Philosophy

Why should our mind-reading abilities be involved in the explanation of phenomenal consciousness?∗ Diana I. Pérez CONICETUniversidad de Buenos Aires abstract In this paper I consider recent discussions within the representationalist theories of phenomenal consciousness, in particular, the discussions between first order representationalism (FOR) and higher order representationalism (HOR). I aim to show that either there is only a terminological dispute between them or, if the discussion is not simply terminological, then HOR is based on a misunderstanding of the phenomena that a theory of phenomenal consciousness should explain. First, I argue that we can defend first order representationalism from Carruthers' attacks and ignore higher order thoughts in our account of phenomenal consciousness. Then I offer a diagnostic of Carruthers' misunderstanding. In the last section I consider further reasons to include mindreading abilities in an explanation of phenomenal consciousness. key words representationalism, high-order theories of consciousness, mind-reading abilities resumen. En este trabajo considero las discusiones recientes dentro de las teorías representacionalistas de la conciencia fenoménica, en perticular las discusiones entre el representacionalismo de primer orden (FOR) y el representacionalismo de orden superior (HOR). Mi objetivo es mostrar que, o bien hay sólo una diferencia terminológica entre ellos, o bien que si la discusión no es simplemente terminológica, entonces HOR está basada en una mala comprensión del fenómeno que una teoría de la conciencia fenoménica debe explicar. En primer lugar, argumento que se puede defender al FOR de los ataques de Carruthers e ignorar a los pensamientos de orden superior en nuestra explicación de la conciencia fenoménica. Luego ofrezco un dignóstico de la incomprensión de Carruthers. En la última sección considero razones adicionales para incluir a las habilidades mentalistas en una explicación de la conciencia fenoménica. palabras clave ∗ Previous versions of this paper were presented at the Simposio Lenguaje, mente y conocimiento. 40 años de Crítica, Instituto de Investigaciones Filosóficas, UNAM, Mexico, April 9 13, 2007 and the XVII Interuniversitary Workshop on Philosophy and Cognitive Science: P. Carruthers, Palma de Mallorca, May 24-26, 2007. I thank P. Carruthers, L. Skidelsky, E. Txapartegi, and the audiences at the two conferences. Financial support has been provided by ANPCyT (PICT 2005/33150) and CONICET (PIP no. 5987). representacionalismo, teorías de la conciencia de orden superior, habilidades mentalistas. What are we talking about when we engage in philosophical discussions about phenomenal consciousness? Are we discussing that peculiar feature which distinguishes humans from all other species in the world? Or, are we talking about a primitive kind of consciousness, the kind of consciousness we share with other species (for example, the great apes) and pre-linguistic children? I do not know whether there is a neutral way to answer this question. Probably not. But, I believe that what makes us unique in the animal kingdom are our cognitive and linguistic abilities, and not the subjective character of our experience. I think I am in line with the philosophical tradition: the renewed interest in consciousness in philosophy over the last 30 years began with Nagel's famous question about the subjective character of the bat experience ("What is it like to be a bat?" Nagel 1974). I will base my paper on this conception of phenomenal consciousness, and, from this conception, I will consider recent discussions within the representationalist theories of phenomenal consciousness, in particular, the discussions between first order representationalism (FOR) and higher order representationalism (HOR). I aim to show that either there is only a terminological dispute between them or, if the discussion is not simply terminological, then HOR is based on a misunderstanding of the phenomena that a theory of phenomenal consciousness should explain. The explicit difference between HOR (in Carruthers' version) and FOR is the need to include a special relationship with our mindreading abilities to give a philosophical account of phenomenal consciousness. In my view, we can defend first order representationalism from Carruthers' attacks and ignore higher order thoughts in our account of phenomenal consciousness. The paper is organized as follows. The first section presents both theories. The second section considers the main arguments against first order representationalism given by Carruthers, and tries to provide a first order reply. The third section offers a diagnostic of Carruthers' misunderstanding. The last section considers further reasons to include mindreading abilities in an explanation of phenomenal consciousness. I. Varieties of Representationalism If we consider the current discussions about phenomenal consciousness, we will find abundant literature on the controversy between representationalism or intentionalism and anti-representationalism. Representationalism about phenomenal consciousness holds that the phenomenal character of experience is one and the same as (or, in its weaker form, supervenes on) representational content that meets further conditions. Anti-representationalism denies this claim, holding that there exist (in reality, or just in some not too distant possible worlds) cases with the same phenomenal content but with different representational content (inverted spectrum cases) or cases with the same representational content but with different phenomenal content (inverted Earth cases). In this paper I will focus on the representationalist theories of phenomenal consciousness. 1.1. There are different types of representationalist theories depending on the "further conditions" that a given representational content should meet in order to be identified with phenomenal content. Tye (1995, 2000) and Dretske (1995) propose a theory of phenomenal character according to which the further constraints are: (1) that the representation should be poised for use by the cognitive system, and (2) that the representation has nonconceptual content, that is, that the representational content should be connected with the agent's beliefs and judgments about her experience, but it has to be independent of the possession of the concepts that a third person (or the individual) should use in order to characterize the experience and independent of the concepts which constitute the individual's beliefs about her own experience. Tye (1995) called this theory the "PANIC theory" of phenomenal character and summed up his view: Phenomenal content [...] is content that is appropriately poised for use by the cognitive system, content that is abstract and nonconceptual. I call this the PANIC theory of phenomenal character: phenomenal character is one and the same as Poised Abstract Nonconceptual Intentional Content (Tye 1995, p. 137). Tye assumes that "the cognitive system" refers to the normal adult human being's cognitive system, which includes a mindreading system.1 But in Tye's explanation of phenomenal consciousness, this mindreading system has no special role. Phenomenal content depends upon its being poised for use by our decision-making mechanisms, or by our fixation beliefs mechanism, but phenomenal content does not necessarily have to be the object of higher order thoughts. Summing up Tye's view, phenomenal character is identified with nonconceptual representations which are: (1) the outputs of sensory modules; (2) the inputs to the central system/conceptual modules; (3) items not directly tied to action (the relation with action is mediated by conceptual representations); (4) items whose existence and content is independent of the possession of a public language, and also independent of the possession of concepts, that is, of stored schemas in memory; (5) intentional, because they can misrepresent things, or even represent something that is nonexistent, and they are fine-grained;2 and (6) items whose semantics is externalist (defined by causal covariation under optimal conditions). Phenomenal content does not occur within the sensory modules. On the contrary, Tye holds that experiences and feelings are identical to the outputs of sensory modules, which are, at the same time, inputs to the cognitive system. 1 I do not discuss here whether these mindreading abilities depend upon the possession of a module or whether they belong to the central system. I will call it a "mindreading system", a neutral characterization. 