Ethical universality in medicine: A critical rational bioethics beyond cultural relativism.

INTRODUCTION: Cultural diversity in healthcare raises a central question: are ethical obligations in medicine universal or culturally dependent? While modern medicine presupposes moral equality, cultural relativism challenges the universality of ethical standards. MATERIALS AND METHODS: Conceptual and historical analysis of medical ethics. The major ethical codes and dominant frameworks: cultural relativism, common morality, and reflective equilibrium were critically examined to assess how ethical norms develop and how ethical judgments are evaluated. RESULTS: Ethical progress in medicine is better explained by the recognition and correction of error than by the convergence of cultural beliefs. Cultural relativism is incompatible with moral equality and risks undermining consistent patient protection. Existing frameworks provide limited accounts of ethical knowledge development. A problem-driven, critical model, "Critical Rational Bioethics", is proposed, in which ethical judgments are treated as conjectures subjected to systematic scrutiny and revision. DISCUSSION AND CONCLUSION: Ethical universalism follows from moral equality and is incompatible with cultural relativism. Ethical progress in medicine is best understood as the correction of error rather than the justification or convergence of beliefs. Critical Rational Bioethics provides a problem-driven, fallibilist framework in which ethical judgments are critically assessed and provisionally retained. This approach reconciles universal ethical obligations with context-sensitive implementation, supporting consistent patient protection in multicultural clinical settings.