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For this week, I am going to answer question 1. I would have to say that the way the hepatitis vaccine was developed at the Willowbrook State School was not ethical. My reason for this is because, in the reading, it was mentioned that people who opposed the way the vaccine was developed stated that the consent process was not clearly given to them before giving consent.

For the second question, I am going to answer question 4. The author makes the argument that in global bioethics, we can adopt a culture that holds stronger moral values. In the reading, the author uses the example of women's reduced autonomy in African cultures.

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Noah Burke

Question 3: What aspects of African and Asian cultures complicate our understanding of the bioethical principals of autonomy, beneficence, maleficence, and justice.

One principal that is making it complicated would be autonomy. Bioethics in the United States means that a individual is self determined. This is where they are making their own choices about their body or the treatments they receive from doctors or other providers. While we decide what we want for our own bodies, that is not what many cultures do. In fact, the African and Asian cultures makes the decisions as a family where everyone puts in their word and come up with the answer together. An example of this would be a diagnosis of cancer for a family member and the family would decide whether they put that on record or not because they want to cause the least amount of stress as that diagnosis tends to add a lot of stress for a patient. African families tend to let their elders give them guidance for medical decisions. They would come to the elders of their family to ask for guidance on what steps to take from a diagnosis or which treatments they should do. While all of these are part of their culture, this clashes with the “normal” western practice of medical decision-making with it being more self centered rather than asking for help.

Question 4: Define moral relativism (discussed in the Tosam readings) in your own words. What dangers do these considerations present in the context of global bioethics?

Moral relativism states that there is not an objective, absolute, or moral truths that control societal ethics. This claims that moral absolutes are only an illusion and are very dependent on the culture of your family. These can be common principals along the lines of, “do not murder” or even values like being compassionate (Tosam, p. 4). According to moral relativism, the notions of right and wrong are influenced extremely by a person’s culture, religion, historical context, experiences, and specific events. A great example of this would be the medical practice of euthanasia. Euthanasia is the act of intentionally ending a life to end the suffering and pain of diseases or injuries. This can be done in many ways through injections or self-injections guided by a doctor. Many culture see this as unethical as it is taking ones life away when it is not needed. Even though some cultures see this as an unethical practice, many cultures see it as a compassionate act that one can perform. The act of relieving the pain and suffering from an individual is seen as the right thing as it is allowing them to be free of any of this suffering. This can be dangerous for many reasons including how family may influence something that the certain individual may not want but by their culture will be forced to act in accordance with the families guidance.

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1. Was the research conducted at Willowbrook State School to develop a hepatitis vaccine ethical? Why or why not? Use the bioethical principles--autonomy, beneficence, non-maleficence, and justice--to justify your response.

The research conducted at Willowbrook State School to develop a hepatitis vaccine was unethical. The following bioethical principles describe why the case was unethical:

Autonomy: To begin with, children cannot consent because they are at an age where they cannot freely speak for themselves. In this case, parental permission was granted. However, since the children were disabled, they were sent to the WIllowbrook State School and forced to live in unsanitary conditions that ended in catching hepatitis. The children had no autonomy/choice in living in these conditions and, due to disability and age, didn’t understand the ramifications of what living there would be. They were not willing participants in any sense for this experiment.

Beneficence: In a sense, there were benefits for the patients, their families, and the community around them. By finding a vaccine, each of these groups would be benefited. Additionally, “they would be admitted to a special well-staffed unit where they would be isolated from exposure to other infectious diseases; they were likely to have only a subclinical infection followed by immunity to the particular hepatitis virus”. This, in a sense, would be beneficial for the children.

Non-Maleficence: There was inherit harm perpetuated onto the children on purpose in this experiment. By intentionally injecting them with hepatitis, there was harm inflicted. Additionally, harm came from lack of alternative treatment options, “Moreover, due to crowding and long wait lists for admission to the school, at times the only available rooms for children were on the experimental wing, thus influencing the decision of some parents who did not have the resources to care for their children.”

Justice: Despite the end goal of having justice for everyone, there was no justice obtained for the children. There were still ableist and predatory beliefs that permeated the study that did not give justice for the struggling children, but instead benefited other individuals.

4. Define moral relativism and moral imperialism (discussed in the Tosam readings) in your own words. What dangers do these present in considering global bioethics?

Moral relativism: In my own words, moral relativism is the idea that there is no universal moral code that can apply to every case around the world. Different people have different morals and cases can be approached in a myriad of cultural, religious, and personal ways. There is no universal yes or no answer every time for every person.

Moral imperialism: In my own words, moral imperialism is the idea that one culture essentially “colonizes” another culture’s moral code. This is done primarily by Western countries with the idea that their morals are superior and more “correct” than how other countries look at morals. This can be seen with how they spread their religious beliefs and how those tie into morals.

Dangers: Extreme outlooks on moral relativism can present a danger when considering how people could use it to justify heinous crimes, “Extreme relativism maintains that no moral act is universally right or wrong. Extreme moral relativism justifies any moral act. For example, extreme moral relativists would justify Hitler's atrocities… Macklin argues that ‘one consequence of belief in an extreme version of ethical relativism is its inconsistency with the notion that fundamental human rights exists’”(Pg. 615). Moral imperialism can present a danger when considering the current power dynamic between the West and other areas of the world. The West has pushed their moral code onto the rest of the world for some time now, but has increased heavily with Trump’s presidential career. Aid is offered with conditions that downright disrespect the receiving country’s moral code, but under the risk of lack of funds, the countries are forced to adhere to the West’s idea of morals.

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1. Looking through the four principles, the Willowbrook experiments were unethical. The children involved could not give consent on their own and some of their parents were either misled or forced to give consent, which would go against autonomy as the participation wasn’t truly voluntary. The researchers also claimed that the study was targeted towards benefiting public health however, they were literally injecting children with hepatitis and exposing them to harm, which would go against beneficence, and non-maleficence. On the Justice side, the use of children from several low-income families can easily be seen as unethical, and ethical research should never use vulnerable people unless absolutely necessary and with full consent, which as stated before was not present.