2 Tye 1995, 4.3. Tye 2000, 3.3. (Tye, 1995, p. 137) He sums up his proposal pointing out four differences between beliefs and experiences, all of which are dependent upon Tye's characterization of nonconceptual (or nondoxastic) representation. (1) There is a difference in content: experiences represent determinate features; beliefs represent determinable ones (Tye, 1995, p. 139). (2) The vehicles of representation are different; experiences represent as maps or matrices do; beliefs represent as sentences do. (3) Experiences do not make use of memorystored representations, and beliefs must draw on such representations. (4) Experiences are poised for use by the cognitive system; beliefs are part of the cognitive system. (Tye 1995, p. 142). Although Tye's first examples of phenomenal consciousness are perceptual experiences, he explicitly extends his representational theory to many other experiences, including afterimages, bodily sensations, background feelings, emotions and moods. Let us consider Tye's theory of pain. According to Tye, pains are sensory experiences which track (under normal conditions) certain sorts of disturbances in the body, for example bodily damage. Pains are, therefore, representations of different kinds of disturbances in the body.3 The response of the brain to our bodily damage is as mechanical as the response to external stimuli and, as in the case of vision and other perceptual experiences, there are no concepts involved in this process. Pain, according to Tye, is not identical to the awareness of pain: while the first is a nonconceptual representation of a certain disturbance in the body, the second one is a cognitive state, which brings experience under concepts (Tye, 1995, p. 115). The parallelism between external sensory representations and internal ones is complete. 1.2. On the other hand, quite recently, Peter Carruthers developed a new version of higher order representationalism, which gives our mind-reading abilities a special role in explaining phenomenal consciousness. He says: 3 See Tye 1995, p. 113 My own view about phenomenal consciousness is a form of representationalist, or intentionalist, one. I think that phenomenal consciousness consists in a certain sort of intentional content ("analog" or fine-grained) that is held in special-purpose functionally individuated memory store in such a way as to be available to a faculty of higher order thought (HOT) (Carruthers 2005, p.8). According to Carruthers, the "further condition" a representation should fulfill to be phenomenally conscious is to be disposed to impact the mindreading system, that is, it should have some potential impact on the subject's theory of mind. In other words, it is because we have a mindreading faculty capable of higher order thoughts about our own experiences that they become phenomenally conscious. Carruthers defends a version of consumer-semantics, which gives two different contents to the percept – a conscious one ("analog seeming red") and an unconscious one ("analog red"). He labels his theory "dual content theory", or "dispositional higher order thought theory" of phenomenal consciousness (in opposition to Tye's and Dretske's "first-order representationalism"). The key to Carruthers' proposal is dual content but he does not give sufficient details about it. He characterizes this content as "analog content" (following Dretske 1981), but he does not propose a clear distinction between analog and digital content. He simply says, "Intentional contents are analog when they have a finer grain than any concepts that the subject can possess and recall. Intentional contents are nonconceptual when their existence is independent of any concepts that the subject possesses" (Carruthers 2005, footnote 5, p. 102). The first characterization is weaker than the second, and Carruthers prefers it because it is compatible with the idea that certain analog contents could be partly conceptual. This is a crucial difference between FOR and HOR, because FOR holds that phenomenal content is entirely nonconceptual, while HOR holds that phenomenal experiences are partly conceptual and partly nonconceptual because they have two contents. The first order one is nonconceptual and the second order one should be conceptual because of its second order nature. (Carruthers' examples of these contents are: "analog-experienced-green" or "analog-experienced-smooth", Carruthers 2005, p. 68). Carruthers also distinguishes his position from other higher order theories: (a) inner-sense theories, which characterize consciousness as a kind of perception of a first order state, and (b) actualists' higher order thought theories according to which, in order to be conscious, a given state should be the object of an actual higher order thought, and not just be disposed to produce a higher order thought, as Carruthers claims. These other forms of representationalism go beyond this paper. Summing up Carruthers' theory, he holds that a phenomenally conscious content is that which is potentially/dispositionally (not actually) the content of cognitive (not perceptual) higher order representations, in particular, they have to be the potential content of a system that can distinguish between the world and our experiences about the world, that is, a theory of mind system, capable of separating appearance from reality. II. Arguments against FOR There are many arguments against representationalism, for example, the above inverted-type arguments that I will not consider here. I will focus on the arguments against first order representationalism, not against representationalism in general. Carruthers proposed three main arguments to reject the first order version of representationalism. The first argument runs as follows. First order representationalism does not distinguish between (a) what the world is like for an organism and (b) what the experience of the world is like for this organism. Tye mixes both but they are (at least conceptually, according to Carruthers) different: (a) is a property of the world, (b) is a property of the organism. Carruthers says: We [...] need to distinguish between two different sorts of subjectivity – between worldly subjectivity and mental state subjectivity between phenomenal properties of the world and phenomenal properties of one's experience of the world (Carruthers 2005, p. 43). The "dual content" that Carruthers proposes is designed precisely to distinguish between these two kinds of subjectivities – worldly subjectivity, identified with first order content, and mental state subjectivity, identified with the higher order content. Given that first order representationalism only considers one kind of content, the distinction cannot be made. In my view, Carruthers demands too much to a theory of phenomenal consciousness. This theory has to explain what our sensations, feelings and emotions are, independently of the way in which we conceptualize them. Let me explain. One of the main arguments for representationalism (an argument that Tye mentions once and again: Tye 1995, p. 30, Tye 2000, Chapter 3) is based on the transparency of experience. According to this idea, when we are attending to how things look to us, we are not aware of any inner object or thing or any qualities of our experience; we are just aware of the external objects and their qualities. Hence, we cannot make the distinction Carruthers holds in this first argument between the experience of the world and the experience of our mental states, while we are attending to our experience. Of course, we can make this distinction when we think about our own experiences, but we cannot make this distinction while we are undergoing the experience. This is precisely why Cartesian arguments like the dreaming argument or the malicious genius argument are so powerful. There is nothing in the experience itself that allows us to distinguish between the qualities of the world experienced and the qualities of the experience of the world: in the experience there is only one kind of quality. All the rest depends upon our cognitive/conceptual system (in particular, our theory of mind system) which allows us to differentiate between appearance and reality. The second argument is the following. First-order representationalism has problems explaining some non-conscious experiences like the absent-minded driver or the sleepwalker. In these cases we have first order representations of the environment that are poised for the guidance of behavior, in fact, they are actually controlling behavior, although the subject is not conscious of them and reports that he has not seen the streets, the traffic light, other people, and so on. First order representationalism has a dilemma: either these experiences are not phenomenally conscious even if they meet the constraints proposed by FOR, (and so, the definition should be reformulated), or these experiences are phenomenally conscious but inaccessible to the subject. Tye chooses the second horn of the dilemma. Let us consider Tye's explanation of these kinds of cases. Tye reminds us of the distinction between phenomenal consciousness and awareness: the subject is aware of those things to which he has access, but being aware is one thing and being phenomenally conscious is another thing. Being aware depends upon the possession of concepts, and the application of these concepts to experience. Tye says, "Consciousness of one's own mental states is higher order consciousness and in this case concepts are required" (Tye 1995, p. 115). Tye proposes this basic distinction. One thing is the pain experience, and another thing is pain awareness. The second is a higher order conscious experience for the subject because of the many conceptual elements in it, which are absent in the first. Carruthers accuses Tye of generating an infinite regress because Tye would presumably need either an infinite set of "phenomenal concepts", one for each hue of color, for example, or he would be damned