they have the capability to choose the most suitable option and, in this sense, they are autonomous persons.

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Autonomy might not be the goal of the patient–physician relationship, but it is a condition for a satisfactory relationship. As poor and illiterate patients lack some autonomous criteria, such as rational self-governance, their autonomy is not individualistic but rather relational. f. Resolving the conflicting values: The patient’s and the physician’s values may conflict in their relationship. The causes of conflict could be inequalities in health care knowledge, social status, religion, moral beliefs, and so forth. Illiterate people might have dogmatic attitudes, false beliefs, or misunderstanding of religion. As a result, their values may conflict with the values of the physician. Indeed, the same holds for the physician as their attitude toward medical science, the hierarchical social status, and different moral values may conflict with the patient’s values. Different authors have proposed different ways of resolving this conflict. According to Childress, these conflicts may not be reducible to a single moral principle. We need better understanding and interpretation to resolve these issues, involving a plurality of principles and collective justification in order to create harmony between conflicting parties (Childress 1982, 72). Veatch observes that there are three ways to resolve conflict. First, we could choose a single general principle. Second, we may rank the conflicting principles by lexical ordering, and third, we may seek the balancing principles that possess equal status. However, Veatch rejects all of these alternatives when exploring the resolution of conflicting principles (Veatch 1981, 295–305). Pellegrino and Thomasma suggest, “rational organizing” of the conflicting principles on the basis of the “beneficence-in-trust” criterion. Their proposal has two schemes: “procedural” and “metaethical”. According to them, the procedural scheme includes: patient directives and negotiated values, proxy judgments, an ethics committee and a legal system. While the metaethical scheme includes: the last good, patient good, particular good and the biomedical good (Pellegrino and Thomasma 1988, 84–91). As the patients are illiterate, they may have a blind belief or conservative ideas about healthcare values, as I have just mentioned. So, we cannot set out our ideal that the physician and the patient will rationally resolve their conflicting values. Therefore, dialogue or counseling could be appropriate for resolving conflicting values. Counseling could help the patient to change their values, which would aid them in the long run; it would also provide the physician with an opportunity to review his or her particular values. Dialogue will allow both parties to understand each other more clearly and help them find common ground.

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In conclusion, I have shown that it is difficult to set up a high standard ideal for the Bangladesh context, since it is unachievable. We cannot ignore illiteracy, scarcity, and cultural differences when discussing ideal relationships. The proposed context-sensitive ideal is, therefore, a possible fit for Bangladesh. These factors matter morally and so we need ethical theories. An ethical theory will guide the physician as well as the patient to act morally. Theories could be exercised and used to overcome the current problematic situation. Therefore, in the next section we will concentrate on the related ethical theories.

A Brief Discussion of the Related Ethical Theories An ideal patient–physician relationship must be supported on moral grounds. What should be the basis of an ideal relationship: utility, rules, or care? Two prominent approaches to evaluate the moral permissibility of an action are: utilitarianism and deontology. The moral standard of utilitarianism is “utility”, while for deontology it is “moral law”. We may reach two different conclusions by following utilitarianism and deontology in the same case (e.g. truth telling or lying). So, we cannot solve many moral dilemmas in the patient–physician relationship using these two principles. To overcome this problem a new moral approach has been developed, namely, care ethics. Care ethicists claim that some moral problems are solvable by taking “care” as a moral standard. We will discuss these principles in this section. I. Utilitarianism: Utilitarianism is a widely applicable ethical theory in biomedical ethics. Utilitarianism asks us to calculate utility and make decisions by maximizing utility. The chief characteristics of utilitarianism are that, there is one and only one basic principle in ethics, the principle of utility. This principle asserts that, in all circumstances, we ought to produce the greatest possible balance of value over disvalue for all persons affected. (Beauchamp and Childress 1983, 20)

From the above definition, we may say that firstly, the fundamental principle of utilitarianism is utility: i.e. the morality of any action is justified by the utility. Secondly, we need to maximize the value of good consequences over bad. Thirdly, we can calculate the value through a utility calculus. Jeremy Bentham and John Stuart Mill are the most prominent philosophers in the utilitarian tradition. Now, we need to clarify exactly what utility is and whose utility should be maximized. Utility is something which we want for itself and not for its

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consequences. That is, utility is intrinsically valuable and all other things are extrinsically valuable. But ethicists have different opinions about the intrinsic value. Some ethicists (e.g. Mill and Bentham) hold that “happiness”, or “pleasure”, is intrinsically valuable while others (e.g. G. E. Moore) hold that “knowledge”, or “beauty”, is intrinsically valuable. The former approach is known as “hedonism”, while the later is “pluralism”. The solution is that each individual needs to decide which value matters most to them (Beauchamp and Childress 1983, 24–25). Should the individual consider any particular “act” or “rule” to justify an action? There are two answers to these questions. “Act utilitarians” hold that “particular circumstances” are important to determine the rightness or wrongness of any action, while “rule utilitarians” hold that “justified rules” are valuable to determine the rightness or wrongness of any action (Beauchamp and Childress 2001, 342–344). While act and rule utilitarianism differs over the means of the justification, both of these theories agree that we should maximize good consequences over bad. The consequence of an action is the determinant of its moral permissibility. Utilitarianism is thus a consequentialist theory. How does utilitarianism reply against illiteracy, scarcity and cultural differences as well as the patient–physician relationship? As the consequences of an act are the main consideration for utilitarians, they argue for the maximum benefit of scarce resources and for this reason they may support paternalism. For an illiterate society, paternalism is justified from a utilitarian perspective by considering time, patient–physician ratios, and the existing insufficient medical infrastructure. However, we have seen that paternalism is no more acceptable as an ideal model and, in addition, the consequences of paternalism in Bangladesh are terrible. Utilitarianism may not consider individual patient’s welfare because the greatest happiness of the maximum number of people is their ultimate goal. Utilitarianism, also, may not consider relationships because the equal distribution of health care services is, in their view, more desirable. As a result, this ethical theory may not aid illiterate and poor patients. II. Deontology: Deontological theory rejects utilitarian standards of morality and claims for a reason and obligation-based moral principle. Immanuel Kant formulated the core principles of deontological theory, which he calls the “categorical imperative”. All ethical rules derive from the conception of the categorical imperative. Kant’s first formulation of the categorical imperative is to, “[a]ct only on that maxim through which you can at the same time will that it should become a universal law” (Mappes and DeGrazia 1996, 17). The second formulation says, “[o]ne must act to treat every person as an end and never as a means only”

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(Beauchamp and Childress 2001, 350–351). These two principles have a large influence on biomedical issues. Apparently, it seems that when we use human beings as an organ donor, or research subjects, we violate Kant’s second principle, but Beauchamp and Childress argue that, in those cases, we do not use human beings as “merely an end” and that Kant allows using people who have given consent (Beauchamp and Childress 2001, 351). Kant’s “principle of autonomy” protects the notion of respect for people and imposes three duties on everyone: “1. the duty not to kill an innocent person 2. the duty not to lie and 3. the duty to keep promises” (Mappes and DeGrazia 1996, 18). Now, we may consider these principles within the patient–physician relationship. Should the physician ignore the patient’s autonomy? Is lying morally acceptable? If we follow Kantian principles, the answer to these questions is “no”. In any situation, the physician should not lie to the patient and the patient’s autonomy must be protected. How does deontology respond to illiteracy, scarcity, and cultural differences? Deontology offers us such an ideal conception that in any situation, whether literate or illiterate, the patient’s autonomy should be treated as universal. Deontology emphasizes rationality and reason, arguing that moral rules are always absolute. According to Kant, “[t]he principle of autonomy...is ‘the sole principle of morals’, and autonomy alone gives people respect, value and proper motivation” (Beauchamp and Childress 2001, 351). But practically it is difficult to accept that illiterate, poor people could able to apply their autonomy to a Kantian standard. Moreover, the cultural differences in Bangladesh do not allow for a patient to ignore their family’s opinions and, therefore, they cannot be fully autonomous. This does not mean that the family undermines the patient’s autonomy, rather that the patient is embedded within the family and, as a result, family members have a right to make decisions on the patient’s behalf. So, deontology does not consider the reality of illiteracy, scarcity, and cultural differences and strictly applies the same universal moral law in all situations. III. Care ethics: Care ethics values “care” as the primary criteria for morality and rejects the notion of “impartiality” in moral thinking. Care ethicists highlight some human qualities such as care, empathy, and sympathy, which are more associated with the female gender. According to van den Hoven, Care ethicists hold that care should be accepted as a central moral notion, because care is what moves people, what stimulates them to act, and from

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which our legitimate expectations to others derive and are negotiated. (van den Hoven 2006, 93)

Care ethics originates from a feminist approach to morality. Carol Gilligan’s work In a Different Voice (1982) contributes to the development of “the voice of care” (Manning 2001, 99). Why is the “voice of care” morally significant? Van den Hoven interprets this question very clearly when she points out that Gilligan’s works give us a “positive interpretation” through their reconstruction of the traditional negative interpretation of care and reinterprets it as a morally valuable notion. She states that Gilligan believes women are more caring in order to maintain relationships, whereas men are more concerned about “moral rules and justice”. So, women possess a different approach to articulating moral judgment (van den Hoven 2006, 93). According to van den Hoven, an ethics of care provides special emphasis on the individual, she writes that, To conceive of care as a primary moral notion implies that we have to acknowledge that morality and moral deliberation take place within dynamic practices in which the concrete attention to persons is of utmost importance. (van den Hoven, 2006, 94)

Another vital characteristic of care ethics is that it is context-sensitive and denies “universality”, as well as “impartiality”, as preconditions of moral deliberation. However, a care ethicist does not refuse wholly these two notions and rather argues against their necessity as a “starting-point” for “moral deliberation” (van den Hoven 2006, 95). Joan Tronto indicates that care ethics is not only helpful when making balanced interconnected ethical decisions but also it eliminates all oppression against women. Susan Sherwin goes a step further and claims that we can apply care ethics to solve bioethical problems (Dodds 2000, 222). The main theses of care ethics are valuing relationships and interconnectedness. This theory discourages isolation and tries to solve the debates that arise by following isolated autonomy-based bioethics. Dodds mentions that, “[t]he care focus gives us an awareness of the relationships between people and the ways these relationships are affected by health care” (Dodds 2000, 222). How can care ethics contribute to our ideal patient-physician relationship? Care ethics emphasizes caring as a moral phenomenon and, in the patient–physician relationship, a mutual understanding is expected. The basic structure of this relationship could be contractual, deliberative, or one of the others discussed earlier. Indeed, the care could provide an extra advantage and help to resolve conflict caused by self-interest. As van

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den Hoven writes, “[t]he fact that care is our central moral notion implies that being attentive to the needs of others is a moral quality of agents and failure to see and meet the needs of others will be morally reproachful” (2006, 97). The conflict of interest might sometimes be much more difficult to resolve but caring attitudes could help to provide reasonable and acceptable solutions to these problems. As Purdy says, Should doctors lie to cover up negligence? Should they suggest unnecessary surgery to make an extra buck? Should we invest in strategic defense initiatives when AIDS patients languish without care? Everybody knows the answers: the question is whether we care enough about others to do the right thing. (1992, 10)

Illiterate and poor patients expect a caring relationship with their physician. They may not have the ability to analyze information, understand informed consent, have a basic standard of competency or a sense of autonomy but they can surely feel how much a physician cares about them. We claim that many ethical dilemmas, as well as negligence and medical malpractice will be greatly reduced if this humane principle is included in Bangladesh healthcare practice.

Conclusion To summarize, in this chapter I have tried to build a framework for ideal patient–physician relationships within the context of Bangladesh. In this, I have created a balance between ideal scenarios and reality by incorporating some minimum requirements. So, illiteracy, scarcity, and cultural differences are morally as well as practically relevant. Care ethics provides the moral basis of an ideal patient–physician relationship because poor and illiterate people perceive autonomy as relational and evaluate this relationship through standards of sympathy, empathy, and care.

References Beauchamp, Tom L. and James F. Childress. 1983. Principles of Biomedical Ethics. 2nd ed. New York: Oxford University Press. —. 2001. Principles of Biomedical Ethics. 5th ed. New York: Oxford University Press. Childress, James F. 1982. Who Should Decide? Paternalism in Health Care. New York: Oxford University Press.