4. Moral relativism is the belief that ethical standards are directly dependent on ones cultural or personal beliefs. Moral imperialism is when a culture tries to pressure their own morals and beliefs onto other cultures because they think it is superior. While both are dangerous, moral relativism can lead to the acceptance of harmful practices like child marriage or the denial of your own medical condition solely because of the want to respect ones culture. Moral imperialism risks erasing cultural identity and forming a larger amount of trust issues throughout the world. Tosam explained himself that both of these fail to create ethical frameworks that ensure inclusiveness, respect, and adaptability to different cultures around the world.

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3. Cultural differences in Africa and Asia can significantly complicate the application of Western bioethical principles like autonomy, beneficence, non-maleficence, and justice. One major complication arises with the principle of autonomy. In many African and Asian cultures, decisions about healthcare are often made collectively within the family or community, rather than by the individual patient alone. For example, in some African communities, a family elder or traditional healer may have significant influence over medical decisions, potentially overriding the patient's personal preferences. Similarly, in some Asian cultures, respect for elders may lead a patient to defer to their parents' or grandparents' wishes regarding treatment, even if it conflicts with their own desires. Another principle that faces challenges is beneficence. While Western bioethics emphasizes doing good for the patient, African and Asian cultures may have different understandings of what constitutes "good." For instance, some traditional healing practices, while intended to be beneficial, may not align with evidence-based medicine. Balancing the desire to respect cultural beliefs with the obligation to provide effective and safe care can create ethical dilemmas.

4. Moral relativism is the idea that moral standards are subjective and vary from culture to culture, meaning there's no universal right or wrong. Moral imperialism, on the other hand, is the belief that one's own moral standards are superior and should be imposed on all cultures. The danger of moral relativism in global bioethics is that it could lead to accepting harmful practices simply because they are culturally sanctioned. Conversely, moral imperialism could result in disrespecting and undermining valuable cultural traditions and beliefs in the name of imposing a single, supposedly superior, ethical framework.

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1. How does gender intersect with disability and/or aging in other nations or cultures? How is this similar to or different from the U.S.? Provide specific examples.

In general, according to UN 2022, “Older women with disabilities also often experience discrimination and human rights violations due to the combined effect on ageism and ableism and associated with the bias that sees older persons and persons with disabilities as naturally deserving less rights and agency”. This goes across the board globally for aging women and women with disabilities. However, how it affects women specifically can differ between cultures and country policies/wealth. For instance, women in Bangladesh are highly dependent on men for autonomy of everyday needs such us transportation. This is not as often seen in the U.S., but still relates back to this discrimination.

2. How are girls and women with disabilities throughout the world empowered to fight for their rights? Provide specific examples.

These women and girls find a strong sense of empowerment through their own identity. This includes banding together as a community to find pride in their voices. As women, as individuals with disabilities, as elders, in health, and in culture. They reclaim their narratives with determination and do not settle to be spoken for.

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3. What aspects of African and Asian cultures* complicate our understanding of the bioethical principles of autonomy, beneficence, maleficence, and justice. Select one or two of the bioethical principles to discuss and provide specific examples. (*-This comes with the caveat that individual cultures within these continents are unique, though share some characteristics and values.)

Answer: One principle complicated by cultural values in many African and Asian societies is autonomy. In Western bioethics, autonomy is often understood as individual self determination the right of a person to make decisions about their own body and treatment. However, in many African and Asian cultures, decision-making is more collective or family-centered. For instance, in parts of East Asia, such as Japan or China, families may withhold a cancer diagnosis from a patient to protect them from distress, believing it is more compassionate. While well-intentioned, this contradicts Western norms of full disclosure and informed consent.

Similarly, in many African cultures, such as among the Akan people of Ghana or the Zulu of South Africa, communal well-being often takes precedence over individual rights. Decisions about healthcare may be made by elders or family heads rather than the patient, especially if they’re young or female. This challenges the assumption in Western bioethics that the individual’s choice should be paramount.

These examples highlight how applying universal standards of autonomy without considering cultural context can lead to misunderstandings and ethical dilemmas in global health and cross cultural care.

2. There is debate on whether there can be a "global bioethics"--meaning if autonomy, beneficence, non-maleficence, and justice can be applied globally, to all cultures. What is your take on this debate after doing the readings?

After engaging with the readings, it’s clear that while the principles of bioethics autonomy, beneficence, non-maleficence, and justice offer a strong moral foundation, applying them universally across all cultures is not straightforward. A rigid, one size fits all model of “global bioethics” risks ignoring cultural values and decision-making norms that are central to non Western societies.

For example, Western bioethics emphasizes individual autonomy, but in many cultures, the family or community plays a central role in medical decisions. If we insist on applying autonomy as individual consent in these settings, we may disrespect cultural norms and even cause harm contradicting the very principle of beneficence.

That said, the core ideas behind these principles like respect, doing good, avoiding harm, and fairness can be adapted. A global bioethics is possible, but it must be flexible, culturally sensitive, and dialogical, not prescriptive. It should seek common ground while allowing for contextual interpretation of each principle.

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What aspects of African and Asian cultures* complicate our understanding of the bioethical principles of autonomy, beneficence, maleficence, and justice? Select one or two of the bioethical principles to discuss and provide specific examples. (*-This comes with the caveat that individual cultures within these continents are unique, though they share some characteristics and values.)

In African and asian cultures the autonomy is seen differently than in other cultures around the world. Instead of making decisions alone, people will often bring family into the matter, especially when someone's health is on the line. For example, some asian families might choose not to tell a patient that they have cancer to protect them. However, for African families, the elders of the family will give guidance about medical decisions that are being made. This shared decision-making can clash with a Western cultural idea that a person should always make the decision themselves.

Define moral relativism and moral imperialism (discussed in the Tosam readings) in your own words. What dangers do these present in considering global bioethics?