to lose the fineness of grain of experience. However, Carruthers, in my view, misinterprets Tye: he does not require the application of a special kind of concept, but just ordinary concepts. I am aware of having a stabbing stomachache, but I am not aware of experiencing the specific red29. If awareness is a conceptual state, as Tye holds, it necessarily lacks the fineness of grain that our nonconceptual experience has. Carruthers seems to hold that there are some representations with both analog and conceptual content at the same time. Yet, as I said before, it is necessary to explain how a given content could be, at the same time, conceptual and nonconceptual. The second step is my own answer to these cases from a first order perspective. In my view, the correct answer to these cases is that we have to distinguish two kinds of behavior: rationally controlled behavior and automatic behavior. Moreover, only the first one is involved in Tye's characterization of "phenomenal consciousness": the representations that produce only automatic motor answers are not poised to the cognitive system of decision-making and belief fixation. In fact, we are usually unaware of the automatic actions we perform and do not remember having acted (as in the sleepwalker case). The kinds of cases considered in the argument against FOR include automatic behaviors like driving or sleepwalking, which are neither rationally controlled by the subject nor usually remembered, and there would seem to be no problem holding that those cases are not phenomenally conscious. The last argument is more complex. Carruthers offers six desiderata for a successful reductive theory of phenomenal consciousness: (1) A successful reductive theory of consciousness should explain why phenomenally conscious states have a subjective aspect to them. (2) A successful reductive theory of consciousness should explain why there should seem to be such a pervasive explanatory gap between all the physical, functional and intentional facts, on the one hand, and the facts of phenomenal consciousness, on the other. There is a growing consensus that this can be explained by appealing to "phenomenal concepts" or "recognitional concepts", which have no conceptual connections to physical, causal-role or intentionalcontent concepts (Loar 1990, Tye 1999). So, the theory should allow for pure recognitional concepts of experience. (3) A successful reductive theory of consciousness should explain why people believe that the properties of their phenomenal experience are intrinsic, being non-relationally individuated. (This is the qualia intuition.) (4) A successful reductive theory of consciousness should explain why their possessors consider phenomenally conscious experience ineffable. (5) It should explain why their possessors consider it private. (6) It should explain why their possessors consider it infallible, not just privileged known. Carruthers' strategy is to show that his theory can explain these features, while FOR cannot. Except for (1) which is basically the same argument as the first one I mentioned above, all the other desiderata are concerned with the way in which we conceptualize our experience, that is, the way in which people think or know their experience, not with the experience itself. At this point Carruthers changes the subject. I will not analyze his explanation of these points here. I merely point out that his explanation includes phenomenal concepts, purely recognitional concepts, the kinds of concepts that the private language argument wanted to refute (Wittgenstein 1953). These special kinds of concepts play a central role in his explanation. I will return to this topic below. But, I will first show why these desiderata are not adequate for a theory of phenomenal consciousness: this will be the topic of the next section. III. In defense of FOR or what a theory of phenomenal consciousness should supposedly explain. Carruthers says: I propose to argue that phenomenal consciousness will emerge, of metaphysical necessity, in any system where perceptual information is made available to higher order representations in analog form, and where the system is able of recognizing its own perceptual states, as well as the states of the world perceived. For by postulating that this is so, we can explain why phenomenal feelings should be so widely thought to possess the properties of qualia – that is, of being non-relationally defined, intrinsic, private, ineffable, and knowable with complete certainty by the subject (Carruthers, 2005, pp. 45-6). It is clear that Carruthers holds that a theory of phenomenal consciousness should explain not only this phenomenon, but also why we conceive of this phenomenon in the way we do. This is exactly the point that I criticize. It does not seem adequate to expect that much for this theory. Surely, why we think about phenomenal consciousness as we do depends more on the way we actually think and the concepts that we have, particularly psychological concepts, than on the peculiarities of the phenomenon itself. (Granted, for the sake of argument, we think about it as Carruthers says we do and this way of thinking about phenomenal consciousness is not in itself implausible, as Dennett 1988 argues). In fact, the way in which Carruthers' theory explains the desiderata that first order representationalism cannot explain depends on the fact that we can distinguish between appearance and reality, and that we have purely recognitional concepts, in short, that we have concepts like "seeming red" as opposed to "being red", undoubtedly a difference belonging to our conceptual cognitive system. As I said above, in the very experience of the world there is no place for the appearance/reality distinction (quizá habríaque matizar esto: los argumentos de Descartes se refieren a la imposibilidad de establecer la distinción con certeza desde dentro de la propia experiencia, no a que no tengamos experiencias subjetivas vs objetivas – esta es lo que lleva al planteo kantiano: cómo es posible que lo que se me presenta en la experiencia lo experimentecomo objetivo) Si borro esta frase te parece bien? creo que es efectivamente demasiado fuerte, y sin ella mi punto queda intacto. Decime.... When we philosophically explain phenomenal consciousness, we want to explain the peculiar subjective character that Descartes experienced while sitting in his chair meditating, independently of whether that flow of experience turned out to be veridical or the product of a malicious genius. Therefore, a theory of experience (or phenomenal consciousness) does not have to explain this distinction, which depends on something further, that is, our conceptual capacity to consider our experiences the experiences of a world that exists, independently of us, about which we can make mistakes. True, to make this distinction, we need the categories of the theory of the mind and, surely, only human beings can enjoy a theory like this. The point is whether the explanation of our conception of experience as we conceive of it, given the ordinary psychological concepts that we possess, should form part of the theory of qualia. Let me consider three reasons why it should. The first reason is to believe that a philosophical theory of qualia need not be concerned with qualia itself, but that it should provide a conceptual elucidation of our concept of quale, and therefore should explain why we think about phenomenal consciousness as we actually do. Nevertheless, this does not seem to be Carruthers' reason because he affirms that he is not giving an analysis of a concept, but a substantive theory about a certain phenomenon: consciousness (Carruthers 2005, p. 47). That is to say, Carruthers is in line with the orthodox view that contemporary philosophers of mind hold. They say that a naturalistic vision of philosophy should provide a good explanation of a certain phenomenon (for example, conscious experience), using data from the different scientific disciplines while considering conceptual questions. But, he does not believe (and I agree) that the philosophical activity could be exhausted by conceptual analysis. The second reason would be that representationalism aims to be a reductive theory of qualia, and therefore brute identities postulated by first order representationalism would not suffice to offer a genuine reductive explanation (Carruthers 2005, p. 103). In fact, according to the functional model of reduction, the first step for a reductive explanation is the conceptual analysis of the phenomenon to be explained (Chalmers 1996, Jackson 1998, Kim 1998). However, here we find ourselves in the following paradoxical situation: the concepts that Carruthers adds to complete the partial reduction offered by first order representationalism are phenomenal concepts, which cannot be functionalized! Even if there is no consensus about the way in which we have to understand this special kind of concept, these concepts are conceptually irreducible, non-analyzable in terms of other concepts. Carruthers realizes that what is added does not have the characteristics required by the functional model of reduction and he subtly changes the subject. He says that his theory does not offer an analysis of these concepts, but "allows us to explain