Keywords

Introduction

The Global Code of Conduct for Research in Resource-Poor Settings (GCC) is built around four values : fairness , respect , care and honesty . In this chapter, we tackle the moral relativism claim against values approaches. Some readers may feel that no such effort is necessary. It may, in their view, be obvious that fairness, respect, care and honesty are worthy values. They may also believe that these values have application in global research ethics and that they can counter ethics dumping , the practice of moving unethical research from a high-income setting to a resource-poor setting, which – by definition – requires a global approach. For those who are more sceptical, we sketch a plausible response to the moral relativism objection.

The GCC’s value of respect recognizes significant variation in cultural norms and practices (for example in article 8Footnote 1), while implicitly assuming that the four values the code recommends are globally applicable. How do we reconcile this tension? That is, how do we demonstrate that, in making use of the four values, one group is not illegitimately imposing its values on others, in ways that the GCC itself would deem unacceptable?

The surest way of doing this is to defend the claim that the four values, which we believe have particular application in research in resource-poor settings , could be global or universal values. Let us call this claim “the global applicability thesis”. We need somehow, then, to be able to maintain the global applicability thesis alongside the recognition of significant variation in norms across cultures . We will look in turn, in the sections that follow, at a number of suggestions about how this may be achieved.

First we will consider the possibility that the requirement to proceed with fairness , respect, care and honesty leads to an acceptance of a thoroughgoing moral relativism  – that is, a robust and unflinching commitment to the belief that all values are culture-bound, and that there are no “extra-cultural” values or norms. We will argue that, for reasons articulated by Bernard Williams (1972) nearly half a century ago, such strict moral relativism is unsustainable.

Then we will consider the merits of a more moderate moral relativism , of the sort argued for by the Chinese-American philosopher David Wong (1991, 2009). This approach combines a recognition of variation in norms across cultures with a certain sort of universalism. For Wong, what remains constant across disparate systems of moral norms is the purpose behind any such system, or the aim of morality as such. We will argue that Wong’s approach, though an improvement on a more extreme relativism, does not provide what we need: that is, it does not show there to be some universal norms – among which are our four values  – in addition to some genuine cross-cultural normative variation.

Finally we introduce an approach that has much in common with the TRUST Footnote 2 approach: the “four-principles approach” presented by Tom Beauchamp and James Childress in successive editions of their book Principles of Biomedical Ethics (2013). Beauchamp and Childress maintain that there are four central values /principlesFootnote 3 (see the box below for the difference between the two) that are especially applicable to their own area of ethical interest, biomedical ethics. They use the term principles, and identify them as respect for autonomy, non-maleficence (do no harm ), beneficence and justice (Beauchamp and Childress 2013).

Values and Principles

The words “values ” and “principles ” are often used interchangeably. We will distinguish them as below.

If people value something, they hold it dear, and they believe it is of high importance. This could be power , money or kindness; values are not necessarily morally positive. Ethical values , on the other hand, are guides on the route to doing the right thing or developing a moral character. They are by definition morally positive. For example, greed is not an ethical value, but generosity is.

A principle is a behavioural rule for concrete action. When you know the principle, you know what to do. For instance, the principle in dubio pro reo has saved many innocent people from going to jail as it gives courts very concrete advice. It means, “When in doubt, then favour the accused,” (in other words, “innocent until proven guilty”) and goes back to both Aristotle and Roman law.

Beauchamp and Childress maintain that their four principles are globally applicable – that is to say, they are universally relevant to the sorts of ethical questions that arise in biomedicine; they are every bit as integral to the understanding and resolution of medical ethics problems in Bangkok as they are in Boston, equally pertinent in both Cape Town and Copenhagen. Their status as globally applicable is, according to Beauchamp and Childress, underwritten by their forming part of what they call “the common morality ”, understood as a system of general norms that will be specified differently in different cultures , but to which all morally committed persons everywhere will subscribe.

We want to argue that the four values  – fairness , respect, care and honesty  – are rooted in a globally applicable common morality , the norms of which can be specified in various ways in disparate cultures . Insofar as this is the case, our argumentational strategy will be similar to that of Beauchamp and Childress.

However, we want to maintain that the four GCC values, taken together, have a less contentious claim to be globally applicable than Beauchamp and Childress’s principles , for two reasons.

  1. 1.