Moral relativism is the belief that what's wrong and right depends on the person's culture. And Moral imperialism is the opposite of it, when one group thinks their moral beliefs are the only right, but that person has to turn to push their beliefs

Both of them are risky in global bioethics. One of them can make it hard to protect people, and the other can lead to ignoring local values

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2. There is debate on whether there can be a "global bioethics"--meaning if autonomy, beneficence, non-maleficence, and justice can be applied globally, to all cultures. What is your take on this debate after doing the readings?

I think that a generalized idea of the bioethical principles to protect humans in general is fair, as long as it is very carefully constructed (with self-critical attitude towards moral values) but it would be inefficient to try to make one set of rules that can provide enough coverage for individuals across all cultures. Different people from different cultures, some minority some not, face different challenges, so it is important not to make assumptions for the protection of everyone. Tosam wrote, “… proponents of culturally responsive bioethics are concerned that common morality may result in moral imperialism because of the asymmetry of power in the world. It is in this context that critics argue that global bioethics is impossible because of the difficulties to address these two theoretical concerns” (Tosam, 1).

4. Define moral relativism and moral imperialism (discussed in the Tosam readings) in your own words. What dangers do these present in considering global bioethics?

Moral relativism refers to the idea that moral values are dependent on individual cultures and defined differently by different people between cultures. Moral imperialism refers to the act of imposing or trying to infiltrate another culture’s moral values by pushing your own upon them. Both of these terms makes it difficult to provide one globalized set of bioethical principles, since what is considered right or wrong, or what challenges different cultures face, may be completely varied. Tosam seems to think it is possible to do so, though, if it is carefully constructed and respects all cultures and their differing views. Which, I agree with, just with the concern that assumptions may accidentally be hidden within this project and its product.

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1. Was the research conducted at Willowbrook State School to develop a hepatitis vaccine ethical? Why or why not? Use the bioethical principles--autonomy, beneficence, non-maleficence, and justice-- to justify your response.

No, the research at Willowbrook State School was not ethical. In the article by James DuBois, there are about four principles that tell us if something is right or if it is wrong in healthcare. These four principles are, autonomy, beneficence, non-maleficence, and justice. The Willowbrook study failed every single principle which is why it was not an ethical decision.

Autonomy allows people the freedom to make their own choices and decisions. The children that were at Willowbrook could not make any choices for themselves because of their age and disabilities. The students lacked autonomy, this is the first principal the school failed. Their parents were told that the only way to get into the school was to agree to doing the study. That was not fair at all. The school influenced their decision in the study.

Beneficence means doing good for the people you are in “charge” of. The main goal for this study was to create a hepatitis vaccine, but the children who were involved in the study did not benefit much from being used. The kids at the school were technically used as a trial to help people in the future.

Non-maleficence means to “do no harm.” But the children were intentionally infected with hepatitis, a disease that can be very deadly if not treated properly. That clearly caused harm to the children and no reason was ever good enough to do something like this. Ever.

Justice means treating everyone fairly. At the school only poor and disabled children were used in the trial. The reason they were targeted was because they were easier to control. That’s not equal or fair at all.

The reading argues that we should protect the people around us who are vulnerable and avoid using them just because it’s convenient. It’s not right and in no world is that ever okay to do. Especially to kids. The Willowbrook study was not ethical at all.

4. Define moral relativism and moral imperialism (discussed in the Tosam readings) in your own words. What dangers do these present in considering global bioethics?

Moral relativism explains that every culture has its own beliefs, and we should never judge them, even if we do not always agree. For example, in Tosam’s article, he says that moral relativism can sometimes get so far in other people heads that it leads people to ignore bad things like child marriage or lack of women’s rights, just because of the standard “that’s their culture.” This is a very dangerous thing, because it lets harm continue to people who do not deserve it.

Moral imperialism is the complete opposite. It means forcing your own values onto others instead of keeping them to yourself. In the article, Tosam says that western countries often push their ideas on other cultures, assuming that their way is the only possible way to do things. This can cause people from other cultures to feel disrespected in their traditions and cause a lot of conflict and tension.

The danger in both is that we either ignore harm or try to take over. In global bioethics, there needs to be some kind of balance. We should always respect different cultures, but we also need to speak up when people are being hurt. Especially kids. Tosam says we should look for things that we have in common, like protecting human health, while still being open to the differences in culture.

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1. Was the research conducted at Willowbrook State School to develop a hepatitis vaccine ethical? Why or why not? Use the bioethical principles--autonomy, beneficence, non-maleficence, and justice--to justify your response.

Autonomy- No - Autonomy was ignored for participants (the children), they were forced to be infected and participate in the study against their will. Not to mention, they aren’t at the age(s) where they could consciously make their own decision without being heavily influenced by their parents or other community members.

-Technically, this was adhered in regard to the other ‘outside’ stakeholder, those being: parents, the school, researchers, fellow community members, or students. However, the patients/participants directly at stake were not given anatomy.

Beneficence- Yes- Being critical of the case here this as all done for the good of the community/society along with the people already infected by hepatitis. This of course was to find a cure (which luckily, they did) to cure everyone who was or would contract it in the future from preventing it. This would prevent current and future harm.

Non-Maleficence- No- This study intentionally put the patient at risk by subjecting them to infecting them with Hepatitis, despite asking for parental consent.

-Although they may have thought that asking the parents’ consent would ‘bypass’ this, however, hindsight is 20/20. Also, they may have been ‘blinded’ by their motive of trying to find a cure, which they believed that the ‘overall good’ was worth putting the ‘few’ at risk.

Justice- No- I would argue no on this, as the main issue stemming that the patient/participant was not given consent to begin with so this isn’t justified as it was forced against their will. However, if they had ten it would have been.

-With everything else at stake I can see from the community and researcher’s perspectives on why they thought it was justified as again it followed the logic of finding a cure for everyone and everyone in the future, again the mentality ‘sacrifice the few for the many.’

4. Define moral relativism and moral imperialism (discussed in the Tosam readings) in your own words. What dangers do these present in considering global bioethics?