its existence" (Carruthers 2005, p. 103), something that first order representationalism would not be able to do. For the sake of argument, let us suppose that we need not include these concepts to give a correct account of qualia. It is far from clear why first order representationalism would not be able to explain its existence. In fact, what we need is an explanation of the existence of a peculiar type of concept, particularly special kinds of mental concepts, that is, the concepts by which we think about our mental life (in this case about our experience). The theory of the mind system is that which produces these kinds of concepts. It is not true that a first order representationalist cannot give an account of these concepts. The fact is that he considers that he does not need them to state a theory of qualia. If the first order representationalist had been asked to explain what human beings thought about their own experiences, he would have given an answer concerning the conceptualization of the experience, not the experience itself, and he would probably have included phenomenal concepts in his explanation (see Tye, forthcoming). There is a third reason, which I will analyze in the final section because it constitutes, in my opinion, the most important argument against the position that I am trying to defend. IV. Two final objections The third reason that Carruthers could offer in his defense is that our phenomenal experience is the way it is in part because we think about it in the way we actually do. That is to say, if a person has the exact same perceptual faculties but does not have higher order thoughts about percepts like ours, then he does not have the same type of phenomenal experience that we have. I have two concerns with this idea. First, if we accept this objection, it seems that it might be just a mere verbal disagreement between the first order representationalist and the higher order one; that is, there is no substantive difference between them that goes beyond the way they decide to use such words as "qualia". In my opinion, under a stringent reading of first order representationalism, phenomenal consciousness is the output of the perceptual system that turns out to be a potential input to a cognitive system like that of the human being, a system with a theory of the mind. Thus, under this reading, first order representationalists would also be able to maintain that without conceptualizing it in the way we actually do, we would not have the experience that we have. (I do not claim that this idea is in Tye's or Dretske's theories. Even more so, as I claimed before, it would seem that by "cognitive system" they understand something less committed to the anthropocentric idea that this system should be something similar to the normal adult human being's cognitive system. This is why their explanation of phenomenal consciousness can be extended to prelinguistic beings like babies, or nonlinguistic beings such as, say, bats). In other words, if the reason to include our mind-reading abilities in the explanation of phenomenal consciousness is that there is an essential or constitutive relationship between the way in which we conceptualize our experience and the experience itself, then, we would probably not be able to distinguish between first order representationalism and a higher order one. (Therefore, this is not a good argument for higher order representationalism). For both theories, it is a contingent fact about the human cognitive architecture that our mind reading abilities are involved in phenomenal consciousness but for both it is not conceptually necessary that it should be so. I think that the answer to the question about the mere verbal disagreement can be yes or no, depending on the way in which we understand the idea of the second order content of experience. If we interpret it as I have tried to describe it, as thoughts whose objects are the outputs of perceptual modules – as genuine higher order thoughts – for example, beliefs or judgments about my own experience, then there is no real disagreement between Carruthers and Tye. They both propose the same architecture although there could be a difference regarding which part of that architecture we should identify as the qualitative content for the subject. But, on reading some other papers we can see that Carruthers has doubts about whether genuine thoughts are involved in phenomenal consciousness, and therefore to consider them as states possessing genuine conceptual content, or whether the higher order states which are involved in phenomenal consciousness are perceptual. Carruthers holds a kind of higher order perception theory, and consequently describes the contents identified with phenomenal experience as nonconceptual content (or not "completely" conceptual content) that is, as an analog content such as "analog seeming red". Under this reading of Carruthers' proposal, there is a real disagreement between Carruthers and Tye, but in my opinion, the burden of the proof is on Carruthers' side, because he owes us an explanation of the nature of this strange analog and, at the same time, conceptual content. My second argument concerns the most basic question: What are qualia? It is true that in describing qualia we necessarily appeal to the appearance/reality distinction, to the subjective/objective distinction. Children acquire these concepts at around the age of three. Some psychologists even claim it is earlier: the 18-month-old toddler who pretends that the banana is a telephone already distinguishes between appearance and reality. The child knows that the banana is not a telephone but pretends it is one. When we have a conscious experience of red, for example, it is not true that we have a conscious experience that something appears to be red (as the argument of the transparency of the experience showed). Clearly, we are able to reconceptualize the experience of red in this way, but this implies mastering the appearance/reality distinction, besides mastering the concept of red. Since Wittgenstein, we all know that concepts like "seeming red" are parasitic on the concept "red". In fact, during most of our conscious life, our everyday life is such that we are conscious of our experience of the world, not of the presence of mere appearances before us. This is the sick case, the anomalous case, that in which we do not see reality as it is, but only as we conjecture it to be. Thus, it does not seem to be constitutive of our experience of the world that we conceptualize it as being a mere experience of the world, like a far away and independent state of the world, which could be exactly as it is without the existence of the world. Let us return to the initial question: What is phenomenal consciousness? The standard answer (and I recommend Chalmers 1996 in his paradigmatic book) is that it is "the most familiar thing in the world" (Chalmers 1996, p. 3), the one that accompanies us constantly, not the sick sensation that the world could not have been exactly what we are in fact perceiving. Therefore, a philosophical explanation of qualia does not need to involve the possession of the appearance/reality distinction by the subject or that we may possibly think that our experience of the world is just an illusion. It is the explanation of what is most familiar to us and, therefore, of the case where we do not even consider the distinction between appearance and reality. This is the phenomenon that a theory of qualia should explain, the phenomenon that is most familiar and constant, the one that brings us closer to more primitive kinds of minds, the one that we can enjoy before we are "contaminated" by philosophy. References: Carruthers, P. (2005), Consciousness. Essays from higher order perspective. Oxford, OUP. Chalmers, D. (1996), The Conscious Mind. Oxford, OUP. Dretske, F. (1995) Naturalizing the Mind. MIT Press. Nagel, T. (1974) "What Is it Like to Be a Bat?", Philosophical Review, pp. 435-50. Tye, M. (1995), Ten Problems of Consciousness. Cambridge, Massachussets, MIT Press. Tye, M. (2000), Consciousness, color and content. Cambridge, MA, MIT Press. Tye, M. (forthcoming) "A Theory of phenomenal concepts" http://www.utexas.edu/cola/depts/philosophy/faculty/tye/Theory.pdf Wittgenstein, L. (1953) Philosophical Investigations, Oxford, Basil Blackwell


Philosophy

To address some questions in global biomedical ethics, three problems about cultural moral differences and alleged differences in Eastern and Western cultures are addressed: The first is whether the East has fundamentally different moral traditions from those in the West.  Concentrating on Japan and the United States, it is argued that theses of profound and fundamental East-West differences are dubious because
          of many forms of shared morality. The second is whether human rights theory is a Western invention with no firm traditions in Eastern moral traditions. It is argued that this thesis is unsupported both historically and in contemporary bioethics. The third problem is  whether multiculturalist theory casts doubt on claims of universal
          principles and rights. It is argued that the reverse is true: multiculturalism is a universalistic theory. The argument throughout supports common morality theory.