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Clarke, Greg, Robert T. Hall, and Greg Rosenerance. 2004. “PhysicianPatient Relations: No More Models.” The American Journal of Bioethics 4(2): 16–19. Dodds, Susan. 2000. “Choice and Control in Feminist Bioethics.” In Relational Autonomy. Feminist Perspectives on Autonomy, Agency, and the Social Self, eds. Catriona Mackenzie and Natalie Stoljar, 213– 235. New York: Oxford University Press. Hui, EC. 2005. “The Centrality of Patient–Physician Relationship to Medical Professionalism: An Ethical Evaluation of Some Contemporary Models.” Hong Kong Medical Journal 11 (3): 222–223. Luna, Florencia. 1995. “Paternalism and the Argument from Illiteracy.” Bioethics 9 (3/4): 283–290. Manning, Rita C. 2001. “A Care Approach.” In A Companion to Bioethics, eds. Helga Kuhse and Peter Singer, 98–105. Oxford: Blackwell Publishing Ltd. Mappes, Thomas A. and David DeGrazia, eds. 1996. Biomedical Ethics. 4th ed. New York: McGraw-Hill Inc. McKinstry, Brian. 1992. “Paternalism and the Doctor–Patient Relationship in General Practice.” British Journal of General Practice 42: 340–342. Pellegrino, Edmund D. and David C. Thomasma. 1988. For the Patient’s Good. The Reconstruction of Beneficence in Health Care. New York: Oxford University Press. Purdy, Laura M . 1992. “A Call to Heal Ethics”. In Feminist Perspectives in Medical Ethics, eds. Helen B. Holmes and Laura M. Purdy, 9–13. Bloomington and Indianapous: Indiana University Press. Talukder, Md. Munir Hossain. 2011. “On Patient-Physician Relationships: A Bangladesh Perspective.” Asian Bioethics Review 3(2):65–84. Travaline, John M. , Robert Ruchinskas, and Gilbert E. D’Alonzo. 2005. “Patient–Physician Communication: Why and How.” The Journal of the American Osteopathic Association 105 (1):13–18. Van den Hoven, Mariëtte. 2006. “A Claim for Reasonable Morality. Commonsense Morality in the Debate on the Limits of Morality.” Quaestiones Infinitae LII. Utrecht: Utrecht University. Veatch, Robert M. 1981. A Theory of Medical Ethics. New York: Basic Books.

CHAPTER TWELVE MULTICULTURALISM AND MINORITY RIGHTS: A DEFENSE OF GEO-CULTURAL IDENTITY1

Cultural diversity often appears as a basic phenomenon in the contemporary globalized world. People who are culturally marginalized often claim various rights, such as language rights, rights of territorial autonomy, immigration rights, and environmental rights. Conflicts between majorities and minorities are therefore likely to cause deadly violence all over the world. Will Kymlicka argues for a new liberal approach to resolve these issues in multicultural politics. He believes that a comprehensive theory of justice in multiculturalism should include universal human rights as well as certain “group-differentiated rights” for minorities. His arguments for group-differentiated rights, as he calls them, are equality-based arguments, history-based arguments, and cultural diversity arguments. This chapter examines Kymlicka’s view of multiculturalism and minority rights, and explores some of his main critiques. It argues that while culture is important for individuals, multiculturalism should rest on the values of cultural diversity and geocultural identity.

Introduction Cultural diversity is a crucial phenomenon in today’s society. Many countries in the world contain diverse language groups, as well as ethnic groups. Therefore, clashes between majorities and minorities are likely, and such ethnocultural conflicts cause deadly violence all over the world. Ethnocultural violence commonly occurs over language rights, land claims, claims for territorial autonomy, immigration policies, and even over public holidays. Will Kymlicka outlines a new liberal approach to resolve these 1

Previously published as “In Defence of Geo-Cultural Identity: An Argument Against Kymlicka’s View of Multiculturalism and Minority Rights” Central European University (CEU) Political Science Journal 8, no. 4 (2013): 405–426.

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issues in multicultural politics. He claims that the present liberal democratic system has undermined and, surprisingly, neglected the rights of cultural minorities, indigenous people, and immigrants. The Universal Declaration of Human Rights was one of the important efforts made to protect minority rights. Nevertheless, according to Kymlicka, human rights are unable to resolve some fundamental questions regarding minority rights. For instance, what languages should get official recognition? Can state funds be allocated to give education in minority languages? What polices should exist to protect immigrants’ cultural identity? The traditional human rights perspective does not have answers to these questions and so, Kymlicka believes, that human rights theory must be supplemented with that of minority rights. His fundamental claim is that a comprehensive theory of justice in multiculturalism should include universal human rights as well as certain “group-differentiated rights” for minorities. In other words, in an acceptable theory of justice minority cultures should get “special status” or “priorities” (Kymlicka 1995a, 27). Kymlicka explores three main arguments for group-differentiated rights of national and ethnic minorities. Firstly, the “equality-based” argument claims minority people are facing “unfair disadvantages”, and that group-differentiated rights can rectify this. Secondly, minorities can historically claim group-differentiated rights on the basis of what he calls a “history-based” argument, and finally, the “cultural diversity” argument, which is concerned with the intrinsic value of a heterogeneous culture. However, other multicultural theorists have criticized Kymlicka’s view on many points. One of the criticisms is that his approach is characteristically Canadian and inapplicable in different contexts. Additionally, though equality and justice are his main concerns, Kymlicka favors a few other minority rights by building a minority rights pyramid. Would Kymlicka’s view be equally applicable in a global scale? For example, if a nation-state wants to preserve both its own cultural traditions and its geographical identity, could Kymlicka’s view be more suitable than that of others? It seems that there are several limitations in Kymlicka’s view when we want to preserve both cultural and geographical identity. Kymlicka has prioritized the minority while overlooking the bond between the individuals’ motherland and cultural practices. A critical review of this widely appreciated theory is therefore necessary. We also need to examine whether Kymlicka’s view is particularly applicable to nation-states that are concerned over both their geographical and cultural identities, (i.e. their geo-cultural identity) and this, as a whole, affects that nation-state’s position in the global scenario.

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This chapter critically examines Kymlicka’s view of multiculturalism and minority rights, and analyzes some of its main criticisms. It argues that recognizing diversity, while at the same time valuing geo-cultural identity, could make multiculturalism more appealing. It begins with a discussion of Kymlicka’s view of multiculturalism and liberalism, and his arguments for minority rights. After that, it reviews the criticisms of such a stance. My own analysis of multiculturalism and minority rights will be presented at the end.

Kymlicka’s View of Multiculturalism and Liberalism According to Kymlicka, multiculturalism may denote many types of “cultural pluralism”, or “cultural diversity” (1995a, 10). Cultural pluralism, along with a comprehensive liberal theory of justice, would lead us to a peaceful coexistence. He writes, “[w]e have no choice but to learn to live with cultural pluralism, and to devise strategies for coexistence that are consistent with principles of freedom, justice, and democracy” (1995b, 21). Kymlicka criticizes traditional multicultural theories that ignore the “differences” among various minority groups. His view of multiculturalism, therefore, is grounded on some basic ideas, such as a distinction between national minorities and ethnic groups, nationality, group-differentiated rights and differentiated citizenship, freedom, and cultural membership. Kymlicka holds that, three rights, namely self-government rights, polyethnic rights, and special representation rights, are group-differentiated rights. A liberal theory would be considered just when it incorporates these three group-differentiated rights. Furthermore, when a country confers all of these rights, beyond the usual citizenship rights, to its minority members then their citizenship is called “differentiated citizenship” (1995a, 26–27). Self-government rights ensure the self-determination of minorities. In order to develop their culture freely, minorities should have the right of “political autonomy” or “territorial jurisdiction”. These rights will grant political power to minorities to allow them to control their territory. Federalism is Kymlicka’s preferred mechanism for recognizing selfgovernment rights because this system gives extensive power to minorities, and guarantees their ability to make decisions. Here, he seems to take federalism not just as a form of administrative decentralization but also as a strategy of empowering minorities. As a common strategy, federalism accommodates national minorities by dividing state powers between the central government and provinces, or states. Thus, in a federal system, at the regional level national minorities could form a majority in order to

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enable their own culture or language to survive. For example, the Quebecois, though a minority in Canada, have extensive power to control education, culture, and even immigration decisions in the province of Quebec. So, the Quebecois have gained self-government rights under the Canadian federal system. Federalism thus promotes self-government rights. Polyethnic rights are also permanent, like self-government rights. For instance, Sikh men may want to wear their turbans, and may demand exemption from motorcycle helmet laws and police dress codes. Similarly, Muslim girls may want to wear scarves, and may, therefore, demand exemption from school dress codes. So, polyethnic rights can help religious or ethnic or other minorities to protect their individuality without hampering minorities’ contributions to mainstream society. Special representation rights may enrich the Western democratic system, which is often criticized as “unrepresentative”. Since Western democracy limits representation from minorities, it is also a form of domination and oppression. Special representation rights may eliminate this problem. There are several ways to implement these types of rights, such as reserving seats for minorities in parliament. Kymlicka outlines three mechanisms to show how a liberal society could accommodate national and ethnic minorities’ demands. However, group-differentiated rights do not yet explain their relationship with individual rights and collective rights, and this is one of the most basic issues within liberalism. Two kinds of safeguards can be made to protect national or ethnic communities. The first is to protect any group from the unsuitable effect of “internal dissent” (i.e. being unwilling to follow traditional customs), while the second is to protect the group from “external decisions” (i.e. any political or economic decision made by mainstream society). Kymlicka calls the former “internal restrictions” and the latter “external protections” (1995a, 35). According to Kymlicka, “[i]nternal restrictions involve intragroup relations—the ethnic or national group may seek the use of state power to restrict the liberty of its own members in the name of group solidarity” (1995a, 36). In contrast, “[e]xternal protections involve intergroup relations—that is, the ethnic or national group may seek to protect its distinct existence and identity by limiting the impact of the decisions of the larger society” (1995a, 36). So, Kymlicka uses these two dominant concepts in order to argue that group-differentiated rights are consistent with liberal principles. In other words, he explores the relation between individual rights and collective rights in liberalism. He believes that both internal restrictions and external protections would uphold the stability of national and ethnic groups in

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their collective rights. Now, the tension is that apparently both internal restrictions and external protections could create injustice because one group may demand state power to impose their will on its own members. Similarly, one group might be preserved through the marginalization of another group. However, Kymlicka claims that a justified liberal theory, which includes group-differentiated rights, could resolve this tension because this theory would grant land claims, language rights, and special representation rights to all minority groups, so that no one group would dominate over another. Nevertheless, some groups may seek internal restrictions to dominate their own members. For example, a Muslim group could forcefully impose compulsory arranged marriages on all of its members. Though such practice is part of a Muslim culture, it is against individual liberty. Thus, Kymlicka says that liberals “can and should endorse certain external protections...but should reject internal restrictions which limit the right of group members to question and revise traditional authorities and practices” (1995a, 37). Many liberals (e.g. Waldron) believe that since a minority does not need their own culture in practice, they could at best claim the “right of non-interference”; this is similar to the right to practice religions privately without getting any support from the state. So, cultural membership is not valuable at all to this minority. However, Kymlicka believes this approach is seriously wrong because it oversimplifies the complexity of blending different cultures. His argument is that if the difference between two cultures is vast, from both technological development and social institutional viewpoints, then some minorities may not integrate themselves successfully. In fact, it might be impossible in some cases. Even if the difference is small, it is not a smooth and easy process. It also possibly involves a costly process (e.g. language learning) and because the desire to retain cultural membership in national minorities is “very strong”, they should not be obliged to pay the cost for an involuntary act (i.e. integrating into a particular culture). Thus, Kymlicka insists that cultural membership is a legitimate claim for minorities because it involves the right to live in and access one’s own culture. John Rawls and other communitarians (e.g. Michael Sandel) also have similar views. Rawls says, “people are born and are expected to lead a complete life within the same society and culture” (1995a, 87). Though Kymlicka agrees with Rawls that leaving a culture is difficult, he differs with Rawls’s argument. An example may clarify this comment. Suppose if someone leaves North Korea for South Korea, they are not breaking the bond of culture and language that Rawls highlights, even though they are