To begin with, Tosam states that moral relativism is or can be referred to as cultural relativism (2020). This essentially states how cultures, communities, or the individual that hold/have ethical and moral judgments, in general, and for specific cases (Tosam, 2020). This is where Tosam brings in the example of African women and their cultural duty to help the community procreate, this can also be seen with similar issues [not the topics but on how to approach ethical issues within a culture] within Asian culture as discussed in ‘Developing culturally relevant bioethics for Asian People’(2020; Cheng-tek Tai, 2001). Whereas moral imperialism is essentially where one culture or country may force their perspective of moral or ethical judgments and standards onto another (Tosam, 2020). Think of colonialism/imperialism but specifically with moral beliefs and practices. With that being said, I think there are many ‘dangers’ that this can present. Outside form what was already discussed I think this article was interesting as, to me, it was just saying ‘everyone should go about these issues case by case, and we all need to be communicative about it,’ well I thought that was rather obvious with any and all topics or issues. Nevertheless, he says it in a well-written style and states great points along the way. I believe the main ‘danger’ this presents, is again the overall ‘definition/defining’ global ethics itself, because if we do need to go about this in a case by case scenario that is more cultural base, what do we do when we come across cultures and governments that might have mass oppression and enslavement of women or other communities, even though us in the western and majority of the global population say it is wrong, how can we if/when they inherently think women are inferior? Do we disregard the war crimes that are being committed on them and still back off? Obviously not, so I think all-in-all a main foundation still needs to be set, which Tosam does allude to. However, I believe this foundation should encompass basic human rights and if it violates such rights, then it can go onto a second stage of specifics of the culture it is taking place and with the individual(s)/communities the topic at hand is affecting. Like Tosam said, it is important both extremes are avoided, and a middle ground is met, but without a foundation where a middle ground can lay, that won’t be possible. Overall, what I am saying is that with both moral imperialism and relativism if one or the other is followed more than the other than neither will be effective and decisions will become dormant or unethical judgments would be passed, cultural practices/beliefs will be ignored, human rights will be ignored, etc. A balance, or foundation as I mentioned, is necessary for global ethics to stand.

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2. I think that there can be global bioethics, just not in the universal/one-size-fits-all way. Tosam (pg. 617) states that if we view things "glocally" then we have a chance to have global bioethics. The benefit of viewing things as "glocal" places us in a state where we all share a common understanding of bioethics, using the same four-step process and definition. This allows each culture their own morals, expectations, standards, and beliefs, and eliminates (for the most part) the colonization aspect of moral imperialism.

I appreciate the concept of moral relativism in that it respects all cultures and communities. However, as mentioned in Tosam (p. 615), people can take extreme stances and justify what is universally acknowledged as an atrocity.

If we take the stance of glocal bioethics, then we can understand and respect all cultures, without walking the slippery slope of potentially justifying blatantly immoral and inhumane acts.

The Tai et. al. (pg. 53) takes the stance that, while global bioethics focused on autonomy, beneficence, non-maleficence, and justice can be valuable as a first look, it is still important to note that in some cases, they should not be weighed equally, and may occasionally need to be viewed as priority balancing. This is also an understandable viewpoint, because all ethics, especially in medicine, should be considered on a case-by-case basis. Nothing is ever exactly the same, and it's unfair to treat situations without appropriate consideration and based solely on prior information.

I think that if we approach the world using glocal bioethics, based on universal morals/ethics, we can more accurately evaluate and learn from other cultures, while still maintaining the universal standards that it's good to be nice, it's bad to hurt people, etc.

4. Moral relativism (Tosam, pg. 614) is the concept that all cultures are different, no one can judge anyone else, and that there is no black and white way to view things. While this does seem ideal at first, it is also very important to note that it can then be argued that there is no right vs wrong. Extreme moral relativism can be used to justify Hitler's actions and the Holocaust (Tosam, pg. 615).

Moral imperialism (Tosam, pg. 615), however, is a bad idea outright. Moral imperialism is precisely what it sounds like, and is essentially the "goal" of more dominant cultures to colonize and rewrite moral or ethical standards of differing cultures to fit a mold(primarily the mold of Western cultures, i.e. the US, Britain, France, etc.).

The issue with considering these two moral ideas about bioethics is that they can both be used to justify erasure and abuse. On one hand, moral relativism justifies moral atrocities because no one is right or wrong. On the other hand, moral imperialism justifies moral atrocities in the name of only one viewpoint being "the correct one."

Neither are good options, nor (in my opinion and moral belief) moral, or should be considered ethical. Erasure and colonization are present in both ideas, and moral relativism can be used to justify moral imperialism.

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4. Define moral relativism and moral imperialism (discussed in the Tosam readings) in your own words. What dangers do these present in considering global bioethics?

Moral relativism is the belief that there are no set or determined morals because there isn’t a universal binding norm shared throughout all cultures and societies. This type of relativism can present dangers in situations where people don’t agree with a procedure, practice, or how care was given.  Using moral relativism in these situations has no way to decipher between what is right or wrong, preventing justification of harmful practices and eliminating the possibility of moral progress because those boundaries do not exist.

Moral imperialism is when cultures that are more dominant cause other cultures to assimilate to their norms. In Tosam’s readings, his specific reference was the western bioethical culture being more dominated, and their values were promoted as the norm. Tosam used the example “President “Trump’s Global Gag Rule’ in global health (Shahvisi 2018) is an example of this form of moral imperialism” (Tosam, 616). Economic aid was used to deny reproductive rights to women in Africa and elsewhere in the world. This is a very controversial topic which many have strong opinions, yet the more dominant party was able to apply their beliefs in use of moral imperialism. Damages that can be caused due to moral imperialism is double standards in healthcare and research, violations of people’s autonomy, and their local values.

1. Was the research conducted at Willowbrook State School to develop a hepatitis vaccine ethical? Why or why not? Use the bioethical principles--autonomy, beneficence, non-maleficence, and justice--to justify your response.