Journal of Practical Ethics TOM L. BEAUCHAMP18 Common Morality, Human Rights, and Multiculturalism in Japanese and American Bioethics ToM L. BeAuCHAMp Georgetown University ABsTRACT To address some questions in global biomedical ethics, three problems about cultural moral differences and alleged differences in eastern and Western cultures are addressed: The first is whether the east has fundamentally different moral traditions from those in the West. Concentrating on Japan and the united states, it is argued that theses of profound and fundamental east-West differences are dubious because of many forms of shared morality. The second is whether human rights theory is a Western invention with no firm traditions in eastern moral traditions. It is argued that this thesis is unsupported both historically and in contemporary bioethics. The third problem is whether multiculturalist theory casts doubt on claims of universal principles and rights. It is argued that the reverse is true: multiculturalism is a universalistic theory. The argument throughout supports common morality theory. Global ethics is a currently fashionable notion, but its meaning and scope remain underdeveloped. To address some questions about universal standards in biomedical ethics, I will investigate three problems about alleged cultural moral differences, concentrating on presumed differences in eastern and Western cultures. The first problem is whether there is merit in the thesis that the east-that is, Asia-has fundamentally different moral traditions from those in the West-that is, europe and the Americas. I will argue, concentrating on Japan and the united states, that the thesis of profound and fundamental east-West differences is dubious in light of our many Volume 3, Issue 2 Common Morality Theory In Japanese And American Bioethics 19 cultural similarities and forms of shared morality. The second problem is whether human rights should be understood as a Western invention with no firm traditions in eastern moral and political theory. I will argue that this thesis is unsupported in contemporary bioethics. The third problem is whether the existence of multicultural societies and pluralism of moral viewpoint support the claim that there is no universal morality. I will argue that this claim too is unconvincing. ALLeGeD DIFFeReNCes BeTWeeN eAsTeRN AND WesTeRN MoRAL VALues I begin with a quote from an article published in 1987 in the Hastings Center Report-an article I have long admired. It was written by professors Koichi Bai, Yasuko shirai, and Michiko Ishii, who presented the following thesis: We must beware of drawing general conclusions as to "Japanese" characteristics on [bioethical] issues. We ought not to assume too readily a uniformity in Japanese culture; nor, needless to say, can we ignore Japanese peculiarity. The key is to observe the situation as it exists.... [I]t is difficult to generalize about the attitude of the Japanese people [on bioethical issues]. Taken collectively, the numerous opinions do not suggest any uniform perspective. Japanese attitudes have not been examined closely because of misinformation and lack of research. These authors argue, based on the empirical data available to them at the time, that there is a "lack of consensus among the Japanese on the acceptability" of conclusions about relatively new issues in bioethics. They say that this situation creates both "a tension and a link between traditional belief and contemporary practice" (pp. s18-s20).[1, see also 2]. I had read this article prior to a Conference in Japan in the 1990s that professor Bai and I both attended. I told him then that I had been struggling to understand what I had been told by a number of people from Japan about Japan. What they had reported as Japanese moral views in conflict with American views is also widely found in bioethics literature. I was at the time reading the available empirical studies of Japanese practices and beliefs that had been published, especially the studies that compared Japanese beliefs and practices with American beliefs and practices. I asked professor Bai, "Can you clarify for me how to think about the numerous reports in Journal of Practical Ethics TOM L. BEAUCHAMP20 the literature that Japanese families and physicians are paternalistic, family-oriented, and opposed to principles in Western ethics such as respect for autonomy, informed consent, and the like." I told him that my problem was that much of what is reported to be Japanese beliefs and practices did not seem supported by the empirical literature on Japanese beliefs and practices. I could find only fragments of support in the empirical literature, which simply failed to show that Japanese physicians, nurses, and patients are morally at odds with American physicians, nurses, and patients. professor Bai had had his eyes locked on his tea cup as I asked my question. In giving a response, he shifted his gaze from the tea cup and fixed his eyes on mine. He said, "professor Beauchamp, the Japanese people will tell you many things about the Japanese people, but look and see." He had given an answer to my question in one astute sentence. I knew immediately what he meant, and it struck me that it applies just as well to the united states. Whether one starts with cultural stories and traditional beliefs in the united states, or Japan, or anywhere else, one has to look and see what the beliefs and practices are before one is entitled to claim a specific viewpoint. I will start by looking and seeing what the situation is today in literature that studies beliefs, and to some extent practices, in Japan and in North America-and how we should assess similarities and differences in these beliefs. I will also assess an entrenched perspective on cultural differences that I label "the received view." THe ReCeIVeD VIeW The received view is about morally relevant cultural differences between Japan and the united states. It asserts that eastern cultures are paternalistic and family-oriented in their moral beliefs and practices, with great deference given to physicians, whereas American and european cultures are nonpaternalistic and anti-authoritarian in their treatment of patients and families. Traditional family values in Japanese society are said to feed this custom: Individuals are expected to be relatively constrained and unassertive, remaining sensitive to the maintenance of fluent relationships that avoid confrontation and self-assertive conduct. This behavior and these cultural expectations are said to contrast sharply with Western emphases on individual rights and individual choice, which, according to the received view, are not admired in Japanese culture. As professor Rihito Kimura once put it, "Autonomy, an important bioethical principle in the Western social context, is out of keeping with the Japanese cultural tradition" (p. 23).[3, see similarly 4]. Volume 3, Issue 2 Common Morality Theory In Japanese And American Bioethics 21 In my arguments against this view, I do not deny that there are some differences in degree between American and Japanese societies on these matters, just as there are between American and european cultures, where the latter have been said to display more support for principles of solidarity and dignity even to the point of making those values more important in europe than respect for autonomy and justice. empirical studies show both modest differences between these cultures, while also showing disagreements within each culture when variables such as differences in time and age are taken into consideration. However, the thesis of basic moral differences in kind-as if people from the east and the West have fundamentally different moral principles, beliefs, practices, and conventions in medical institutions-is not empirically supported. Where others have looked for cultural differences, I will emphasize relevant cultural similarities. My claim is that the available evidence indicates that moral viewpoints in these cultures converge to agreement on basic moral norms and evaluations of moral character, not disagreement. INFoRMeD CoNseNT: HIsToRY, TRADITIoN, AND LeGeND I will use the doctrine of informed consent as my principal example of alleged differences that turn out not to be so different in eastern and Western cultures. This doctrine was for many years, especially in the literature of the 1980s and 1990s, presented as a peculiarly American practice and as a notion poorly suited for an eastern ethics of relationship in communities and family decision making. It was then, and is still today, closely linked in bioethics literature to supposedly distinctive American views of autonomy and individualism. As a paradigmatic example of this view, consider a september 2011 article by professor John-stewart Gordon of the university of Cologne, Germany, who states that, "non-western countries such as China, Japan, and most African countries do not share the idea of individual informed consent in biomedical ethics. Instead, they generally demand that either family-or community-informed consent should be obtained in cases such as life-threatening diseases" (p. 261).[5] The view that informed consent is an outgrowth from a history of American individualism is a strange historical thesis. The term "informed consent" emerged only in the 1950s, and discussions of the concept as we know it today in the u.s. began only around 1972. It had no significant prior history in philosophy, law, medicine, or public policy in the u. s.