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crossing borders. By contrast, if they leave Quebec for Alberta, they are not crossing borders, but they are breaking the bonds of culture and language. Rawls values culture; however, he ignores the governmentcitizen bond. Contrary to Rawls, Kymlicka argues for political ties with culture. So, Rawls’s argument relies on the inherent bonds to one’s own language and history, whereas Kymlicka’s argument relies on the bonds between a government and its citizens (1995a, 87). Similarly, Kymlicka accepts the communitarian claim of a person’s “deep bond” with a social group, but he rejects the scope and goal of that bond. Communitarians are interested in maintaining our attachment with the “subnational groups” (e.g. family) and argue that a conception of “common good” can define individual good. Individual members have a “constitutive bond” to their own cultural group. So, it is moral to limit individual rights in order to promote common rights. By contrast, Kymlicka argues for one “national” level where individuals have the choice to revise their ends in order to enhance their capacity of choosing a liberal education, without limiting their rights. The national culture creates a context for people to live within their own societal culture by valuing freedom and equality (1995a, 92). Why do people consider their bonds to language and culture to be so strong? Kymlicka mentions two major reasons. Firstly, they can express their thoughts and imagination in a meaningful way; in other words, people can self-identify, and feel safe in their own culture. There is no way to ignore one’s bond to one’s own culture and this bond develops as soon as one is born in a culture, and that cultural structure affects their perception of the whole world. Culture teaches one how to live, how to speak, what to eat, and even what follows the end of life. Kymlicka mentions that culture makes the world sensible to us. However, some people might live a cosmopolitan life and feel free to accept any cultural structure. Nevertheless, most people have difficulties with this because they like to be deeply attached to their own culture. Thus, Kymlicka writes, “[c]ultural membership provides us with an intelligible context of choice, and a secure sense of identity and belonging” (1995a, 105). Secondly, their own culture supports people’s dignity and self-identity. Cultures provide a conception of autonomy and identity to each human being. For this reason, the conception of autonomy is relative to one culture (e.g. African communitarian culture) whereas it is individualistic to another culture (e.g. Western liberal culture). In the same way, individuals could find their self-identity in their own cultures. For instance, an English man may feel free to express himself in English culture rather than in a

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foreign language and culture and so most people identify with their own societal culture. In summary, Kymlicka shows that individual freedom is closely connected with cultural membership and, thus, a liberal theory must incorporate the issue of cultural membership into its basic principles. It would be an obvious injustice if national minorities faced restricted access to their own culture. Societal culture, therefore, plays a crucial role in Kymlicka’s understanding of minority rights. In the next section, I will explore how Kymlicka argues that minority rights are the major constituents of justice.

Kymlicka’s Arguments for Minority Rights Kymlicka argues that people want to maintain their own culture, and that access to a societal culture is the legitimate claim for individual freedom. He writes that, “there are compelling interests related to culture and identity which are fully consistent with liberal principles of freedom and equality, and which justify granting special rights to minorities” (Kymlicka 2002, 339). However, protecting individual freedom involves costs for governments, and so Kymlicka has to determine to what extent this claim is justified. Traditional liberalism holds that in an open and free “cultural marketplace” everyone has the right to associate freely with others in any organization, and to share values different from those belonging to other associations. This freedom of association should be enough for minorities. According to this view, supporting cultural membership by state funds would be not only “unnecessary” but “unfair”. In a liberal society, individuals have no difficulty in joining or creating any association and attracting other people. Supporting any particular culture under this system would be unnecessary. In the same way, it is obviously unfair to support someone’s choice to maintain their own culture by sacrificing others’ money (Kymlicka 1995a, 107). I should note that traditional liberals are not against the cultural bond of individuals, but they are opposed to the state’s support of the survival of any particular culture. Justice, in this view, is “benign neglect”. That is, cultures will survive or decay in their own way and the state should not interfere by protecting or promoting any culture. So, traditional liberalism ignores the difference between national minorities and ethnic groups. Kymlicka argues this view is seriously “mistaken” as well as “incoherent”. The state cannot ignore cultural identities, and minorities’ response to many governmental decisions, such as state language, public holidays, and

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even state symbols. He claims that some self-government rights and polyethnic rights are not only “consistent” with, but also “required” by liberal justice (Kymlicka 1995a, 108). He defends this claim by developing three arguments, which I will briefly discuss. 1. The Equality Argument: Accommodation of differences is the main aim of equality. It is the duty of the government to ensure that all citizens are treated equally regardless of their race or ethnic identity. However, this norm of equality is only correct under certain limitations, as Kymlicka believes that “some minority rights eliminate, rather than create, inequalities” (Kymlicka 1995a, 109). All participatory groups in the cultural market place may not be equal and some of them may be in an “unfairly disadvantaged” position, making political support necessary to rectify the situation. The majority’s political and economic decisions might be a threat to the societal culture of minorities. Unlike the national majority, minorities have to face this difficulty. Kymlicka writes, “[g]iven the importance of cultural membership, this is a significant inequality which, if not addressed, becomes a serious injustice” (Kymlicka 1995a, 109). The group-differentiated rights (e.g. language rights, land claims, political representation) that Kymlicka calls “external protections” may help to eliminate this disadvantage. In other words, group-differentiated rights can ensure equal opportunity for minorities. Here, it is clear that Kymlicka is mainly concerned with the disadvantage caused by “cultural membership”, and not economic or racial disadvantage. Moreover, he believes that the disadvantages caused by cultural membership are “unchosen inequalities”, and a plausible liberal theory of justice should rectify them. One way to rectify such inequalities is by endorsing special rights for minorities, and recognizing “external protections”. A liberal egalitarian theory, for instance Rawls and Dworkin’s, also justifies the elimination of unchosen inequalities and could underpin these rights and protections. As noted earlier, unlike national minorities, ethnic minorities are more worried about “equal access” to the mainstream culture. To ensure equality, some polyethnic rights are justified for ethnic minorities, for example, flexible public holidays, exemption from official dress codes, secular instead of religious state symbols, and so forth. So, the equalitybased argument shows that the government should not be “neutral” or “silent” with regard to national and ethnic minorities, as the “benign neglect” ideal proposes.

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2. The Historical Argument: The historical argument states that group-differentiated rights are simply reflections of historical agreements, treaties, and confederations. Justice would require respecting these historical agreements. Opponents of this view would naturally claim that most agreements are outdated or are based on ignorance. But then Kymlicka could ask, why not follow the relevant parts of these treatises that require the principle of equality now? For example, there could be an exemption from some laws for minorities. The government should consider that they have gained the authority to govern indigenous people, now national minorities, by historical mutual agreements. The state should respect historical treaties for two reasons. Firstly, they are morally and legally obliged to respect certain rights noted in those treaties. Secondly, respecting treaties ensures citizens’ trust and good faith towards the government. These confederation agreements support certain rights (e.g. self-determination) for national minorities. However, such rights should be outlined in accordance with the equality argument. As Kymlicka says, “[m]any of the group-differentiated rights which are the result of historical agreements can be seen as providing the sort of protection required by the equality argument” (1995a, 117). The historical argument recognizes some polyethnic rights (e.g. exemption from certain education and laws) for ethnic minorities. Contrary to the views of some liberals, Kymlicka has argued that few immigrants may historically claim exemption from certain state laws. For instance, one of the Christian sects called “Hutterites” was promised exemption from education, military service, and land laws if they migrated to western Canada. So, the Hutterites can historically claim exemption from these state laws. 3. The Diversity Argument: This argument is about the value of diversity of cultures. As diversity enriches lifestyles, our experiences, and also promotes our interests, we should support it. The diversity argument differs from the earlier two arguments as an appeal of self-interest, not justice. In other words, the earlier two arguments are based on “obligations”, while the diversity argument is about the “interests” of majorities (Kymlicka 1995a, 121). According to Kymlicka, the cultural diversity argument does not put much weight on the rights of national minorities. One of the main problems of this approach is that diverse national minorities may contribute less to intercultural diversity. Moreover, it costs more than many other options, such as increasing the number of immigrants from different cultures. So, Kymlicka holds this argument is “insufficient” in

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the sense that the majority culture may not always accept diversity as “enlightened self-interest” (1995a, 122–123). Nonetheless, the diversity argument provides a strong defense for polyethnic rights because ethnic minorities can contribute to the mainstream culture through diversity of arts, music, cinema, and so on. In most cases, state-funding policies include such diversity. However, learning the mainstream language may promote diversity for minority groups, but there is no legitimate moral ground why minorities should learn it. Therefore, Kimlicka asserts that the diversity argument is a “supplementary” claim but not a necessary claim of equality. To conclude this section, I have presented Kymlicka’s view of multiculturalism, and his three main arguments for minority rights. He believes that individual freedom is dependent on cultural membership and the group-differentiated rights, as external protections, can ensure the rights of national and ethnic minorities. His equality argument, historical argument, and diversity argument insist that a liberal theory of justice should incorporate the group-differentiated rights. However, Kymlicka’s claims are disputable, and have faced several objections. In the next section, I will focus on some major critiques of his view.

Critiques of Kymlicka’s View Brian Barry raises some fundamental questions that challenge Kymlicka’s view of minority rights. For example, he questions whether rights can be ascribed to cultures and asks if cultures can be morally relevant. Brian Barry argues that cultures are not “the kind of entity to which rights can properly be ascribed” (Barry 2001, 67). In other words, we cannot take culture as an end in itself. However, communities may have valid claims when they are defined by an element of culture such as language. The validity of such claims depends on the “legitimate interests” of the members of that particular community. Barry supports Peter Jones who argues that cultures cannot be regarded as moral entities. Cultural fairness simply means the fairness of creating a common ground for the people of each culture. Justice to cultural diversity should require “the people who bear them” as the final concern, not the cultures themselves. According to Barry, cultural membership cannot give any rights to citizens. All citizens are equal because they have the equal rights provided by citizenship and these rights are the same irrespective of their gender, culture, race, and religion. Barry does not think cultural diversity is intrinsically valuable because individuals have the freedom of choice to join and exit from any group and, therefore, belonging to any cultural

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group is not significantly important for cultural diversity. However, cultural diversity will be sustained in its own way. Barry’s liberalism argues that the state should be neutral with regard to cultural and religious practices. His view is opposed to the coercive assimilation of minority cultures into mainstream cultures. The state, rather than individuals, has an obligation to bear the legitimate costs when someone wants to exit the group. Barry points out that Kymlicka has developed a relationship between culture and intrinsic value, and forcefully claims that cultural survival is intrinsically valuable. He values the survival of cultures more than the people who belong to them. In fact, he positions cultural survival as an end. Again, Barry uses Jones’s argument to refute the view that cultural survival has intrinsic value. He criticizes Kymlicka’s claim, by saying that, “this is the kind of nonsense that follows from attributing an intrinsic value to cultural survival, detached from the interests of the individual bearers of that culture” (Barry 2001, 68). Barry believes that cultural survival, when distinguished from the interests of its individual members, has no value. Thus, the goal of cultural survival cannot be an “end in itself”. If the members of a minority culture find that their culture is able to fulfill their various interests and needs, then, and only then, would the claim of its survival be valid. Beyond their interests, cultural survival would be meaningless. According to Barry, the claim that cultural survival has an intrinsic value means that human beings would be treated as “mere cyphers”, or as “instruments of a transcendent goal” (Barry 2001, 67). Thus, Kymlicka’s point that, regardless of individual’s interest, multiculturalism, as a political morality, should accommodate national and ethnic minority cultures is problematic. Barry believes that such a conception of multiculturalism neither promotes the interests of the majority nor that of the minority. Therefore, cultural diversity or group identity “cannot be preserved like items in a museum” (Parekh 2002, 137). Barry also criticizes Kymlicka’s support for “asymmetric federalism”, which grants additional powers to the province of Quebec in comparison to those given to the other provinces in Canada. According to Barry, instead of taking multiculturalism as a “political program”, Kymlicka has understood it as an expression of some “facts” when treating minorities. Moreover, Kymlicka believes that “a culture” is “synonymous with ‘a nation’ or ‘a people’—that is, as an intergenerational community” (1995a, 18). Such an attempt is unacceptable to Barry because it “is simply equating nationhood and cultural distinctiveness”. According to Barry, the idea of defining a nation by its culture or people, what he calls “romantic nationalist doctrine”, is incorrect because it was unsuccessful in many