    One of Beauchamp and Childress’s principles  – respect for autonomy – has often, and with some justification, been criticized for being culturally bound rather than universal (Huxtable 2013, Kara 2007, Cheng-Tek Tai 2013, Kiak Min 2017)

  2. 2.

    The GCC’s four-values approach was developed collaboratively with diverse stakeholders from all continents, including significant representation from vulnerable research populations (see Chapters 6 and 7).

The Four Values and Moral Relativism

Giving the value of respect high standing, as one of only four values in the GCC framework , opens the framework to attack for being morally relative. Unlike fairness , care and honesty , the value of respect centres on foreseeable disagreement. If I have to respect what somebody does in a country that is not my own, even though I disagree heavily for moral reasons, does this mean there are no globally shared values? If this were the case, it would mean that no global moral framework is available to ground the 23 articles of the GCC.

In philosophy, this conundrum is called the doctrine of moral relativism. Such relativism has been divided into three related forms with different emphases : descriptive relativism , metaethical relativism and normative relativism .

Descriptive relativism

Descriptive relativism is a sociological or anthropological, rather than philosophical, doctrine, which is based upon observations of disparate cultures . It holds that, as a matter of fact, moral norms show considerable variation across societies: courses of action deemed permissible or even obligatory in one society may be proscribed in another.

MetaethicalFootnote 4 relativism

Metaethical relativism is a philosophical doctrine that we may be tempted to adopt if we find ourselves convinced by the claims of the descriptive relativist. It maintains that there are no universal or extra-cultural moral truths: insofar as a given moral judgement can accurately be described as true or false, this position maintains that it is true or false only relative to a given society.

Normative relativism

If we subscribe to metaethical relativism, then we can only say that a particular action is wrong in our society, not in other societies. Our only option is to “live and let live”.

A summary of these positions and how they follow from each other is shown in Figure 4.1.

Fig. 4.1
figure 1

Different types of relativism and their relationship

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Normative relativism might seem to offer us a way to resolve the apparent tension in the four-values approach, which might be thought to dovetail neatly with the normative relativist’s outlook. Since we have no business interfering in or evaluating the moral codes of those from other cultures , our interactions with them, including research interactions, need to be as “light-touch” as possible. We need to treat each other fairly and with care , respect cultural differences, not impose our own values, and ensure our interactions are honest.

The problem here, however, is that just as descriptive relativism does not entail (though it may lend support to) metaethical relativism , metaethical relativism also does not entail normative relativism (and provides no support for it at all). This point is well argued by Bernard Williams (1972: 34) in his 1972 book Morality, in which he calls normative relativism “possibly the most absurd view to have been advanced even in moral philosophy”. He writes:

[T]he view is clearly inconsistent, since it makes a claim … about what is right and wrong in one’s dealings with other societies, which uses a nonrelative sense of “right” not allowed for in [metaethical relativism].

In other words, metaethical relativism does not lead to any position, including normative relativism , which tells us what we should do in interacting with those from other cultures . This is simply because metaethical relativism itself tells us that there is no global “should”. Every claim about what we should do has been generated and will be bound by our own culture. If the imperative to treat those from other cultures with fairness , respect , care and honesty is thought to be one that floats free of, and exists outside, any culturally bound system of values , and we want the GCC to apply globally, then we cannot be metaethical relativists.

A More Moderate Relativism

It may be that we can justify the four values by appealing to the more moderate form of relativism espoused by David Wong (2009). According to Wong, although moral norms do indeed vary across cultures , as the descriptive relativist assumes, and although there is no one single true morality, there is something that is universal about morality, and common to all particular moralities worthy of the name.

What is common is the central aim or purpose of morality. This aim is not itself a value in any given moral system, but rather what determines whether any given value is fit to figure in such a system. A consequence of this, and one which renders Wong’s relativism more palatable for many than more extreme versions, is that although there is no single true morality, some moral systems are better than others. Why? Because moral systems regulate interpersonal and intrapersonal conflicts. More precisely (Wong 2009: xii):

Morality … comprises an idealized set of norms in imperatival form (“A is to do X under conditions C”) abstracted from the practices and institutions of a society that serves to regulate conflicts of interest , both between persons and within the psychological economy of a single person.