[6] The histories of patient-physician interactions in Journal of Practical Ethics TOM L. BEAUCHAMP22 medicine in europe and the united states prior to the 1970s are at root paternalistic and antithetical to informed consent. The history is one of tight physician control of information and patient deference to physicians.[7] In an empirical study in the u. s. published in 1970, 50% of the physicians surveyed thought it medically proper, and 30% thought it ethically proper, for a physician to perform a mastectomy with no authorization from the patient other than her signature on a blanket consent form required for hospital admission; half of these physicians thought that it is ethically appropriate for a physician not to tell a cancer patient that she has been enrolled in a double-blind clinical trial of an experimental anti-cancer drug and is currently receiving a placebo.[8, 9, 10, 11] only during the years between 1972 and 1980 did a major shift occur favorable to the view that physicians have a moral and legal duty to obtain an informed consent from patients for many procedures. Accordingly, I do not accept the received view's claim that American tradition is non-paternalistic, whereas Japanese traditions are deferential to physicians and rest on a paternalistic model of medicine. european and American traditions of medical ethics derive from centuries of physician paternalism and cultural deference. American interest in patients' rights and paternalism is a phenomenon largely of the last thirty-five years of American history. eMpIRICAL sTuDIes oF JApANese BeLIeFs ABouT INFoRMeD CoNseNT Is the situation significantly different today in Japan, by contrast to the u. s., either as a matter of cultural attitude or medical practice? There are differences, but my working hypothesis is that today no profound cultural differences in consent practices exist between Japan and the u.s. To assess the current situation, I will consider the findings of several empirical studies about paternalism and informed consent that have been conducted in Japan about the opinions of Japanese physicians, nurses, patients, and families. over three dozen such studies have been conducted in Japan since the early 1980s. I will mention only a representative sample conducted or reported over the course of 20 years from 1986 to 2006. These studies reach similar, though not identical, conclusions. I know of no scholarly study that contains significantly different findings than those I will mention. The first study was reported by professor Hiroyuki Hattori and five associates, Volume 3, Issue 2 Common Morality Theory In Japanese And American Bioethics 23 published in 1991, having been conducted in 1986-87. The data in this study show some striking similarities of attitude and behavior to earlier empirical studies of American physicians.[12] This questionnaire survey reached the following conclusions: Japanese physicians are willing to give their patients information adequate to obtain an informed consent, but many physicians retain discretion to judge how much information should be provided. In every category tested, over 50% of Japanese physicians stated that they morally should make adequate disclosures and receive an informed consent. one interesting response came in answering the question, "How do you explain high-risk diagnostic procedures to the patient?" Across medical students and physicians in university and other hospitals in Japan a consistent result appeared of from 56% to 60% who give the answer, "We explain the incidence and the severity of the risk, and if the patient seems to be bewildered by the information, we explain them to the relatives" (p. 1013).[12] These results are largely consistent with various studies of the behavior of American physicians. A second study, conducted in 1989 by professor Yutaka Mizushima and eight associates. This study examined disclosures of a diagnosis of cancer (in Toyama prefecture), and asked the opinion of physicians, para-medical personnel, and lay persons about Japanese practices of nondisclosure.[13] one goal of the study was to critically examine the widespread belief that, "In Japan, more than 90% of medical doctors hide the actual diagnosis of cancer from patients. on the contrary, in the unites states of America, . . . more than 90% of MDs reveal the diagnosis of cancer to their patients." The Mizushima study brought to light a very different picture of Japan than the 90%/90% hypothesis suggested. In response to the question, "Do you think we should reveal the diagnosis of cancer to patients who have requested it?", 69.2% answered "yes," 12.7% indicated they were not sure, and only 17.7% answered "no." similarly, to the question, "Would you wish to be told the diagnosis of cancer if you had cancer?", only 13.2% of these physicians answered "no." This rate of "nos" is not surprising in light of another Japanese study that had shown nondisclosures and deception to have been steadily declining in Japan throughout the 1980s.[14] They declined still further in the 1990s. In a third study, in 1995, Atsushi Asai and associates published a questionnaire study about terminally ill patients that was administered to both Japanese and Japanese-American physicians. The most intriguing feature of this study is that significantly fewer Japanese physicians would want for themselves the very same interventions that they recommend to their patients. For example, 74% would recommend Journal of Practical Ethics TOM L. BEAUCHAMP24 blood transfusions for gastrointestinal bleeding to their patients, but only 29% would want these transfusions for themselves.[15] Fourth, a 1997 qualitative study, again by Asai and associates, used focus groups. [16] A number of physicians reported that they regularly disclose a diagnosis of cancer to a patient and also give an accurate prognosis and explanation of the effectiveness of available treatments. Many physicians reported that they make recommendations to patients about life-sustaining interventions, which the patients are free to reject. The study showed a considerable diversity of opinion among Japanese physicians about disclosure, about making decisions together with patients, about whether to always respect and follow a patient's decision, about withdrawing life-support once started, and about obligations generated by advance directives. As I read this study, the reports of these physicians show deep similarities at the time between u. s. and Japanese physicians in their beliefs and practices. A fifth study is a 2005 questionnaire study on the subject of "negotiating endof-life decision making" for incurably ill patients with metastatic gastric cancer, conducted by Baback Gabbay, shinji Matsumura, et al.[17] This comparative study of resident physicians in both Japan and the united states was conducted at two u. s. sites and five Japanese sites. The widest variation these researchers found is that 94% of Japanese residents try to include both the patient and the family when disclosing the diagnosis and prognosis, whereas only about 54% of American residents routinely include the family. Also, Japanese residents generally prefer discussions with the family first, and Japanese residents reported in much higher numbers (76%) than Americans (18%), that they had sometimes deceived patients at the request of families. These findings might seem to support the received view of a significant cultural difference in the family's role. However, a strong cultural-difference interpretation of this study would be a mistake. First, the fact that 54% of American physicians follow the apparent Japanese cultural pattern of including the family hardly shows that Japanese are family-oriented whereas Americans are autonomy-oriented. Although a much higher percentage of Japanese physicians reported deceiving their patients at the families' requests, a large number of Japanese physicians in this study expressed serious remorse, guilt, and moral uncertainty about their own moral judgments and behaviors when asked their ethical assessment of their deceptive conduct. only 5% to 8% of Japanese medical residents were confident that their approaches to disclosure were the best way to handle the situation. put another way, 92% to 95% of these Japanese physicians expressed some level of uncertainty about their moral duties of Volume 3, Issue 2 Common Morality Theory In Japanese And American Bioethics 25 disclosure. 45% of Japanese residents and 61% of American residents reported that they felt guilty either "all of the time" or "most of the time" when concealing a diagnosis. Both American and Japanese physicians, in comparable numbers, reported high levels of uncertainty about the proper ethics of the disclosure situations in which they find themselves. In the end, the single biggest difference between Japanese medical residents and American medical residents, based on this study, is that 44% of Japanese residents would prefer to disclose a diagnosis of cancer to the family first, whereas only 2% of American residents would prefer that practice. Although this difference may seem large, only 44% of Japanese residents prefer this approach, well short of a majority, and this 44% figure goes down to 23% when the disclosure to the family is of both a diagnosis and a prognosis. At this point we see only a relatively small difference between the practices in Japan and the u.s. Gabbay, Matsumura, et al, in addition, point out that several studies conducted in Japan indicate that Japanese cancer patients are now directly expressing to their physicians a desire for disclosure, even though their families often do not express the same desire. These investigators cite approvingly a sixth study by N. Horikawa, et al about how rapid the changes have been in Japan regarding the disclosure of a diagnosis of cancer to adult patients. The Horikawa study found that in 1993 disclosure of a diagnosis of cancer was made by physicians to only 27% of their Japanese patients, whereas five years later, in 1998, disclosure of the diagnosis of cancer increased to 71%. These investigators state flatly that the higher level of disclosure in 1998 is to be explained by the growing social importance of informed consent.