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parts of Europe and caused the Franco–Prussian war in 1870 (2001, 308– 309). Barry argues that Kymlicka’s asymmetric federalism is unfair. Canada allows representatives of Quebec to vote in the national parliament on issues that do not affect Quebec, but it does not allow others to vote on issues that only affect Quebec. Thus, Kymlicka constructs the concept of “culturalist” nationhood in order to support Quebec in Canada and, thereby, reveals, “he is strongly committed to one side” (Barry 2001, 310). Kymlicka claims that it would be just to allow Quebec to be a “distinct society”, and Quebecois should have additional powers (e.g.. the power of self-government). The claim is, therefore, about the asymmetric decentralization of state power. But Barry maintains this asymmetry implies that “Quebec alone is a nationality-based unit within Canada” (Barry 2001, 310). Kymlicka’s model eventually gives the same powers to two majorities: Quebecois and all citizens minus Quebecois. Barry believes that this asymmetric model actually is a “recipe for chaos”. Moreover, it creates two classes of citizens in one country; he writes, “[t]he complaint, dismissed by Kymlicka, that asymmetry ‘create[s] two classes of citizens’ seems to me completely valid” (Barry 2001, 311–312) and, therefore, asymmetric federalism cannot ensure justice. Iris Marion Young argues that Kymlicka’s view is problematic on two points: firstly, his distinction between national minorities and ethnic minorities is “too rigid”, and even “contradictory”; secondly, he uses the concept of “nation” controversially (Young 1997, 49). Kymlicka distinguishes two minority groups on the basis of their aims. National minorities aim to achieve self-government rights so that they can maintain and appeal to their distinctiveness; thus, they have a tendency to be separated from the mainstream culture. In contrast, the objective of ethnic groups is to participate in the main society, or, in other words, to achieve polyethnic rights and, so, they have a tendency to integrate into the larger society. Kymlicka believes that all minority groups would fit into one or other of these two categories, but Young argues that his claim is too simple. Moreover, Young points out that there are some other minorities (such as African-American) who do not fit any of the categories mentioned by Kymlicka. Another important unique group that Young mentions is “former colonial subjects”, who do not belong either to national minorities or to ethnic groups. So, there are a large number of people who should be treated as minorities but who are neither national nor ethnic. These examples call into question Kymlicka’s use of the term “nation”, and his distinction between national and ethnic minorities.

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According to Kymlicka, a nation is “a historical community, more or less institutionally complete, occupying a given territory or homeland, sharing a distinct language and culture” (1995a, 11). Young asks whether, prior to the founding of Israel, Jews should be considered a nation by this definition? Similarly, why should African-Americans not be considered national minorities (Young 1997, 50)? Young rejects the possibility of only two options, separation and integration, for minorities in a multicultural society and writes, “I think that this analysis, however, puts into question the very possibility of a multicultural society” (1997, 51). Her suggestion is that Kymlicka should be “softening and pluralizing” his dichotomous model, so that there might be various possibilities where not only societies but also individuals are given opportunities to be “multicultural”, or at least “bicultural”. One way of softening and pluralizing Kymlicka’s dichotomous model, according to Young, is to consider cultural minorities within a “continuum” or “a set of continua” (1997, 50–51). Basically, cultural minorities differ by degrees, and not by kinds, because their wish to be integrated with, or to be separate, from the larger society is a matter of degree. Similarly, how the larger society accepts their participation is also a matter of degree. So, Young believes that a conception of continuum with minorities on one side and groups by degree of cultural differences on the other, can replace Kymlicka’s dichotomy. Then multiculturalism would not be a choice between national minorities and ethnic minorities, rather it would be a continuum, and, thereby, would allow pluralism. Chandaran Kukathas has rejected giving any special status or groupdifferentiated rights for minorities in order to compensate for the inequalities caused by culture. Contrary to Kymlicka, he believes “cultures should not be given special protection, that there are no cultural rights” (Kukathas 1995, 245). Kukathas criticizes Kymlicka’s idea of protecting cultural communities in the name of cultural rights. Kymlicka defends cultural rights on two grounds: firstly, he says cultural membership is valuable because culture gives a meaningful life to individuals; secondly, he invokes the liberal equality principle according to which all people have equal rights irrespective of their race, gender, and religion. The first point argues that culture directs people’s choices, their thoughts, and life goals. In short, cultural structure provides individuals with “the context of choice”. For Kymlicka, the main reason to support cultural membership is “that it allows for meaningful individual choice”. So, beyond individual rights or freedom, liberals should be concerned with the question of cultural membership. However, Kukathas claims that such

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a view is “untenable” from a liberal perspective, as well as from the perspective of those who are sympathetic to cultural minorities. The problem arises when Kymlicka tries to justify cultural rights within a liberal framework. As a liberal, Kymlicka maintains that autonomy is the essential basis for the individual’s life, and cultural rights are fully compatible with liberalism. People can express themselves more easily within their own culture and, therefore, culture, in this sense, guarantees the ability to make significant choices. However, Kukathas disagrees because, according to him, culture very often subordinates the choices of its members. Some cultures may expect and require individuals to obey and accept their cultural traditions uncritically and, with regard to this, Kukathas writes, “[o]ften, the individual and his interests are subordinated to the community. Moreover, the individual might be expected to accept uncritically the long-standing practices of the cultural group” (1995, 242). Kymlicka also uses the notion of liberal equality in order to defend rights. He argues that cultural minorities “can face inequalities which are the product of their circumstances...not their choices or ambitions” (quoted in Kukathas 1995, 241). Therefore, a liberal theory should include groupdifferentiated rights. Kukathas raises two issues here: firstly, before incorporating group-differentiated rights we need to consider whether that particular culture is itself liberal or not. If the culture is not liberal, it may not value people’s choices. Secondly, all minorities do not face the same inequalities and some would prefer additional rights to group rights. Moreover, it is not always justified to give a special status to those in a disadvantaged position because they have a lack of choice available to them. Kukathas says, there is no good reason to think that only minorities can face inequalities which are not the product of their choices. Anyone born physically or mentally disabled, for example, could make this claim no matter what his culture, as indeed might anyone born into poverty. (1995, 245)

Thus, Kukathas concludes that lack of control over circumstances cannot justify special rights to cultural minorities. Unlike Kukathas, Ten Chin Liew agrees with Kymlicka that cultural membership gives people the context of choice, and also helps them to make a meaningful choice from various options. However, he does not believe that this necessarily justifies the protection of minority cultures using special rights. He believes that there are other ways, such as tolerance, by which a liberal state could respond to the question of multiculturalism and enable minority groups to participate in and benefit

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from other cultures. Liberal attitudes towards cultural diversity would allow an individual to choose their own way of life from a wide variety of options. Moreover, Ten argues that Kymlicka’s attempt to reconcile “minority rights with the liberty of individual members of minority groups” creates “internal tensions” within his own approach (2004, 21). Like Barry and Young, he rightly shows that Kymlicka is not consistent within his analysis, particularly with regard to the distinctions he makes between the thin and the thick sense of culture. The thin sense of culture refers to language and the historical heritage of cultures or, in other words, the cultural structure itself, but it does not include any shared values or ends. So, in this sense, people can live in the same cultural community without having common ends or values. For instance, the French-Canadians do not share values but do have the same cultural identity. By contrast, the thick sense of culture refers to our participation, from childhood onwards, in different spheres of life, such as eating habits, style of dress, festivals, religion, sex, education, and so on. In short, it includes the meaning and values that make our life worthwhile. The thick sense of culture, therefore, provides some shared values and practices. However, Ten points out that when Kymlicka argues that cultural structures create meaningful choices for individuals, he “invokes” a thick sense of culture. He states that, Kymlicka’s argument adds a layer of complexity to the liberal account of culture, but it does not provide a strong enough case for the state to help in preserving the culture of a minority group. (Ten 2004, 22)

Finally, contrary to Ten, Jeremy Waldron is doubtful that human beings need any deep bond to their own culture and language, and he does not believe that they should protect their cultural membership to live a worthwhile life. He proposes the “cosmopolitan alternative”, which means that people can select and pick “cultural fragments” from a variety of cultures without feeling any deep bond to any particular culture. For example, one can eat Chinese food and hear Western rock music without being a member of either Chinese or Western culture. So, he rejects Kymlicka’s core idea that cultural membership shapes and gives meaning to our lives. Kymlicka wants to fill in the gaps of John Rawls and Ronald Dworkin’s liberal theory because it only considers individual rights, and underestimates the cultural rights of minorities. He advocates that culture should be a primary good in the Rawlsian sense, and argues that cultural structures, or cultural contexts, allow people to have the option of living a

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meaningful life. However, Kymlicka is committing a fallacy of composition here, according to Waldron. He writes, Kymlicka is guilty of something like the fallacy of composition. From the fact that each option must have a cultural meaning, it does not follow that there must be one cultural framework in which each available option is assigned a meaning. (Waldron 1995, 106)

Waldron believes people need culture but that this does not imply that one’s cultural structure is valuable or meaningful. Meaningful options can, instead, originate from fragments of a variety of cultures. Waldron further argues that the modern world is a creation of heterogeneous, rather than homogenous, cultures. For example, there was Palestinian culture, Germanic folklore, and then finally Roman Republic mythology. So, the idea of “a single cultural matrix” is unacceptable in liberal theory as it locks individuals into a particular choice, lifestyle, and interests. In short, Waldron maintains that, “identification with a single cultural frame or matrix, has none of the importance that Kymlicka claims it does” (1995, 108). As discussed above, liberals differ with Kymlicka on various grounds. Most of the critiques show that his view of multiculturalism, which strongly argues for giving group-differentiated rights to minorities, is theoretically and practically incoherent. However, his view is certainly important when considering culture as one of the main minority concerns. He is correct to point out the power of culture in shaping and giving meaning to our lives, but the problem occurs when he says that cultures are morally significant. This would mean that cultural membership could claim some special rights to ensure justice and equality. Some liberal scholars, such as Barry and Kukathas, have rejected this claim, and maintained that cultures are not morally significant at all. Other liberal scholars, such as Young, Ten, and Waldron, agree with Kymlicka that cultures are valuable and allow individuals to live meaningful lives. However, they believe a plurality of cultures and tolerance of that cultural diversity would be sufficient. In the next section, I coin a new term “geocultural identity” and argue that a justified multicultural society does not need to incorporate all group-differentiated rights for minorities. I will also suggest that we do not need a classification among minorities. I will insist that tolerating cultural diversity and promoting geo-cultural identity could make multiculturalism more appealing.