For instance, Western liberal democracies stress individual rights, while other systems involve a commitment to community goods, such as those to be found in Chinese, Indian and traditional African communities (Wong 1991: 445). When we consider such differences, what reason could we have for pronouncing one culture right and the others wrong? A relativistic approach will reply, “None.” Wong tells us (1991: 446):

The argument for a relativistic answer may start with the claim that each type focuses on a good that may reasonably occupy the centre of an ethical ideal for human life. On the one hand, there is the good of belonging to and contributing to a community; on the other, there is the good of respect for the individual apart from any potential contribution to community. It would be surprising, the argument goes, if there were just one justifiable way of setting a priority with respect to the two goods. It should not be surprising, after all, if the range of human goods is simply too rich and diverse to be reconciled in just a single moral ideal.

Wong’s approach may be more acceptable than an extreme, uncompromising metaethical relativism (and potentially more serviceable as a means of grounding the four GCC values ), but it is not without its problems. For example, Michael Huemer (2005) points out a dilemma for any such relativism. That dilemma is revealed when we ask whether the regulation of interpersonal and intrapersonal conflicts is itself something that we should regard as good. If it is, then the regulation of such conflicts represents a value that transcends cultures , grounding any acceptable morality in any society and/or time. Hence, we would have at least one universal value rather than a form of relativism.

As a result, Wong’s approach still does not give us any definite universal values (at a minimum, the four values that feature in the GCC).

Grounding the Global Applicability Thesis of the GCC in a Common Morality

In their celebrated book Principles of Biomedical Ethics, Tom Beauchamp and James Childress have, over the course of 34 years and seven editions , maintained that there are four principles that are particularly applicable to problems in biomedical ethics: respect for autonomy, beneficence, non-maleficence and justice. As explained above, their claim is that these principles are globally applicable because they are part of what Beauchamp and Childress call “the common morality”, which is to be understood as a set of principles subscribed to by all morally committed people, whatever their culture , and whatever the time in which they live. The principles of the common morality, then, are globally applicable, in just the way that the authors of the GCC want the four values of fairness , respect, care and honesty to be.

To the rather obvious objection that no set of values/principles seems to possess the universality they ascribe to the common morality, given the observations of descriptive relativism , Beauchamp and Childress have two responses.

  1. 1.

    It is not the case that every principle that exists finds a home in the common morality: some principles are purely local.

  2. 2.

    More importantly, the principles of the common morality may be variously specified in different cultures .

The great benefit of the common-morality theory is that it allows an optimum balance of universality on the one hand, and variation across cultural settings on the other. There is a set of high-level values /principles that are internal to morality, but these are expressed in differing ways in particular moralities associated with particular communities.

If the supposed common morality is a set of general, unspecified values to which all who are morally committed subscribe, how do we know which these values are? Would we not first have to identify some morally committed people, and then carry out an empirical investigation into the values they hold? The most general values shared by them all would then be those that constitute the common morality. But problems loom here; circularity threatens.

How do we determine who is morally committed in the first place? Presumably, we do so by examining what values they hold. If they adhere to value1, value2, value3, and so on up to valuen, then, we might want to say, they are morally committed. But this is an unacceptable, question-begging way of proceeding. If we want to find out what values the morally committed hold, and thereby find what values constitute the common morality, it is no good defining the morally committed in terms of their subscription to a certain definite list of values settled in advance. There either has to be an independent way of identifying the morally committed (without reference to the precise values they hold), or an independent way of determining the values of the common morality (without reference to the idea of the morally committed agent).

This last criticism was advanced by one of the authors of this book (Herissone-Kelly 2003). It was suggested that if the principles /values of the common morality are those that are internal to the concept of morality, an independent way of determining what they are will be available. What Herissone-Kelly had in mind was the sort of picture painted by Philippa Foot (2002: 7):

[T]here are … starting points fixed by the concept of morality. We might call them “definitional criteria” of moral good and evil, so long as it is clear that they belong to the concept of morality – to the definition and not to some definition which a [wo]man can choose for [her/]himself. What we say about such definitional criteria will be objectively true or false.

The thought, then, is that we perhaps can, at least in theory through a no doubt arduous and protracted process of conceptual analysis, find out what values are essential to morality. Having done that, we will be in a position to pick out those who are morally committed: they will be that group of people who subscribe to the common morality’s values. But what those values are is a claim that will have been fixed quite independently of their association with the morally committed.