[18, 19] This rate of change in the Japanese medical context seems to almost completely close what had until the late 1990s been the biggest gap in disclosure and consent practices between American and Japanese physicians. A seventh study, by Yasuhiko Miura and associates, reported in 2006, contains results about how well Japanese families and physicians understand what patients actually want.[20] using a questionnaire, they studied 450 dialysis patients in 15 hospitals in Japan. They found that only 47% of patients believed that their families could correctly report what they would want in the way of life-sustaining treatments; and only 31% believed that their physician could do so. As it turned out, about 68% of families made correct predictions of what the patients' preferences would be. physicians were slightly less accurate in reporting what their patients would want. Investigators point out that the ability of both families and physicians to accurately predict patient prefJournal of Practical Ethics TOM L. BEAUCHAMP26 erences is only slightly above chance. These investigators note that their conclusions generally agree with the results of similar studies in the united states. Finally, I mention a 2006 analysis of "Informed Consent Revisited: Japan and the u.s.," by Akira Akabayashi and Brian slingsby-a view expanded on in their recent book with satoshi Kodama.[21] They assert that informed consent is now an "imperative aspect of clinical medicine worldwide" and that "nondisclosure is no longer practiced regularly." They analyze the history and meaning of "informed consent" in Japan, noting the importance of recently issued "professional ethics Guidelines for physicians" of the Japan Medical Association, which asserts that "physicians have an ethical obligation to inform patients" and to "fully disclose all relevant information," even though physicians have some "leeway not to inform patients directly." They note similarities in the u. s. and Japan in the system as it now exists and maintain that any differences in cultures are "far less important than the need to understand each patient and family." The six studies and the seventh commentary that I mentioned in this section show the shallowness of the received view about cultural differences, at least when it comes to the imperative of receiving an informed consent. Both the u. s. and Japanese medical cultures have been in a process of progressive change over the course of the last 25 to 35 years, and both have been chipping away at past paternalistic practices.[22, 23, 18] The idea that there is a deep divide in medical ethics of consent and paternalism between east and West should now die a quiet death. It might be maintained that the goal of "looking and seeing" what Japanese beliefs and practices are might not be well served by the attention given in this section to empirical studies using questionnaires and the like. These instruments might motivate both patients and physicians to say what they think they are expected to say. I do not deny that there are methodological limits to these studies, but their convergence is important and cannot be dismissed. HuMAN RIGHTs AND CoMMoN MoRALITY I will hereafter assume that there is little, if any, credibility in the received view of differences in bioethics. I move on now to ask whether there is good reason to think there is a substantial, globally shared agreement over moral matters-and, if there is not, then whether there should be. I am shifting from a paradigm case of shared belief to the far more general subject of universal morality, or common moVolume 3, Issue 2 Common Morality Theory In Japanese And American Bioethics 27 rality, first considering what we today conceive as human rights. Again I will argue against a view that has been prevalent in the literature. This view is related to the received view, but now I focus on the claim that beliefs in human-rights are western inventions uncongenial to eastern moral and political views. I concentrate on human rights because this category occupies the most prominent place today in discussions of universal morality. The literatures of philosophy, political science, and bioethics often discuss problems of human rights through the lens of "human rights theory" or "political theory." My concentration here is not on such theory but on the underlying cultural values in moral traditions that gave rise to the discussions that have occurred at least since the seventeenth theory in human rights theory. The fact that these values may not have been designated "human rights" is unimportant to the argument. seN's ACCouNT oF RIGHTs AND eAsT-WesT DIFFeReNCes I begin with an argument presented by Amartya sen in a lecture on "Human Rights and Asian Values." [24, pp. 10, 13, 17, 27, 30] since sen is from India, his moral outlook presumably descends from an eastern culture. But sen rejects the way eastern views are often presented, especially when it comes to issues of freedom and human rights. sen points out that the idea of "Asia as a unit" with a set of Asian values about freedom that are different from those of the West has no historical grounding. He notes that 60 percent of the people in the world live in Asia, with virtually nothing to solidify them as a uniform moral culture-or to distance them as a culture segregated from europe, for that matter. sen argues that "There are no quintessential values that apply to this immensely large and heterogeneous population, that differentiate Asians as a group from people in the rest of the world." He finds that the major constituent components of basic ideas of liberty, especially political liberty, are present in both eastern and Western traditions. even if the concept of human rights and human rights theory are relatively new to all parts of the world, as they are, the values that gave rise to these conceptions need not be new. sen's claim, as I understand him, is that the thesis that the values underlying human rights theory are friendly to Western tradition and alien to eastern tradition is "hard to make any sense of." I completely agree with him. In speaking of freedom and authority in the east and the West, sen need not be taken to mean that individual autonomy is prized to the same extent in the east as in Journal of Practical Ethics TOM L. BEAUCHAMP28 the West. perhaps many populations in the east prioritize community and authority over individual autonomy to a higher degree than do many populations in the West. But this thesis does not entail that eastern populations deprecate or reject either individual autonomy or political liberty. sen's claim is that, as a moral matter, liberty rights are not antithetical to eastern traditions of freedom and that claims of human rights are not less important in one place by comparison to another. uNIVeRsAL MoRALITY: ITs BRoAD sCope The point of human rights language is to provide standards that transcend norms and practices in particular cultures that conflict with human rights, but universal morality-the common morality shared by all morally committed persons- is composed of much more than what we today designate as human rights. These "rights" are merely one way of carving out the territory of universal morality. We also share universal morality's rules, virtues, and ideals. I will now briefly examine these three categories of rules, virtues, and ideals. uNIVeRsAL RuLes oF oBLIGATIoN I start with a few examples of what I will call rules of obligation in the common morality: These rules require not killing, not causing pain or suffering to others, preventing evil or harm from occurring, rescuing persons in danger, telling the truth, nurturing the young and dependent, keeping one's promises, not stealing, not punishing the innocent, and obeying the law. These rules of obligation have been justified in various ways in various philosophical theories, but I will not treat problems of justification here. These cross-cultural norms are implemented in different ways in different communities, but the general norms themselves are not culturally contested in any community of persons committed to morality. uNIVeRsAL VIRTues Common morality also contains standards that are moral character traits, or virtues. Here are some examples: honesty; integrity; nonmalevolence; conscientiousness; trustworthiness; fidelity; gratitude; truthfulness; lovingness; and kindness. These human traits are universally admired (pp. 33-34, 46-50),[25] and a person is Volume 3, Issue 2 Common Morality Theory In Japanese And American Bioethics 29 deficient in moral character if he or she lacks one or more of these traits. Negative traits opposite the virtues are vices-for example, malevolence, dishonesty, lack of integrity, cruelty, etc. These character traits are substantial moral defects, universally so recognized by persons committed to morality. uNIVeRsAL IDeALs The final of my three examples of the common morality (in addition to rights) is moral ideals, such as charitable goals, community service, maximum dedication to one's job, and service to the poor. These aspirations are not required of persons, but they are universally admired and praised in persons who act on them (pp. 20-26, 76-77).