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A Defense of Geo-Cultural Identity In the process of globalization, the preservation of culture is one of the main challenges for the state as well as for individuals. New technologies are contributing to changing cultural values. Modern states are now incorporating new definitions of citizenship while relaxing their immigration policies and welcoming immigrants mainly for economic reasons. However, other reasons, such as the lack of experts in different sectors, scarcity of skilled workers, developments in science and technology, education, health, and the charity sectors, are also related to immigration. Most nation-states in today’s globalized world are, therefore, multicultural. There is no way to keep any nation-state isolated or distinct from this process. All states, whether for or against globalization, operate within this system. Nevertheless, many nation-states, on one hand, want to preserve their cultural heritage, but on the other hand, are committed to ensuring the individual’s freedom and equality. I maintain that multiculturalism, primarily as a political theory, guides us on how we should live with a cultural diversity, which has political as well as moral implications. The political section of this chapter will focus on the form of government in a culturally heterogeneous state. The moral section will explore how multiculturalism can provide justice for minorities in these states. My defense of multiculturalism and minority rights is grounded in tolerating “cultural diversity” and promoting “geo-cultural identity” through freely willed integration. Kymlicka justifies minority rights on the grounds of cultural membership and equality. But does cultural membership relate to justice and equality at all? Do group-differentiated rights really rectify inequalities and ensure justice? We have already discussed, in the previous section, how liberals have different opinions regarding these questions. I believe that although Kymlicka raises an interesting question, he still gives much more weight to cultural membership than it deserves. However, he is correct in saying that culture gives individuals an “intelligible context of choice”. Here the term “intelligible” is crucial. If one does not understand various options in their own way, how can they be able to choose among them? Although cultures shape our imagination, thoughts, values, likes, dislikes, and so on, we refine our thoughts and values by learning voluntarily from other cultures and this is a point that Kymlicka misses. My approach to multiculturalism differs from Kymlicka in the belief that people appreciate other cultural practices and values, while at the same time they are also aware of their geo-cultural identities. In other words, they want a territorial landscape where both culture and geography

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are favorable to them. For this reason, in many Western countries one can find a China Town, an India Square (or Little India), and an African Village. Contrary to Kymlicka, I believe that cultural membership may not always “secure” an individual’s identity. To some extent, someone may feel secure in their own culture, but if their beliefs and wants clash with their cultural norms and values, then they may feel insecure. This person is more likely to prefer living in another culture although, obviously, emotional attachment with his or her own culture would not totally disappear. In this sense, cultural identity gives us viability, rather than security. In my approach, mere cultural membership is not enough to complete the sense of identity for an individual. Kymlicka holds that most national minorities want to survive as distinct societies and will, therefore, demand self-governing rights to preserve their own culture. While Kymlicka strongly supports this distinctiveness, would it, in the narrow sense of cultural identity, be enough for the survival of minority people? In my view, both geographical and cultural identities are crucial to survival as a nation. People’s identity can only be meaningful and complete through their geographical and cultural identities. Cultural identity refers to their language, dress, food, festivals, norms, values, and so forth, whereas geographical identity refers to their homeland. Kymlicka undermines the geo-cultural identity of a nation and an example will clarify my point. Anywhere in the world, people whose food habits, dress style, and languages are “Chinese” can be identified as a member of “Chinese” culture. While the cultural identity of these people is “Chinese” but, geographically, they could be different. For instance, most Chinese people live in China, but some are settled in Taiwan, Thailand, Singapore, Malaysia, Burma, Vietnam, and so on. So, Chinese people in different nation-states have the same cultural identity, but different geographical identities; therefore, when we introduce a Chinese Singaporean we could say their cultural identity is Chinese but their geographical identity is that of a citizen of Singapore. So, their complete identity is Singaporean Chinese. My claim is that cultural membership alone is not enough for an individual’s identity because we must also express their geographical identity. The Quebecois cannot only hold onto their territorial identity because they also need to assimilate into Canadian culture. Kymlicka does not take this point into consideration. The concept of geo-cultural identity creates a balance between Kymlicka's view of multiculturalism and the classical liberal view. For classical liberals, cultural membership is less important when minorities

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get special rights. For Kymlicka, cultural membership is much more important even when minorities get some special rights. The concept of geo-cultural identity emphasizes both cultural membership and the geographical integration of an individual. One of the main problems with this geo-cultural approach is that many countries might have citizens, some of them minorities, who speak different languages and who are from a range of cultures. What would these citizens’ identities be? Should such countries allow coercive assimilation in order to create a homogeneous identity? I believe that the geo-cultural approach could solve this problem without coercive assimilation. The alternative Kymlicka proposes to coercive assimilation is three groupdifferentiated rights: self-government rights for national minorities, polyethnic rights for ethnic minorities, and special representation rights for national non-ethnic social groups like women or the poor. The aim of introducing group-differentiated rights is twofold: to rectify inequalities and to accommodate cultural heterogeneity. However, it is not clear to me why Kymlicka believes that immigrants have “no basis” for claiming selfgovernment and special representation rights. Why should national minorities alone receive self-government rights? More importantly, why should all minorities belong to only one category? Will categorization of minorities and the creation of various rights lead to injustice rather than justice? Suppose, for the sake of argument, we accept that the national minority should have self-government rights. One of the ways to give these rights to them is asymmetric federalism but this concept is currently losing support because, in today’s world, states are more concerned with security and geographical unity. Terrorism is one of the main worries for all states, whether rich or poor. It is not unlikely that a self-governed state would claim geographical independence as per the examples of Tibet and Kashmir. So, all three of these group-differentiated rights are not necessary for justice because they will create division among minorities and could pose a threat to the security and unity of the state. However, I agree with Kymlicka that minorities should have some sort of special representation rights for certain periods. This will not only create equal ground for all minorities but it will also reduce their disadvantaged position. Furthermore, contrary to self-government rights and ethnocultural rights, special representation rights do not act in opposition to geo-cultural identities. We need to preserve a minority culture and, at the same time, we also need to protect citizens’ geo-cultural identities.

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It seems to me that Kymlicka argues not only for equal opportunities but, also, that each culture has the same degree of influence. But I believe that equal opportunities are more important than having an equal influence. Moreover, demanding the same degree of influence from each culture seems impractical and chaotic. For instance, the Muslims in the U.K. cannot claim to have the same degree of influence as the Christians majority has within that particular society. Similarly, Christians in Iraq cannot claim the same degree of influence as the Muslim majority in that country. Therefore, meeting the demand for equal influence of Muslims in the U.K., or Christians in Iraq, would cause societal unrest. However, if Christian and Muslim minorities have equal opportunities to practice their own religious faith, equal access to societal institutions, equal rights to freedom of speech, equal rights with regard to national issues, and so on, in any country then that would be enough to create harmony and peaceful coexistence. Having the same degree of influence in society does not guarantee the survival of a cultural minority. So, if members of each culture have equal opportunities, then that would be sufficient for justice. People are more worried about free speech, equal freedoms, equal opportunities, and equal rights than the fact the majority prefer their own culture to that of the minority. It is against the principles of liberalism for a minority member to feel that they are oppressed due to their culture. In this case, “equality” means equal opportunities and this also applies to immigrants because, like other minorities, they sometimes demand equal access to the mainstream culture. Probably, an Indian immigrant would not mind if there is no Indian culture in the U.K. but they would feel bad if they found discrimination between an American and an Indian. Nevertheless, some Indians may feel better if Indian culture had an equal influence in the U.K. How can minority cultures be preserved? I believe that a combination of two policies could preserve minority cultures: firstly, as Professor Ten suggests, “we should cerebrate, protect, and encourage” cultural diversity (2004, 1) and secondly, we should protect and promote geo-cultural identity. Tolerating and celebrating cultural diversity will enrich our ability to live worthwhile lives because there is no single formula for a good life. Showing respect to different cultures will eventually lead to respect for all individuals regardless of their race, color, nationality, or religion. Tolerance teaches us to accept criticisms of our own way of living, removes cultural blindness, enables us to share others’ decisions, and leads us to reject coercive assimilation. I believe that we should protect and promote geo-cultural identity in order to maintain cultural diversity.

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Geo-cultural identity is a source of cultural diversity. Imagine if the Canadian immigration policy failed to preserve Chinese culture in Canada. Would Chinese culture then vanish? This is absurd because we know that China is present geographically and the people of China will also preserve their own culture. Therefore, we would still be able to celebrate Chinese food, dress, dance, herbal medicine, and so on. Individuals will be able to decide whether they would like to belong to their own culture, or a different one. However, people cannot change their physical attributes, skin color, body structure, and so on and all of these features are embedded in geographical identity.

Conclusion Will Kymlicka questions how minority rights can be defended within a multicultural society. He believes that “benign neglect”, where the state is neutral towards culture or religion, is unsuccessful. Therefore, a new liberal approach to enable the incorporation of minority rights is needed. According to Kymlicka, cultures are morally significant and cultural membership gives people a secure life with an “intelligible context of choice”. He divides all minorities into two groups: national and ethnic. National minorities prefer to survive as a distinct society and demand selfgoverning rights, whereas ethnic minorities want to integrate into the main population but demand the recognition of their ethnic identities. Kymlicka argues that a liberal theory of justice must include three groupdifferentiated rights namely, self-government rights, polyethnic rights, and special representation rights. He justifies the rights of cultural minorities by using the equality argument, the historical argument, and the diversity argument. However, liberal scholars, such as Brian Barry and Chandaran Kukathas, have rejected the claim that cultural membership is morally significant. Liberal scholars, such as Iris Marion Young, Ten Chin Liew, and Jeremy Waldron have criticized Kymlicka’s theory as incoherent. They believe that without addressing the group-differentiated rights we could still respond to the question of multiculturalism. My view of multiculturalism rests on the values of “cultural diversity” and a new concept which I called “geo-cultural identity”. I have argued that Kymlicka’s distinction among various minority groups would create injustice rather than justice. Moreover, except for special representation rights, all group-differentiated rights are not only unnecessary but also against liberal equality. My suggestion is that all minority groups should belong to one category, and equal opportunities policies will be sufficient to treat minority groups in the same way. In order to preserve minority

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cultures we should tolerate cultural diversity, while at the same time promote the geo-cultural identity by using non-coerced integration. This means that nation states that worry about their geographical and cultural identities but also want to acknowledge minority rights could incorporate multiculturalism. Further research is needed to understand the ability to uphold geo-cultural identity at territorial, local, and global levels. Wherever people live, the psychological identification that they have with their land and culture supports and influences their commitment to their own geo-cultural identities. Thus, it goes without saying that it is necessary to study this factor in order to create better immigration policies.

References Barry, Brian. 2001. Culture and Equality: An Egalitarian Critique of Multiculturalism. Cambridge, Massachusetts: Harvard University Press. Kukathas, Chandran. 1995. “Are There Any Cultural Rights?.” In The Rights of Minority Cultures, edited by Will Kymlicka, 228–256. New York: Oxford University Press. Kymlicka, Will. 1995a. Multicultural Citizenship: A Liberal Theory of Minority Rights. Oxford: Clarendon Press. Kymlicka, Will, ed. 1995b. The Rights of Minority Cultures. New York: Oxford University Press. Kimlicka, Will. 2002. Contemporary Political Philosophy: An Introduction. 2nd ed. New York: Oxford University Press. Parekh, Bhikhu. 2002. “Barry and the Dangers of Liberalism.” In Multiculturalism Reconsidered, edited by Paul Kelly, 133–150. Cambridge: Polity Press. Ten Chin Liew. 2004. Multiculturalism and The Value of Diversity. Singapore: Marshall Cavendish Academic. Young, Iris Marion. 1997. “A Multicultural Continuum: A Critique of Will Kymlicka’s Etnnic-Nation Dichotomy.” Constellations 4 (1): 48– 53. Waldron, Jeremy. 1995. “Minority Cultures and the Cosmopolitan Alternative.” In The Rights of Minority Cultures, edited by Will Kymlicka, 93–119. New York: Oxford University Press Inc.

CHAPTER THIRTEEN IS PROFESSIONAL “ETHICAL EXPERTISE” POSSIBLE?1

Discussions over the possibility of ethical expertise have been ongoing in the last few decades. Can ethics graduates consider themselves experts in the manner of medical or engineering practitioners? Can they be hired as consultants? Although many scholars have attempted to give a satisfactory answer to these conceptual questions, the issue still remains unsolved. In this chapter, I will discuss whether professional ethical expertise is possible at all. I argue that ethics experts must satisfy some criteria before claiming an expertise in this field. This expertise, however, is not only limited to the ethics graduates.

Introduction There are two opposite stances regarding the possibility of ethical expertise. Bruce D. Weinstein (1994) argues that ethical expertise is possible in an epistemic as well as a performative sense. Epistemic experts are able to justify their claims about a subject, while performative experts perform the skill of living a good life. Performative experts are “unable” to justify their claims by rules, proper evidence, principles, or theories. Applying these conceptions in ethics, Weinstein sustains the possibility of ethical expertise in a performative sense as well as in the epistemic sense. Christopher Cowley (2005) and other scholars reject both of these possibilities. They provide arguments against the possibility of ethical expertise in any sense. I will discuss these arguments and maintain that none are satisfactory. Then, I will propose that ethics experts must be able to provide correct moral advice and justify their claims with proper evidence.

1 Previously published as “Ethical Expertise in Practice: How Is It Possible?” Bangladesh Journal of Public Administration 23, no. 2 (2015): 35–46.

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Finally, considering these criteria, it will be argued that ethical expertise is possible only in an epistemic sense and not in a performative sense.