The research conducted at Willowbrook State School to develop a hepatitis vaccine is not ethical at all. The children were held in unsanitary locations like test subjects and exposed to infectious materials that could cause harm to them. This violates non-maleficence and justice. The children who were the “guinea pigs” of this experiment were permitted to be there with parental permission; yet according to J.C. Gibbs “the parental permission letter downplayed the fact that the children would be intentionally infected with hepatitis.” It is unjust for people to hold an experiment without giving proper information to the patients and parents. This violates not only the parents’ trust but the children as well who placed their autonomy in their parents' hands. Maleficence is violated in this case as well because there is harm intentionally being done. There are ways researchers could have gone about the experiment to find safer ways to conduct the procedure, yet they continued to approve the study with the conditions they provided.

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1. Was the Research Ethical?

In my opinion, the research conducted at Willowbrook State School was not ethical. Even though the researchers claimed they were trying to “control” hepatitis in a place with poor living conditions, the study had many ethical issues, especially when applying bioethical principles such as autonomy, beneficence, non-maleficence, and justice. The risks to the children involved were too serious, the claimed benefits didn’t make up for the harm they’ve implemented to others.

Autonomy

Autonomy means that people have the right to make decisions about their own bodies. In this case, sadly, that right was taken away from them. According to the reading, “Only children with parents with informed consent would be included” (DuBois, 2008, p. 48), but many of those parents likely felt pressured. Since the children were institutionalized and the parents were told that “the only available rooms were on the experimental wing,” (DuBois, 2008, p. 48). Families likely felt they had no other choice. That makes the consent among the patients feel coerced rather than a willing decision. Today, we’d say this type of consent wouldn’t meet the ethical standards because it wasn’t voluntary or informed especially considering the parents’ desperation for care and the children’s inability or fear to speak for themselves.

Beneficence

Beneficence is about doing good and making sure the research benefits the people involved. In the Willowbrook study, the researchers seemed to believe that children would benefit from being in a controlled and supervised environment and that they would just have “a subclinical infection followed by immunity to the particular hepatitis virus” (DuBois, 2008, p. 48) But that wasn’t enough. The children were intentionally exposed to a serious illness, and any immunity they gained doesn’t change the fact that they were put at risk. It seems like the main goal of the study was to help society by creating a vaccine, not to help the kids. That doesn’t align with beneficence, especially when the people being harmed were already vulnerable and didn’t get much out of it themselves.

Non-Maleficence

Non-maleficence, the principle of “no harm,” was clearly violated in this study. Despite receiving medical care and protection from other diseases, the children were still infected with hepatitis. While they “received proper medical care” (DuBois, 2008, p. 48), this does not justify the actions taken. Providing care does not erase the fact that they were intentionally harmed. Hepatitis can lead to serious long-term health consequences, which the researchers failed to consider, resulting in many suffering. The researchers’ attempts to create a safer environment do not excuse the risks they caused. This could have been entirely avoided by choosing not to infect the children in the first place.

Justice

Justice is about making sure things are fair and that no group is treated unfairly. This study mostly used institutionalized children who were already vulnerable. The fact that the only available rooms were sometimes in the experimental wing (DuBois, 2008, p. 48) shows how little choice these families had. These kids were chosen for the study not because it was fair or just, but because they were vulnerable and had limited options. That’s not ethical. It shows how the study may have taken advantage of their situation instead of protecting them. The risks weren’t shared equally, and the children didn’t fully understand or agree with what was happening. This violates the principle of justice because the research placed the burden on those least able to protect themselves.

4. Moral Relativism

It is important to realize that not all cultures share similar values. This is where the moral relativism is displayed. According to the reading, “Moral relativism, sometimes referred to as cultural relativism, is an ethical theory which holds that there are no universal or absolute standards for judging an act; each society makes moral norms and principles based on their moral beliefs and perspectives” (Tosam, 2020, p. 614). In my understanding of the definition, moral relativism suggests that ethical principles are not fixed or universal, but rather shaped by cultural, social, and individual beliefs that change over time. What one society considers normal or morally acceptable may be deemed unacceptable in another. For example, a woman having an abortion in some religions they are against it and they may force the woman to carry the pregnancy full term regardless of the circumstances, or the family may shun her entirely. This ties into the reading, which states, “the standpoint of a pro-choice about abortion differs from that of the pro-life” (Tosam, 2020, p. 614). Instead of focusing on a single standard of morality, ethical judgments vary based on one's values and beliefs, which differ across cultures.

Dangers

A danger that presents considering global bioethics would be the lack of support as well as health care, as someone may become desperate to get out of their situations, and potentially harm themselves or experience health issues or death due to the lack of health care. Also, the right of their autonomy is stripped away, and they have no say in what happens to their bodies. After reading this article, I realized how difficult it can be for outsiders to understand certain practices unless they are part of that cultural context. While I’m not saying all practices are right, things we do every day may be judged by others, just as we may judge them, but it's how we've chosen to live our lives.

Moral Imperialism

Moral imperialism commonly occurs when cultures implement their values on less powerful societies, which causes individuals to disregard their own beliefs and practices. According to the reading, “Moral imperialism is the exportation of moral standards from one culture to another, usually from a politically, economically, and culturally dominant group to weaker groups as universally applicable to all persons and cultures” (Tosam, 2020, p. 615). Oftentimes, moral imperialism involves imposing one group’s ethical standards onto others under the assumption that these values are universally correct. “These standards are often political, economic, or cultural and are pushed by dominant powers who may ignore or suppress the values of other cultures” (Tosam, 2020, p. 615). This can happen through policies that come with strings attached, forcing less powerful countries to abandon their own beliefs. A clear example from the reading is the “Mexico City Policy,” also known as the Global Gag Rule. This U.S. procedure blocks federal funding to international NGOs that perform or promote abortion, even if abortion is legal in their country. According to the reading, “This forces poorer nations to accept the moral standards of the U.S. to receive assistance, completely disregarding or ignoring their own cultural or ethical beliefs” (Tosam, 2020, p. 616). This illustrates how financial power can influence a country’s values at the expense of another’s, even without explicitly asserting dominance.