In the 6th edition of Principles of Biomedical Ethics, Beauchamp and Childress (2009: 395) take up Herissone-Kelly’s suggestion when they refer to

a plausible hypothesis, that the concept of morality contains normativity not only in the sense that morality necessarily contains some action guiding norms, but also in the sense of necessarily containing specific moral norms. These norms are privileged norms that are constitutive of morality itself .... As we have occasionally said of the four principles that provide the framework norms in this book, they are very general starting points that are fixed by morality. One way of understanding this claim is that these anchoring norms belong conceptually to morality.

Beauchamp and Childress appear to agree that an exhaustive analysis of the concept of morality is a task that lies beyond the scope of their (or any) book. However, in the absence of such an analysis they make two ingenious suggestions about how we might determine the constituents of the common morality and so establish the global applicability thesis. These suggestions, if they are acceptable, provide a legitimate way of using the identification of the morally committed in order to establish the constituents of the common morality.

The first suggestion is that some values are internal to the concept of morality and thus globally applicable. As a result, they can be legitimately employed in the sort of cross-cultural context that the GCC is designed to cover.

The second suggestion is that once it is agreed that there will be certain (as yet unidentified) values that are constitutive of morality, one can with confidence identify at least some such privileged values , even in the absence of anything like a comprehensive, conceptual analysis.

Beauchamp and Childress maintain that one principle that unequivocally appears internal to the concept of morality is that of non-maleficence, or do no harm .Footnote 5 This is an enormously plausible view; it seems unthinkable that any system lacking this principle could even be counted as a candidate for a morality.

Armed with the knowledge that non-maleficence is a foundational principle, and so a principle to which the morally committed will pay heed, Beauchamp and Childress (2009) go on to suggest that we can first identify a large sample of agents who adhere to that norm, and then determine what other general, non-specified principles they all hold in common. Those further general principles will be the remaining constituents of the common morality.

In this scenario, partial analysis of the concept of morality reveals that one of its internal principles is non-maleficence. Morally committed persons can then be identified by their subscription to this principle (and not by their adhering to some principle that we just happen to like to think of as very important).

The next stage in this method would involve determining what other principles all those morally committed persons champion. In this way, one could discern the constituents of the common morality without undertaking the rather forbidding chore of a full-blown, exhaustive analysis of the concept of morality itself.

Beyond this thought experiment, however, we would still have to account for what appear to be counter-examples to Beauchamp and Childress’s claim that their four principles are globally applicable. Such counter-examples have been produced, especially against the principle of respect for autonomy, which is regarded as bound to Western cultures (Huxtable 2013; Kara 2007, Cheng-Tek Tai 2013, Kiak Min 2017). We want to examine one such counter-example.

R.E. Florida (1996), in an article entitled “Buddhism and the Four Principles”, insists that no principle of respect for autonomy is to be found in Buddhist cultures at all, due to Buddhism’s metaphysic of “co-conditioned causality”. The thought seems to be that autonomy is not going to show up as a value , and so as something especially worthy of respect, in a culture that holds to a conceptual scheme in which there is no genuine separation between what those outside that culture call “individuals” (any apparent separation being at best an illusion).

The interesting thing about the Buddhist example is that it would be very difficult to argue that Buddhist culture is not fundamentally committed to non-maleficence. The notion looms exceptionally large in Buddhist ethics , in the shape of the norm of ahimsa, or non-harm . Those who are committed to Buddhist ethics, then, are, by Beauchamp and Childress’s vision, morally committed. And yet, if Florida is right, subscription to the principle of non-maleficence is not universally accompanied by subscription to the principle of respect for autonomy. Hence, at least one element of the group of four principles chosen by Beauchamp and Childress, namely respect for autonomy, does not seem to belong to the common morality .

Conclusion

The most promising approach based on values /principles to claim global applicability for its framework has a hole. As the example of Buddhist ethics shows, respect for individual autonomy cannot be regarded as a globally applicable value/principle that all morally committed people would subscribe to. Respect for autonomy, with the focus on individual autonomy, as understood by Beauchamp and Childress (2013: Chapter 4) does not seem to qualify for global applicability, as the Buddhist counter-example is solid. But that does not mean other values systems must fail.

If key values are, as argued above, internal to morality, the four-values approach developed for the GCC is valid until falsified with rigorous counter-examples, such as the Florida example against respect for autonomy.