Distinction between Epistemic Expertise and Performative Expertise An epistemic ethics expert has a strong knowledge of ethical standards, principles, and theories. This type of expertise requires not only competency in ethical theories and principles but also their appropriate application and critical evaluation. All epistemic ethics experts have the capacity to provide sufficient justifications to prove their claims. Weinstein says, We speak of experts in biochemistry, experts in French history, and experts in the works of Jane Austen or Ernest Hemingway. This sense of expertise refers to the ability to make justified claims about a subject, and we might refer to it as “epistemic” expertise. (1994, 62)

An example may help us to clarify the concept of epistemic expertise. Beauchamp and Childress claim that, “[n]onmaleficence and beneficence have played a central historical role in medical ethics, whereas respect for autonomy and justice were neglected in traditional medical ethics” (2001, 12). Their argument is concerned with biomedical ethics and Beauchamp and Childress have justified it in their book, Principles of Biomedical Ethics. So, they have expertise in the domain of biomedical ethics in epistemic sense. From Weinstein’s definition of epistemic expertise we may point out first, epistemic expertise is an achievable capability. Secondly, epistemic experts are capable of making justifiable claims supported by proper evidence. However, performative ethics experts practice and exercise moral rules in their own lives without providing any specific justification as to why and how they do this. Performative ethics is the practice of secular, religious, and traditional ethical rules and virtues in practical life without epistemological justification but which leads to a good life. The only feedback of performative expert is to inspire people to live a moral life. Weinstein defines performative expertise as, “[e]xpertise in the performative sense refers to the ability to perform a skill well” (1994, 70). Performative experts are not capable of providing any justification. However, this type of expert inspires others to live an ethically good life. As Weinstein says, “[w]hile a performative expert may not be capable of providing a strong moral justification for what we ought to do, she or he

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can, through example, inspire others to live a morally good life” (1994, 71). For example, a physician may refuse to discriminate against patients on the basis of their religion or race. If we ask them what the ethical underpinning behind this is, they may not be able to provide the justification except by saying, “I have taken oath as a physician and oblige to treat all patients equally”. So, this type of expert has a strong commitment to live a moral and, possibly, virtuous life. Cowley states that, “[a] performative expert is widely recognized as being able to ‘get it right’, but without being able to justify or explain how he got it right” (2005, 273). From Weinstein’s definition of performative expertise, we may point out that performative expertise is based on skill and that performative experts are unable to provide any justification for their abilities. Also, most of the decisions made by performative experts are intuitive. George J. Annas, Leonard Glantz, Ruth Shalit, and Christopher Cowley reject the possibility of ethical expertise in any sense. It is important to analyze the arguments against ethical expertise carefully.

Analysis of Arguments against the Possibility of Ethical Expertise Firstly, ethical expertise is not scientific like medicine, which, therefore, means it is not possible. The word “scientific” refers here to the methodological, systematic, and logical foundation of knowledge in medicine. Science is the formal study or causal explanation of events. It is closely related to quantitative explanations. The use of experiments and observations are the main characteristics of science. However, all phenomena or events in this world may not be explained using a scientific framework. We have emotions, such as sympathy, kindness, honesty, and morality, all of which may not be possible to explain statistically and are unquantifiable. We study, discuss, and explain these subjects in the humanities. We question why should we be moral and, yet, there are no scientific answers to this question, although one possible response could be because we want to be a good human being. All human subjects are concerned with to improve our humane qualities, so that we can lead a good social life. Therefore, science may not be the only standard for explaining our world. Understanding ethics is as important as medicine, even though ethical experts may not be able to solve ethical dilemmas in the same way that doctors are able to cure disease by using medicine. Moreover, sometimes medicine has to depend on the “trial and error”

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method and as a result, a factual statement does not always follow. However, ethical expertise may help us to moderate, purify, and develop our moral beliefs and this is as equally valuable as medicine. We need scientific knowledge, as well as humane knowledge, to live a good life. If we reject ethical expertise as unscientific, then we have to reject all other humanities subjects for the same reason. Therefore, we may not reject the possibility of ethical expertise as merely unscientific. Even if ethical expertise is unscientific, then it does not imply that this sort of knowledge is unimportant. The scientific/unscientific nature of knowledge may not be a decisive factor on the possibility/impossibility of a certain type of expertise. Secondly, there is no objective moral truth or criteria for justifying the correctness or incorrectness of an ethical problem. Ruth Shalit has made this argument in The New Republic (Yoder, 1998). She argues that there is no consensus among ethicists about the criteria of judgments. Ethical standards vary from person to person and culture to culture; therefore, ethical expertise is not possible. Two questions are relevant here: is only objective knowledge sufficient when making decisions? And can we validly deduce the conclusion “ethical expertise is not possible” from the premise “there is no objective moral truth”? Although there is objective knowledge and enough agreement in medicine; culture, society, economy, religious belief and individual practice may influence clinical decisions. For example, clinical decisions surrounding abortion and brain death are not only taken by objective knowledge in medicine but are also influenced by culture, religion, and socio-economic conditions. In these cases, medical practitioners have to consider clinical knowledge as well as all these factors in order to make the best and most suitable decisions. So, objective knowledge could be one criterion, but it cannot be the only one when making decisions in any field of knowledge. Shalit fails to recognize this fact. In order to answer the second question, we need to explain the nature of ethical knowledge. Ethics is a normative study and it differs from pure science and mathematical science. Ethical expertise may not demand an objective moral knowledge because the role of ethics in society is not to establish moral principles or solve moral dilemmas in an algorithmic way. Moreover, since morality is a relative concept, objective moral truth may not be possible in ethics. Truth is connected with scientific investigation and it may have a universal formulation based on statistics, experiment, and observation. Conversely, morality is associated with the voluntary actions of social human beings. As morality is relative, objective moral

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truth is useless when trying to justify the correct attitude in response to a moral problem. Thirdly, ethical expertise cannot be acquired by specialized training (Cowley, 2005). We may take training as a pharmacist, an electrician, or as a musician but it is not possible to take training as an ethical expert; therefore, ethical expertise is not possible. Training helps us to develop our capacity to complete a job in a better manner. However, in this argument the word “training” is used in a very narrow sense; for example, to undergo training as a singer or a messenger are two very different things. There is nothing creative in a messenger’s job and anyone can be a messenger but this is not true of a singer because singing requires more skill and talent. Similarly, it may be true ethical expertise cannot be acquired from specialized training in a narrow sense. To be an ethical expert, knowledge in ethics, ethical jargons, ethical justifications, and so on is required; additionally, both practice and experience are needed in order to perform this job effectively. Another point is that training may not ensure the success of a profession; for example, training cannot establish someone as a writer, poet, or lawyer because certainly practice, experience, and creativity are all needed. It is impossible for ethical experts to be trained in all present and future ethical problems, and so they should be trained instead in ethics, ethical norms, ethical arguments, and ethical principles to help them solve future ethical problems. In this sense, ethical expertise can be acquired by specialized training. The fourth argument is that moral judgments are purely personal (Cowley, 2005). Morality is not only concerned with individual because its primary goal is to achieve social good. Ethics provides us with some guidelines, rules, norms, and principles of conduct. It also helps us to provide explanations on how should we conduct ourselves as moral agents. To justify our conduct we need to set ourselves standards of what is good and bad, as well as what is right and wrong. Morality is public as well as private but moral standards are not personal because moral standards have a universal framework (e.g. killing an innocent person is immoral in any society). As a result, we are able to evaluate our moral judgments. Ethics itself cannot make us good or bad but it can help us to understand what is good or what is bad, and how should we live. So, the true aim of ethics is the concern for the individual as well as collective social welfare. Anyone can make moral judgments that are not necessarily correct; for example, the judgment that “abortion is morally wrong” is a personal moral judgment that needs to be justified. So, if it will save the mother’s life then abortion is morally permissible. Ethics experts are not be able to change personal moral judgments, but they can help the individual to understand,

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analyze, and revise moral judgments. Individuals may have incorrect moral beliefs, limitations of moral knowledge, and dogmatic attitudes, which could be rectified by an ethical expert. So, this is an invalid argument because while moral judgments are personal ethical expertise is also personal and that’s why not possible. From the above discussion, we have seen that none of these arguments are satisfactory. In the next section, I will discuss the criteria for ethical expertise and then examine the possibility of ethical expertise using this analysis.

Criteria for Ethical Expertise Ethical expertise can be defined as the capability of giving correct advice in order to solve an ethical problem by providing sufficient justification for this claim. From this definition, two criteria of ethical expertise are clear. Firstly, ethical expertise involves having the capability to give correct advice in order to solve ethical problems and secondly, having the ability to provide adequate justification for that advice. So, if there is a lack of these prerequisite criteria, then ethical expertise is not possible. Epistemic sense of ethical expertise is more compatible with these criteria than performative expertise. As performative experts are unable to provide any justification, they may not be considered experts. The main task of ethics experts is to give reliable, correct ethical advice and offering justifications for this advice. In this sense, ethics and experts are as closely related as physicians and medicines. Experts’ judgments need to be both dependable and trustworthy. Non-experts are also able to make moral judgments but these judgments are justified by common sense morality. As an ethics expert it is not sufficient to know what is right and wrong, but they must also understand why. Rational defense is the basic foundation of ethical expertise. Non-experts who want ethical solutions do not only want to be told what to do, they also want to know why they should be doing something. When experts are not able to provide a rationale for their suggestions, most people will feel too unsure to take risks following their advice. For two reasons the capacity to justify is a necessary condition for ethics experts: firstly, because in the absence of a sufficient rationale, their advice may seem as “groundless advice” and secondly non-experts do not want to depend on the “face value” of expertise without clear justification (Cholbi, 2007). Ethics experts should motivate people to act according to their moral guidance, as well as helping individuals to find their own moral judgments and to, if necessary, guide them to analyze and modify their own beliefs.

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As a whole, an expert’s personality should be impressive and acceptable to non-experts. By their capacity of reasoning, justification, moral knowledge, and useful ethical recommendations, an epistemic expert should be able to motivate and influence the general public. Ethics experts face a dilemma when they enter into this profession, because clients are not interested in understanding ethical norms, principles, and theories. Instead, they expect experts to help them solve their ethical problems and provide sufficient justification for this solution. In order to offer strong justifications, ethics experts should have some training in their respective fields. For example, medical ethics expert should have some training in health care systems, health care laws, health care policies, health care structures, and health care economics, as well as the cultural, social, and religious beliefs that influence health care decisions. In addition, they will also require good interpersonal and psychological knowledge, and so on. This means that an expert’s training in ethics must be complimented with other fields of study. Therefore, an expert’s background in ethics is incomplete or insufficient without sufficient knowledge of other respective fields. This latter knowledge is necessary for an improved quality of service to society as an ethics expert. From this perspective, ethical expertise becomes a capability. On one hand a fresh ethics graduate without adequate capabilities cannot be regarded as an ethics expert, but on the other, anyone without a strong knowledge in ethics will also be disqualified from being considered as an ethics expert. Therefore, ethical expertise is not granted to either an ethics graduate or a graduate in another subject without special knowledge in ethics. An analogy may help us to understand the concept of an ethical expertise. Consider the role of a film director. A film director is a person who has specialized knowledge in film, cameras, acting, editing, costumes, culture, emotions, scripts, and business. In addition, a film director’s role is that of a manager because she or he has a responsibility to coordinate many areas of work. Most of the time, a director has to create a message for their viewers and so, like film directing, ethical expertise involves the capability to coordinate ethics and other branches of knowledge to provide the best solution for an ethical dilemma.