[26] Four examples are exceptional forgiveness; exceptional generosity; exceptional compassion; and exceptional thoughtfulness. some diversity of judgment will arise in interpreting and implementing all of the norms I have used as examples. My claim is only that these norms are shared across cultures and are universally recognized by morally committed persons. THe uNIVeRsALITY oF pRINCIpLes oF ReseARCH eTHICs I will now extend this discussion of rights, rules, virtues, and ideals to what I take to be a fact about recent developments in biomedical research ethics where a base of values spread from one part of the globe to what is, in effect, a universal presence. Forty years ago, or even thirty years ago, there was no recognized universal research ethics of the sort that has become familiar to us in recent years. There was then scarcely any research ethics. Today we can see a vast similarity, in virtually every developed nation, in moral codes, declarations, laws, and regulations governing research with human subjects. There are understandable and justifiable differences from country to country, but the differences pale in comparison to the sea of similarity in the moral and legal norms governing how biomedical research can and cannot be conducted. Many principles are globally accepted, and violations of them are universally condemned. examples include: ✤ Disclose all material information to subjects of research. ✤ obtain a voluntary, informed consent to medical interventions. Journal of Practical Ethics TOM L. BEAUCHAMP30 ✤ Maintain secure safeguards for keeping personal information about subjects private and confidential. ✤ Receive surrogate consent from a legally authorized representative for incompetent subjects. ✤ ethics review committees must scrutinize and approve research protocols. ✤ Research cannot be conducted unless its risks and intended benefits are reasonably balanced; and risks must be reduced to avoid excessive risk. ✤ special justification is required if proposed research subjects are vulnerable persons. several global organizations and many governments have subscribed to these norms in guidelines, codes, or regulations, but the force and authority of the norms is not contingent on particular laws or agreements. These norms are human rights of research subjects and they are in each case correlative to duties of researchers and sponsors. (see, as one of many examples, the World Medical Association's Declaration of Helsinki.[27]) Having now explored the categories of rights, principles, virtues, and ideals, I could go on to several other domains of universal morality, but this project is too much of an undertaking for this paper. In making the claims I have advanced about global moral beliefs I do not deny that historical context and political circumstance have had a major role in the way these values have been transmitted across the centuries. Research ethics is a good example. I have not tried to explore such an historical point of view, as it too requires more than can be attempted in this paper. MuLTICuLTuRALIsM In conclusion, I turn to the related subject of multiculturalism, which I interpret as a form of human rights theory. However, many writers see matters very differently. They maintain that the idea of a universal, or common, morality does not appreciate the "multicultural world" that we now experience. They hold that multiculturalism and secular pluralism have delivered a post-modern world in which our robust past beliefs in the universality of moral precepts are no longer sustained. For example, H. Tristram engelhardt and Kevin Wildes maintain that a "theoretically intractable Volume 3, Issue 2 Common Morality Theory In Japanese And American Bioethics 31 secular moral pluralism" pervades the modern world, rendering it unamenable to any form of common morality. From this perspective, one cannot say anything about what constitutes proper physician-patient relationships, what human rights might mean, or what constitutes virtue and character-except from within a commitment to the moral framework of a particular moral community.[28, 29] This theory too makes no sense to me. It is also dangerous in what it defends. Among the human rights that today should be most vigorously defended are rights against the oppression of minorities, women, children, and other targeted groups. When complaints about violations of rights arise, governments or other controlling groups often use the excuse that they are treating women and children in accordance with their cultural and religious traditions. The premise that cultures have a right to protect their traditional values, beliefs, and rituals is unacceptable when used to prevent women from educational opportunities, to exploit human subjects in research without appropriate consent, to foster oppressive child labor conditions, or to discriminate against minorities and disenfranchised populations. These practices are basic human rights violations. THe uNIVeRsALITY IN THe THeoRY oF MuLTICuLTuRALIsM Many of today's exponents of the view that there are no universal norms have misrepresented the commitments and objectives of multiculturalist ethical theory. Multiculturalism is the theory that respect is owed to cultural traditions because morality demands this respect.[30] Multiculturalists accept the principle that group traditions, institutions, perspectives, and practices should be respected and should not be violated as long as the members of the group do not themselves violate the standards of the common morality. The objective of multiculturalism is to provide a theory of the norms that universally should guide the protection of vulnerable cultural groups when threatened with marginalization or oppression caused by one or more dominant cultures.[31, 32] Multiculturalism from this perspective has a humanrights dimension. CuLTuRAL DIVeRsITY These comments do not undercut the importance and legitimacy of cultural diversity. A multiculturalist account protects diversity. From the fact that we are reJournal of Practical Ethics TOM L. BEAUCHAMP32 quired to tolerate and protect different cultural traditions, different religious views, and the like, it does not follow that all convictions and practices must be tolerated and protected. some basic norms govern everyone's conduct, whereas some norms hold exclusively for particular groups. CoNCLusIoN I have argued that it is easy to overlook similarities in cultures because of various cultural differences that capture our attention. Whatever our differences, the u. s., europe, and Japan share a great deal in common, and no differences in our cultural histories now present major barriers to accord on basic values in bioethics. My perspective has been universalistic from the first section on shared values such as informed consent requirements to the final two sections on human rights and multiculturalism. In these last two sections it became apparent that multiculturalist theory is a form of human rights theory. In the first section the conclusion reached was, in effect, that the right to give an informed consent to a medical intervention is a human right, even if rights language is not used. These themes have great interest for contemporary bioethics, because there continues to be a shift in the direction of a globally shared bioethics. I have highlighted both clinical ethics and research ethics as examples of the gradual shift to a global bioethics. My hypothesis is that we are well down the path of a process that is still today leveling previous differences through cultural exchange and learning. I am not maintaining that a moral imperialism is being imposed universally by the most powerful nations so that learning is unidirectional from west to east. I mean that we have much to learn from each other that we can share. For example, at the current time in the u. s. we are learning to modify our practices of "community engagement" to protect the interests of participants in research and to create a better set of responsive relationships while engaging in research with human subjects. In this conception, distinctive social, cultural, political, and economic contexts of research participants will be taken into consideration and rules and practices negotiated. u. s. investigators and writers in bioethics have much to learn on this subject from other nations with a history of keenly sensitive practices. I project that a dialogue and leveling of this sort will continue to occur in bioethVolume 3, Issue 2 Common Morality Theory In Japanese And American Bioethics 33 ics and public policy, hopefully erasing all differences of actual practice that prevent human rights from being firmly in place. Acknowledgements: None ReFeReNCes 1 Bai K, shirai Y, Ishii M. In Japan, consensus has limits. 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