Dangers

A huge concern in global bioethics is that those in desperate situations may turn to unsafe alternatives, such as purchasing unregulated medications or seeking care from unqualified providers. This desperation can result in severe tragedies and health issues, including life-threatening illnesses or even death.

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prompt one:

No it was not. While I can understand the argument for science and “doing it for the better good” how it and who it was done to was not ethical. The main concern is the violation of the children’s autonomy due to the fact he “his study design involved feeding children local strains of live hepatitis-thus infecting them” as stated on page 48. This is a direct violation due to the fact these individuals were infected without total informed consent to do so and the fact the only available units where the ones on the experimental wing. There is also the is also the fact that the doctor wanted to make these kids sick on purpose rather than being concerned with making them better. There was also the fact that the children were living in “unsanitary conditions” (pg 48). How was it fair to these kids and families that because of their situation they were viewed as potential test subjects rather than children.

Prompt 2: While it might be possible I do not think there is a way to write the meanings in a way that also encompasses all cultures and their views on things like autonomy and justice. I think the article about Asian culture sums up my views pretty well when it says “ transferring an idea from one place to another is transplanting an organ from donor to recipient- rejection is expected” (Tai & Lin pg. 1). Many cultures are deeply rooted in traditions and asking someone to throw away all of that to fit the needs of principles is not fair to anyone or ethical. For example, “in Taiwan if diagnosed with cancer the patient is not the first to know, rather the head of family is made aware so that a decision can be made by the family” (Tai & Lin pg.2). This would be considered a violation of autonomy in the US as medical information about someone can only be shared with parents or guardians if the patient is under 18. These are both considered common practice in the respective area. So having a versatile and changeable global bioethics might be possible, but made to ensure culture, religion, and traditions are respected.

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Was the research conducted at Willowbrook State School to develop a hepatitis vaccine ethical? Why or why not? Use the bioethical principles--autonomy, beneficence, non-maleficence, and justice--to justify your response. The research conducted on the development of the hepatitis vaccine I do not believe is ethical. I believe this because the doctor downplayed to the parents that there children were going to be intentionally infected with hepatitis, there was nothing said about making the children more comfortable the doctor just isolated and fed live strains of hepatitis to the children, and only children with mental disabilities were being used to develop the hepatitis vaccine.

Define moral relativism and moral imperialism (discussed in the Tosam readings) in your own words. What dangers do these present in considering global bioethics? Moral relativism is the belief that what is right or wrong is based off of cultural, and social norms. Dangers of moral relativism is that people are in no position to define the values of others. Moral imperialism is the belief that one culture’s or group’s groups value is being forced onto another. Dangers of moral imperialism is that it may effect local identities and local trust.

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1. Was the research conducted at Willowbrook State School to develop a hepatitis vaccine ethical? Why or why not? Use the bioethical principles--autonomy, beneficence, non-maleficence, and justice--to justify your response. 4. Define moral relativism and moral imperialism (discussed in the Tosam readings) in your own words. What dangers do these present in considering global bioethics? 

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1. Was the research conducted at Willowbrook State School to develop a hepatitis vaccine ethical? Why or why not? Use the bioethical principles--autonomy, beneficence, non-maleficence, and justice--to justify your response. 4. Define moral relativism and moral imperialism (discussed in the Tosam readings) in your own words. What dangers do these present in considering global bioethics? 

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1. This research for a hepatitis vaccine is unethical because autonomy was not respected. Although it is said that "only children with parents who gave informed consent would be included. However, critics of the study thought the parental permission letter downplayed the fact that the children would be intentionally infected with hepatitis" (Solving Ethical Problems Analyzing Ethics Cases and Justifying Decisions 3). Informed consent was said to be used, but other individuals thought that the informed consent wasn't as thorough as it could have been. Informed consent is defined more or less as "In health care decisions, our respect for the autonomy of the patient would, in common parlance, imply that the patient has the capacity to act intentionally, with understanding, and without controlling influences that would mitigate against a free and voluntary act" (Principles of Bioethics 1). Informed consent requires complete understanding of all the benefits and risks, and the ability to make "a free and voluntary act" (Principles of Bioethics 1). If the parents were not fully understanding that their children would be fed a live strand of hepatitis and the risks and benefits involved with doing so, then even if the parents were to make a voluntary decision on behalf of their child that decision would be partially uninformed. In the case of nonmaleficence, "The principle of nonmaleficence requires of us that we not intentionally create a harm or injury to the patient, either through acts of commission or omission" (Principles of Bioethics 1). However, it is also said that "In the course of caring for patients, there are situations in which some type of harm seems inevitable, and we are usually morally bound to choose the lesser of the two evils, although the lesser of evils may be determined by the circumstances" (Principles of Bioethics 1). So, in the case of the hepatitis issue, it would seem that giving the children live hepatitis strands is the better choice because it will be easier to maintain, it will hopefully help get the child an immunity to the hepatitis, and the child would be likely to get hepatitis in some form later on anyway so it would be safer to do it now. However, in accordance with autonomy the legal guardians or parents of the child should be given proper informed consent to be able to properly decide if the harm of feeding their child a live strain of hepatitis truly is the lesser evil in their circumstance. In the case of beneficence, perhaps the lead researcher could take children already naturally affected with the hepatitis strand rather than purposefully affecting new children for the research. Also, the people involved would need to be aware risks and what would happen if they were to fall unresponsive during their time affected with the live hepatitis for fully informed consent. In the case of Justice, all parents should have equal opportunity to be able to say whether or not they want their children involved in the study regardless of outside factors such as wealth, social status, age, and jobs.