The Possibility of Ethical Expertise in the Epistemic Sense I have previously discussed how Weinstein claims that ethical expertise is possible in both the epistemic and performative sense. Epistemic ethics expert will provide strong moral justifications and performative ethics expert will influence or inspire people to live a

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morally good life (Weinstein, 1994). That is, a performative expert will possess all the ethical ideals, norms, and values within their lifestyle; therefore, people will follow them and learn morality by observation without receiving justification. But, how far is this claim compatible with the concept of “expertise”? According to our proposed criteria, ethical expertise is possible in an epistemic sense. Firstly, epistemic experts have special knowledge in descriptive ethics, normative ethics, and also metaethics. Such experts also have the capacity to offer correct advice to solve ethical dilemmas. As this type of expert has sound knowledge in ethical principles, theories, norms, and values, they will be more competent at providing ethical advice. In addition, they are aware of the limitations and merits of different ethical principles. Secondly, one of the main tasks of experts is to provide adequate justification for claims they make on a particular issue. Sound justification is necessary for their knowledge to be accepted. Justification provides strong rationales, arguments, and reasons so that people can easily accept this advice. Justification crosses the line between belief and reason. In religion, people are asked to live a good and moral life, and the believer obeys this command without seeking any justification or explanation. The very nature of religious justification is intuitive and so intuition’s role, in this example, is stronger than reason. However, ethics is a different issue and justification is the hard foundations of ethical judgments. This is not a matter of belief. An expert’s capability depends not only on providing justification but also on demonstrating proper evidence, reliable and acceptable methodologies, clear analysis and evaluations. Although there are some disagreements among ethical experts, there are also enough clear agreements to create the possibility of resolving ethical problems. For example, there is a disagreement over whether it is ethical to conduct research on human fetuses. Some ethicists argue that fetuses have the same moral status as fully developed human beings and that the development of life is a continuous process so, therefore, we cannot separate a fetus from a newborn baby. From this point of view, conducting research on human fetuses is immoral. In contrast, others argue that fetuses lack rationality, reason, self-consciousness, and other vital criteria, which means they do not have any moral status; therefore, there is no immorality in using human fetuses for research. Both of these views use the methodologies available for ethical discussions, ethical norms, and principles as well as justification. The underlying connections between these two opposing views are that we should follow strong ethical standards in order to

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conduct research on human fetuses. Also, they both agree that research is not morally permissible at every stages of the fetus’s development, because in week 18 fetuses are able to feel pain and react. Therefore, research should only be allowed before this stage. Thirdly, epistemic experts may motivate clients by providing satisfactory services, advices and logical explanations. As a result, clients have an opportunity to evaluate their own moral judgments. Therefore, epistemic expertise provides a middle position between “sainthood” and “common people”. Epistemic experts are capable of evaluating moral judgments from different perspectives. This type of expertise will also open the door for other academics and professionals to take ethical training. Non-experts face ethical dilemmas that lead them to seek moral advice and justified moral advice will motivate them to behave in an honorable manner. Therefore, motivation is another important phenomenon related to ethical expertise. Cholbi’s notion of expertise comprises motivation. He says, Individual S is an expert in domain D only if (1) when consulted for advice about D, S reliably provides correct prescriptions regarding D, and (2) S can provide reasoned justifications for these D-prescriptions...a third condition (3) S should reliably be motivated to act on S’s D-prescriptions. (2007, 327)

I disagree with him on his third point because an ethics expert does not need to be motivated to act, although motivation is required for nonexperts. An expert’s advice should help to motivate people and by “motivation” we mean specifically “moral motivation”. Although performative experts may motivate non-experts through their moral qualities, they are not able to provide specific explanations for this morality; therefore, their role is that of an ethical “automaton”. As Cholbi says, “we ought be rightfully suspicious of the counsel provided by the performative moral expert, since she too closely resembles a moral automaton rather than an informed or thoughtful moral expert” (2007, 326). As for experts, it is not sufficient to say, “this is my opinion”, they also need to provide justification in order to motivate others to act according to the opinion. Therefore, only epistemic experts can satisfy all of our criteria.

Why is Ethical Expertise not Possible in Performative Sense? Weinstein argues that performative expertise is an ability, which is connected to having the skills to live a good life (1994). The word “good”

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may refer to many noble virtues, such as honesty, sincerity, and truthfulness. However, the concept of good life varies from person to person. A good life for a Utilitarian means the maximization of happiness, while for Kantians it means to follow rules, and for a religious person it is about obeying God’s commands. This means that particular moral beliefs, values, culture, and moral traditions are important here. It is also the point where we may apply the concept of expertise and justification. We face a lot of moral dilemmas in our daily lives and it is not enough to say that “I behave in this way” or “I believe in this” because an expert has an obligation to justify and explain to other people why that belief or behavior is more acceptable for the welfare of the individual or society. As Jan Crosthwaite says, “[i]n such contexts ‘that is how I see it’ is not good enough. One must be able to provide grounds supporting decisions, to one’s peers and to possible challenges from patients and the community” (Crosthwaite, 2005). The main job of a performative expert is to inspire people to complete similar acts. Religious people who give moral guidance and teach people to be ethical have some expertise that is closely related with religious ethics. When a religious person says “you should not kill animals” people do not question it, they just believe it. However, more explanation or justification is demanded of an ethics expert’s suggestions. They want to know why we should not kill animals. What is the ethical norm, rule, or principle behind this statement? A religious person is more likely to be able to inspire people to live a moral life, than a performative ethics expert. Ethics is an intellectual activity that serves to justify our conduct and, as a discipline, it explains moral terms, the validity or invalidity of moral arguments, and provides sound reasoning skills. At present, most common moral principles have been included into the Human Rights Declaration. Professional codes for medical, research, and engineering have also been formulated. So, in the previous example of performative expertise, a person who is not necessarily an ethicist can not discriminate against patients on the basis of their race or religion due to the Human Rights Declaration and other, similar, codes of conduct. As Cowley says, “[i]mportantly, such moral wisdom is accessible to anyone, not just philosophers” (2005, 278). Ethical experts’ role in a society is an intellectual one because they are involved in debating with the rights and wrongs of uncountable moral issues, such as euthanasia. An epistemic expert can explain and provide justification on what type of suffering should be treated as “unbearable sufferings”, which would enable society to make a decision with regard to the euthanasia debate. Weinstein seems reluctant about the vulnerability of

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performative expertise because performative expertise is an idealistic concept and does not adhere to the criteria that form an ethics expert.

Conclusion The fields that ethics experts contribute to are expanding and they are now considered one of the most important professionals in society. Some authors have doubts, objections, and frustrations over the possibility of ethical expertise; however, these objections, doubts, and frustrations are not justified. Moreover, many different professionals are keen to work with ethics experts. I have analyzed here the question of whether ethical expertise is possible in both the epistemic and performative sense. My argument is that ethical expertise is possible only in an epistemic sense and not in a performative sense.

References Beauchamp, Tom L. and James F. Childress. 2001. Principles of Biomedical Ethics . 5th ed. New York: Oxford University Press. Cholbi, Michael. 2007. “Moral Expertise and the Credentials Problem.” Ethical Theory and Moral Practice 10 (4): 323–334. Cowley, Christopher. 2005. “A New Rejection of Moral Expertise.” Medicine, Health Care and Philosophy 8 (3): 273–279. Crosthwaite, Jan. 2005. “In Defence of Ethicists: A Commentry on Christopher Cowley’s Paper.” Medicine, Health Care and Philosophy 8 (3): 281–283. Weinstein, Bruce D. 1994. “The Possibility of Ethical Expertise.” Theoretical Medicine and Bioethics15 (1): 61–75. Yoder, Scot D. 1998. “The Nature of Ethical Expertise.” Hastings Center Report 28 (6): 1–12.

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INDEX

A abortion, 95, 98, 175, 176 act of will, 23 action-guiding principle, 81 action-guidingness, 67, 68 admirability, 65, 66, 69, 71, 76 admirable character trait, 65, 69, 70 agent-based virtue ethics, 66 alternative approach, 49, 79 analogy, 17, 91, 92, 93, 100, 178 anthropocentrism, 4, 5, 40, 49, 58, 59, 63, 190 Aquinas, 19, 33 Aristotle, 11, 12, 15, 17, 18, 19, 23, 26, 27, 28, 32, 66, 67, 75, 76, 77, 78, 79, 82, 83, 183, 187 Arne Naess, 1, 2, 5, 6, 7, 8, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 31, 41, 42, 43, 44, 47, 187, 190 Asian traditions, 40, 44, 45, 48, 49, 51, 57 asymmetric federalism, 160, 161, 168 atman, 12, 37 autonomy, 35, 67, 84, 86, 87, 90, 92, 93, 102, 103, 109, 110, 111, 112, 113, 114, 117, 118, 119, 120, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 137, 138, 142, 143, 146, 147, 148, 150, 152, 155, 163, 173

awareness, 2, 17, 26, 37, 95, 97, 100, 147 axiological direction, 24 B balanced caring, 65, 67, 68, 69, 72, 74 beautiful act, 20, 21, 22, 23, 24 belief, 4, 34, 79, 80, 143, 166, 175, 179, 181 benefits, 59, 84, 85, 88, 89, 90, 92, 110, 111, 112, 124, 126, 131, 138, 140, 141 biocentric holism, 12, 17, 27 biology, 17, 18 biomedical, 95, 123, 129, 133, 143, 144, 146, 173 biosphere, 12, 14 brain death, 95, 98, 99, 175 Buddhism, 12, 19, 25, 26, 28, 29, 44, 193 C care ethics, 66, 74, 123, 135, 147 caregiver, 118 caring relationship, 128, 142, 148 Categorical Imperative, 11, 22 Chinese culture, 54, 170 Chinese tradition, 38, 142 coercive assimilation, 160, 168, 169 collective rights, 153

196 community, 8, 9, 17, 25, 43, 56, 61, 104, 132, 133, 134, 159, 160, 162, 163, 164, 181 companionship, 60, 61 compassion, 14, 25, 27, 42, 76 conceptual resources, 49 conflicting values, 143 Confucius, 37, 44, 55, 58 conservative view, 95, 96 contemplation, 36, 77 context-sensitive, 118, 130, 137, 138, 144, 147 corruption, 103, 115, 116, 117 cosmic unity, 53, 56, 59 cosmology, 32, 37, 38, 54 cosmopolitan, 59, 155, 164 courage, 78 cultural blindness, 169 cultural diversity, 150, 151, 152, 158, 159, 160, 164, 165, 166, 169, 170 cultural embeddedness, 132 cultural fragments, 164 cultural identity, 151, 164, 165, 167, 168, 169, 170, 171 cultural matrix, 165 cultural membership, 152, 154, 156, 157, 159, 162, 163, 164, 165, 166, 167, 170 cultural survival, 160 cultural values, 45 culturally heterogeneous state, 166 culture, 30, 31, 36, 38, 45, 49, 50, 58, 60, 61, 117, 129, 134, 141, 150, 151, 152, 154, 155, 156, 157, 159, 160, 161, 162, 163, 164, 165, 166, 167, 168, 169, 170, 171, 175, 178, 181

Index D Daoism, 38, 46, 188, 189 decision-making process, 103, 105, 112, 117, 128, 140 Deep ecology, 5, 8, 11, 13 deontological theory, 145 deontology, 144, 146 developing countries, 94, 104, 120, 123, 131, 132, 133, 134, 186 dichotomy, 40, 162 differentiated citizenship, 152 dominion over nature, 49 double standard, 98 dukkha, 25 duty, 16, 20, 21, 22, 23, 57, 73, 105, 106, 146, 157 E ecological balance, 8, 35 ecological crisis, 1, 8, 9, 30, 31, 45, 60 ecological ignorance, 8 ecological knowledge, 5, 7 ecological Self, 14, 27 ecological wisdom, 7, 8, 9, 11, 49 ecosophy, 2, 11, 13, 14, 19, 25, 27, 41, 43 ecosphere, 7, 14, 15, 17 ecosystem, 2, 3, 4, 9, 18, 30 eco-wisdom, 60 education, 17, 37, 59, 60, 104, 107, 118, 140, 151, 153, 155, 158, 164, 166 ego, 11, 12, 13, 15, 16, 17, 23, 25 emotional bond, 57, 59, 61 empathic caring, 72, 74 empathy, 14, 27, 42, 73, 74, 108, 118, 129, 146, 148