4. Moral relativism, in this case, extreme moral relativism is the idea that no moral theory can be entirely universal because everyone has different views and values. "Moderate moral relativism maintains that some moral judgments are universally true or false while others are relatively true or false. This version of relativism concurs with the view that ‘murder is wrong’ is a universally true moral statement. This can be applied where there is no epistemologically or normatively acceptable moral theory which justifies murder. However, most moral relativists support moderate moral relativism; criticisms against moral relativism are mostly targeted at extreme moral relativism (Quintelier and De Smet 2013: pp. 216–217)." (Mbih Jerome Tosam 5). Therefore, the more helpful definition to this discussion is that of extreme moral relativism.

4. Moral imperialism is taking a moral theory from a politically powerful country and imposing this theory as universal on other less politically powerful countries regardless of their different beliefs, values, and viewpoints.

4."But does the search for universal morality not rather result, in the long run, to moral imperialism?" (Mbih Jerome Tosam 6).

4.This is the issue in considering global bioethics. Essentially the author believes that when achieving global bioethics, an idea that thwarts moral relativism, this makes moral imperialism a problem because cultural differences are disregarded in favor of a global theory. The proposed solution is this "Only a morally responsive attitude towards other cultures will permit us to descend and appraise these values. Respect for moral and cultural diversity is the appropriate way forward for genuinely global bioethics." (Mbih Jerome Tosam 9).

4.Like in the principles of bioethics, Sometimes the theories are weighed against each other and there is a slight gray area because different decisions can be made depending on the person and circumstances, "there are situations in which some type of harm seems inevitable, and we are usually morally bound to choose the lesser of the two evils, although the lesser of evils may be determined by the circumstances." (Principles of Bioethics 1). Thus, we must approach global bioethics with the same understanding. While the general rules for global ethics are- well- global- there will be individual differences in what that looks like to allow for cultural beliefs and customs.

4. A silly example being, "Everyone should be able to cut their hair to the length they want it," This would be the global 'rule'. However, what that looks like to me versus someone else varies. My parents do not care what length my hair is as long as I am happy. Therefore, I can cut it however I want. Someone in a different culture my hold their parents' wishes of hair length to a higher degree than I do, so this rule would take into account their parents wish for them, whereas for me it would not. This is what the author is proposing we do for a more ethical form of global bioethics.

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Brooke Fishback’s Responses to Questions 2 & 4

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Brooke Fishback’s Responses to Questions 2 & 4

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2. There is debate on whether there can be a "global bioethics"--meaning if autonomy, beneficence, non-maleficence, and justice can be applied globally, to all cultures. What is your take on this debate after doing the readings?

I think the overall thought of a universal society where everyone has the same idea of what autonomy, beneficence, non-maleficence, and justice is ideal, however can get complicated when you throw beliefs and cultures into the mix. I think the world should have the same idea of what autonomy is so that they enforce letting people make their own choices. I also think people should be aware of how beneficence is to do good, non-maleficence is to not do harm, and how justice is to fight for what it right. When finding the balance between these and culture is where we have problems. To do this, we have to have respect for diversity and the different world views (Tosam, 2002, p. 612). In order to have a balance of universal principles and norms based on shared values in diversity, we need to emphasize inter-connectiveness between human beings and also the environment (Tosam, 2002, p. 614). Having a global bioethics can be made to where we can compromise on norms so they can resonate with local cultures as well and not just the most powerful cultures (Tosam, 2002, p. 612). Overall, I think it is possible to do, but will be hard to do to where everyone agrees on the new norms from different cultures.

4. Define moral relativism and moral imperialism (discussed in the Tosam readings) in your own words. What dangers do these present in considering global bioethics?

Moral relativism is the thought of not being able to have universal norms between different cultures.  When considering global bioethics, this allows for the different cultures to make their own norms and get to run their country and society how they want it. This would allow them to be individuals, however poses threats to people in the culture that don’t agree. For example, if the culture rules to have a norm of not allowing women to have their own autonomy and freedom of speech, the women would be harmed and not protected by what they want (Tosam, 2002, p. 613). By doing this, it is dangerous because people are in charge and have power over others and can tell them how to live their lives. This could influence how women see themselves in society and lead to other complications in society. As for moral imperialism, it is taking moral standards from a specific culture and integrating it into another. This is good because it allows everyone to be in unity and evens the playing field for everyone, however, forces cultures that have been living a certain way to change their habits. This could result in them neglecting their history, backgrounds, and beliefs, which could impact the overall well being of their cultures.

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1. Was the research conducted at Willowbrook State School to develop a hepatitis vaccine ethical? Why or why not? Use the bioethical principles--autonomy, beneficence, non-maleficence, and justice--to justify your response.

When it comes to the Willowbrook State School experiments I believe that they were very unethical and using bioethical principles I will attempt to explain why I think it was unethical. Applying autonomy to the situation we can see that it was very overlooked at the children were intellectually disabled and could not provide consent properly (Dubois, 2008). With this, the parents were not told the whole truth and were led to believe something else, as when it came to enrollment of the school, it was overcrowded and by entering the study they would get admission into the school (Dubois, 2008). This is a choice that will permanently change these people's lives as if they don't do the study they miss out on a school that could help their child and if they do the study the child will be infected with a disease that has the possibility of killing them or have them develop worse complications. This goes in to the next principes of beneficence as the researchers claimed that we could understand hepatitis better and develop a vaccine but you are risking children's lives to create this vaccine and what would happen if the project wasn't a success and you didn't develop a vaccine how far would to take this how many kids would have to get infected or worse die for this vaccine to get developed (Dubois, 2008). This crosses over into non-maleficence as it states that we must do no harm, but these people are exposing these children to a disease that has such consequences that it could stick with them for the rest of your life if this does not break non-maleficence then idk what does (Dubois, 2008). Going into justice in which I believe was most violated here from the fact that these children where disabled, and these were not random selections either they were based on factors like vulnerability (Dubois, 2008). In one of the articles, it mentions that justice means not only equitable distribution of burdens and benefits but also solidarity and fairness which was not present in Willowbrook (Chukwuneke et al., 2014).

2. There is debate on whether "global bioethics"--meaning autonomy, beneficence, non-maleficence, and justice can be applied globally to all cultures. What is your take on this debate after doing the readings?