Nature and Life: Essays on Deep Ecology and Applied Ethics environmental crisis, 1, 2, 3, 4, 5, 6, 7, 8, 9, 11, 17, 19, 61, 81 environmental education, 48, 59, 61 environmental ethics, 12, 19, 20, 21, 39, 41, 48, 49, 57, 58, 59, 61, 79, 80, 82 environmental movement, 11 environmental problems, 5, 9, 21, 76, 81, 82 environmental studies, 8 environmental sustainability, 7 environmental values, 61 epistemological, 58, 173 equal opportunities, 169, 170 equality, 59, 67, 90, 150, 151, 155, 156, 157, 158, 159, 162, 163, 165, 166, 169, 170 ethical expertise, 172, 174, 175, 176, 177, 178, 179, 180, 182 ethical principles, 39, 57, 58, 76, 82, 176, 179 ethical problems, 176, 177, 178, 179 ethical standards, 173, 179 ethical training, 180 ethics, 11, 16, 17, 18, 19, 20, 21, 22, 23, 26, 27, 28, 39, 40, 41, 46, 48, 49, 57, 58, 61, 65, 66, 67, 70, 74, 76, 77, 79, 80, 81, 82, 83, 85, 91, 92, 93, 98, 100, 116, 119, 123, 124, 128, 129, 131, 132, 133, 134, 135, 137, 143, 144, 146, 147, 148, 172, 173, 174, 175, 176, 177, 178, 179, 180, 181, 182, 185 ethics expert, 177, 178, 181 ethics graduates, 172 ethnic minorities, 151, 153, 157, 158, 159, 161, 162, 168, 170 ethnocultural conflicts, 150 eudaimonia, 11, 12, 27, 80

197

Europeans, 51 euthanasia, 95, 98, 99, 181 extended family, 51, 52, 53 external protections, 153, 154, 157, 159 F fairness, 67, 159 fetus, 97, 98, 100, 179 filial duty, 57 filial piety, 37, 56 Fox, 13, 24, 28, 187 freedom, 90, 92, 128, 152, 155, 156, 159, 162, 166, 169 G Gandhi, 12, 19, 24, 25, 27, 42, 44 geo-cultural identity, 150, 151, 152, 165, 166, 167, 169, 170, 171 Germanic folklore, 165 good life, 6, 15, 17, 37, 169, 172, 173, 175, 179, 180 government, 104, 105, 106, 116, 119, 152, 155, 157, 158, 161, 166, 168, 170 Greatest Happiness Principle, 34 Greco–Roman cultural tradition, 31 Greek Hippocratic Oath, 102 group-differentiated rights, 150, 151, 152, 153, 154, 157, 158, 159, 162, 163, 165, 166, 168, 170 H happiness, 17, 20, 27, 34, 81, 109, 145, 181 harmonious, 4, 8, 17, 25, 30, 31, 37, 45, 49, 50, 58, 61, 112

198 harmony, 14, 16, 32, 36, 37, 38, 40, 42, 43, 44, 48, 49, 51, 52, 55, 57, 58, 59, 80, 103, 143, 169 Heaven and Earth, 54 hedonistic attitudes, 12 holism, 11, 15, 18 holistic, 17, 19, 31, 38, 40, 129 human dominance, 13 human subjects, 84, 174 human-centeredness, 5, 27, 79, 82 human–nature relationship, 4, 9, 40, 45, 48, 49, 50, 51, 53, 54, 57, 61, 79, 80 Hursthouse, 27, 28, 67, 73, 75, 76, 79, 80, 81, 82, 83, 188 I ideal relationship, 102, 138, 139, 141, 144 identification, 13, 14, 16, 17, 19, 23, 24, 25, 27, 30, 31, 37, 41, 42, 43, 44, 61, 97, 165, 171 identification direction, 24 illiteracy, 91, 102, 103, 104, 107, 108, 117, 130, 131, 135, 137, 138, 140, 144, 145, 146, 148 immigrants, 151, 158, 166, 168, 169 immigration policies, 150, 166, 171 immoral, 21, 24, 69, 137, 176, 179 Indian culture, 35, 36, 42, 52, 53, 169 Indian tradition, 37, 40, 42, 52, 53, 59 individual rights, 153, 155, 162, 164 individual self, 12 inducement, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 186 informed consent, 84, 85, 86, 87, 88, 90, 91, 92, 93, 119, 123, 124,

Index 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 148 instrumentally valuable, 5, 9, 82 integrity principle, 12, 17, 19 internal restrictions, 153, 154 intimacy, 15 intrinsic value direction, 24 intrinsically valuable, 5, 7, 9, 13, 18, 19, 24, 81, 82, 145, 159, 160 intuition, 68, 71, 74, 79, 179 J John Passmore, 39, 41, 44 John Rawls, 154, 164 Judeo–Christian religious beliefs., 31 K Kant, 16, 19, 20, 21, 22, 23, 24, 28, 34, 35, 43, 100, 145, 146 Kantian, 11, 16, 19, 22, 23, 28, 82, 146 Kantianism, 76, 79 kin-centric, 49, 59, 61 kinship relation, 54, 59, 72 L legal document, 124 liberal view, 95, 96, 167 liberalism, 152, 153, 156, 160, 163, 169 lifestyles, 7, 9, 48, 158 living world, 52 Lynn White, 38, 40 M material world, 52 meaningful life, 5, 162, 165

Nature and Life: Essays on Deep Ecology and Applied Ethics medical codes, 109, 119, 124, 142 medical ethics, 173, 178 medical malpractice, 106, 107, 108, 148 mental act, 23 metaphysical similarity, 25 metaphysics, 8, 16, 18, 31, 37, 39, 41, 45, 60 Mill, 34, 43, 46, 47, 144, 145, 189, 193 mind-body dualism, 34 minority rights, 150, 151, 152, 156, 157, 159, 164, 166, 170, 171 Moksha, 25 moral, 5, 9, 11, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 28, 34, 35, 37, 38, 55, 56, 58, 67, 72, 73, 74, 77, 78, 80, 85, 86, 90, 96, 97, 98, 99, 109, 110, 111, 113, 115, 117, 120, 125, 137, 138, 139, 141, 143, 144, 145, 146, 147, 148, 155, 159, 166, 172, 173, 174, 175, 176, 177, 178, 179, 180, 181 moral advice, 180 moral cultivation, 55 moral judgment, 147, 176 moral law, 19, 20, 21, 22, 23, 24, 26, 115, 144, 146 moral norms, 5, 9, 11 moral status, 97, 98, 179 moral term, 12, 22, 23, 24, 26 morality, 11, 13, 16, 18, 19, 20, 21, 22, 23, 24, 35, 58, 61, 74, 109, 144, 145, 146, 147, 160, 174, 175, 177, 179, 180 morally neutral, 11, 12, 19, 21, 22, 23, 24, 26, 28 morally permissible, 84, 109, 114, 176, 180

199

multicultural politics, 150, 151 multiculturalism, 150, 151, 152, 159, 160, 162, 163, 165, 166, 167, 170, 171 myth, 44, 56, 57 N narrow self, 12, 13 nation-state, 151, 166 natural integrity, 18 naturalness, 33 nature, 1, 4, 5, 7, 8, 9, 12, 13, 15, 17, 18, 19, 23, 24, 27, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 43, 44, 45, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 72, 79, 80, 81, 82, 91, 123, 126, 175, 179 neighborhood, 59, 60 Nirvana, 12, 25 non-anthropocentrism, 49, 59 non-violence, 12, 19, 25, 28, 35, 44 normative, 5, 14, 48, 74, 91, 175, 179 norms, 5, 12, 20, 41, 133, 167, 176, 178, 179 O objective moral truth, 175 obligations, 7, 73, 103, 126, 158 ontological, 23, 58, 59 ontologically prior, 19, 24 organic oneness, 13, 16 organic wholeness, 13, 16 P Palestinian culture, 165 paradigm shift, 59

200 paternalism, 102, 108, 109, 110, 112, 114, 117, 119, 120, 124, 128, 134, 137, 140, 145 patient good, 143 patient’s obligation, 110, 126 patient’s rights, 124, 138 performative expert, 173, 174, 179, 181 performative expertise, 173, 174, 177, 180, 181, 182 personhood, 95, 96, 97, 98, 99, 100, 101, 142 phenomenal world, 56 philosophic wisdom, 78 philosophical mindset, 1 philosophical viewpoint, 1 physical act, 23 physician’s role, 111, 112, 113, 115, 141 place-based, 49, 59, 60 Plato, 11, 12, 15, 16, 17, 27, 28, 32, 67, 90, 185 political beings, 55 polyethnic rights, 152, 153, 157, 158, 159, 161, 168, 170 practical wisdom, 26, 27, 76, 77, 78, 79 psychological-cosmological direction, 24 public policy, 35, 127 Q quality of life, 6 R rational beings, 24, 34 rational principle, 77, 78 rationality, 16

Index reason, 4, 15, 16, 17, 23, 24, 33, 43, 51, 61, 70, 77, 78, 79, 80, 81, 90, 91, 93, 98, 99, 100, 145, 146, 155, 162, 163, 167, 175, 179 reasoning skills, 181 relational autonomy, 129, 130, 134, 135 reliability, 68, 118 religio-cultural ceremonies, 53 religion, 36, 38, 41, 51, 52, 61, 71, 143, 159, 162, 164, 169, 170, 174, 175, 179, 181 Rene Descartes, 31, 33 research participation, 87 respect, 19, 21, 23, 24, 35, 36, 44, 59, 80, 81, 82, 86, 110, 112, 118, 125, 130, 131, 133, 146, 158, 169, 173 reverence for nature, 53 risk, 85, 87, 88, 91, 124, 132, 140 risky research, 85, 89, 92 Rolston, 41, 47, 60, 63, 192 Roman Republic mythology, 165 S sacredness, 31, 36, 52, 60, 61 salvation, 15, 37, 51, 110 scarcity, 102, 103, 116, 117, 134, 137, 138, 139, 144, 145, 146, 148, 166 science, 7, 9, 35, 39, 121, 150, 174, 186, 190 scientific values, 60 scientific viewpoint, 2, 4 self, 5, 7, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 22, 24, 25, 26, 27, 30, 31, 35, 36, 37, 38, 39, 40, 41, 42, 45, 54, 55, 60, 67, 72, 73, 77, 95, 96, 97, 107, 125, 129, 142, 143,

Nature and Life: Essays on Deep Ecology and Applied Ethics 147, 152, 153, 155, 157, 158, 159, 161, 167, 168, 170, 179 Self, 11, 12, 13, 14, 15, 16, 17, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 35, 36, 37, 41, 42, 44, 47, 59, 64, 100, 135, 136, 149, 152, 184, 186, 187, 189, 190, 192 self-centered, 5, 7, 72 self-consciousness, 96, 179 self-development, 11, 15, 17 self-government rights, 152, 153, 157, 161, 168, 170 Selfless, 44 self-love, 14, 43 self-mastery, 11, 12, 16 self-realization, 11, 20 Self-realization, 11, 12, 13, 14, 15, 16, 17, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 41, 42, 47, 187, 190 semi-persons, 100 shared values, 164 social identity, 129 socially embedded, 129 Socrates, 15, 22 special rights, 124, 156, 157, 163, 165, 168 Spinoza, 14, 19, 34, 43, 46, 188 spirituality, 37, 48, 52 spontaneous, 37, 38, 44, 55 standard of living, 6, 8 supererogation, 66, 72, 74 sustainable development, 59 T technology, 50 teleological, 18, 35

201

the Creator, 38, 54 theological, 50 tolerance, 37, 163, 165 totality, 13 treatment decisions, 104, 109, 123 trisiksa, 26 U universal human rights, 150, 151 universal Self, 12, 13 Utilitarianism, 76, 79, 144, 145 V value-free information, 111 values, 4, 5, 6, 7, 11, 18, 26, 30, 31, 35, 37, 38, 43, 45, 50, 51, 56, 60, 82, 102, 109, 110, 112, 113, 114, 115, 117, 119, 120, 128, 132, 133, 138, 140, 141, 142, 143, 146, 150, 155, 156, 160, 164, 166, 167, 170, 179, 181 virtue, 11, 12, 19, 23, 26, 27, 28, 43, 65, 66, 67, 68, 69, 70, 73, 74, 76, 77, 78, 79, 80, 81, 82, 83 virtue ethics, 26, 65, 66, 74, 76, 79, 82 virtuous acts, 66, 79 virtuous life, 174 virtuous motives, 66, 72 W Warwick Fox, 24 Western philosophical tradition, 13 Western tradition, 4, 5, 39 Western worldview, 40 wider scope, 23 William James, 14