When reading and reviewing the articles provided and thinking about wheateror not these principles can be used in all cultures I really think they could be used as long as they are formatted in a way to fit that culture as not all traditions are seen equally in a way that something is normal to us in our western culture and not normal is Asian cultures. One of the major risks in global bioethics is falling into the concept of moral relativism which is about accepting all cultural practices without critical thinking or moral imperialism which is just the spread of a predominated culture and looking down on others that do not follow the same path (Tosam, 2020). It is important to avoid these extreme options and look at this with a “culturally responsive and self-critical attitude” (Tosam, 2020). One example is that when it comes to the reproductive autonomy of African cultures, noting how autonomy is more community based rather than based on the wants of the individual, and yest this still respects human dignity within the cultural framework that we use (Tosam, 2020). Another example is with Asian cultures and their prioritization of family and community and basing their decisions from that. When it comes to medical practice informed consent may involve the whole family and not just the individual needing care, which is very different from how the United States does things when it comes to patients autonomy but is not unethical if it respects the culture of the patient (Tai, 2001). Overall global bioethics can succeed but only in a context within the desired culture to make sure that bioethical norms are being followed and not just dominance from one culture.

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2. There is debate on whether there can be “global bioethics” --meaning if autonomy, beneficence, non-maleficence, and justice can be applied globally, to all cultures. What is your take on this debate after doing the readings?

Having finished the readings, I believe that the concept of "global bioethics,” which includes core principles such as autonomy (the right to make one’s own choices), beneficence (the duty to help others), non-maleficence (the obligation to do no harm), and justice (fairness and equality), may not be universally applicable across all cultures. The text notes that although these principles are widely recognized in various societies around the world, they can sometimes conflict with local cultural values, norms, and perspectives, leading to ethical dilemmas. For instance, case one in the text "Principles of Bioethics" highlights that Jehovah’s Witnesses firmly believe it is morally wrong to accept a blood transfusion based on their interpretation of scripture (McCorrnick, p. 1). In situations where a patient’s life is in danger and a blood transfusion is critically needed, ethical complexities arise. The patient must be fully informed about the risks and benefits; however, they retain the right to decline the procedure, even if it contradicts the physician’s medical advice. Additionally, another instance of a controversial issue in modern healthcare is the nuanced question of “who has the right to healthcare?” This inquiry falls under the principle of justice and raises profound concerns regarding its global applicability (McCorrnick, p. 2). Different cultural norms, legal frameworks, socio-economic factors, and social values can lead to varying interpretations and implementations of justice regarding healthcare access. For example, in some countries, healthcare is viewed as a fundamental human right, while in others, it is seen as a privilege determined by individual circumstances or economic status. This disparity complicates the establishment of a universally accepted standard for healthcare access and raises serious ethical considerations that must be addressed in the field of global bioethics.

4. Define moral relativism and moral imperialism (discussed in the Tosam readings) in your own words. What dangers do these considerations present in the context of global bioethics?

Moral relativism asserts that there are no objective, absolute, or universal moral truths that govern societal ethics. This philosophical perspective claims that moral absolutes—principles broadly accepted across cultures, such as the directive "Do not murder" or the value of compassion—are merely illusions and culturally dependent (Tosam, p. 4). According to moral relativism, notions of right and wrong are influenced by various elements, including an individual’s culture, religion, historical context, personal experiences, and specific situations, rendering morality fundamentally subjective. Take the medical practice of euthanasia, for instance. Some cultures see it as a compassionate option that enables individuals to alleviate suffering in terminal situations. In contrast, other cultures reject euthanasia due to their religious convictions, perceiving it as ethically unacceptable. This example demonstrates how various cultural settings can influence moral evaluations in the realm of medical ethics.

On the other hand, moral imperialism refers to a situation where one culture imposes its values on another, often when a more powerful and economically stable community enforces its cultural standards on a weaker one (Tosam, p. 5). This scenario poses notable risks in the realm of global bioethics, particularly when it leads to a culturally homogeneous environment that sidelines diverse viewpoints. Such imposition can cause ethical tensions, especially in healthcare, where different cultures may hold unique beliefs regarding life, death, and medical intervention (Tosam, p. 6). In certain cultures, for example, declining medical treatment due to spiritual beliefs is respected, which contrasts with Western biomedical ethics that often emphasize the preservation of life. Global bioethics cases frequently reveal conflicts that not only undermine the integrity of marginalized communities but also threaten the distinct perspectives essential for fostering global understanding, respect, and collaboration in an interconnected world. Additionally, acknowledging and valuing different moral viewpoints is crucial. In today's globalized environment, individuals often encounter various belief systems and ethical frameworks. This exposure can promote dialogue, fostering a deeper appreciation of diverse ethical perspectives. By encouraging mutual respect and open-mindedness, societies can more effectively navigate differences and collaborate on pressing global issues, such as human rights. Embracing moral diversity ultimately enriches our collective understanding and enhances our ability to address complex, multifaceted challenges. Moreover, engaging with a range of ethical perspectives enables us to reflect on our own beliefs, promoting personal growth and critical thinking. It also underscores the importance of empathy, inviting people to consider experiences and viewpoints beyond their own.

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1. Was the research conducted at Willowbrook State School to develop a hepatitis vaccine ethical? Why or why not? Use the bioethical principles--autonomy, beneficence, non-maleficence, and justice--to justify your response.

2. There is debate on whether there can be a "global bioethics"--meaning if autonomy, beneficence, non-maleficence, and justice can be applied globally, to all cultures. What is your take on this debate after doing the readings?

3. What aspects of African and Asian cultures* complicate our understanding of the bioethical principles of autonomy, beneficence, maleficence, and justice. Select one or two of the bioethical principles to discuss and provide specific examples. (*-This comes with the caveat that individual cultures within these continents are unique, though share some characteristics and values.)

4. Define moral relativism and moral imperialism (discussed in the Tosam readings) in your own words. What dangers do these present in considering global bioethics?