Abstract
Over the past decade, several scholars have advocated for international standards in medical ethics and human rights [1–3]. Others have countered that such standards risk ignoring important cultural differences in the way people conceptualize medical decision-making [4–8]. Within this debate hangs a question for international bioethics: as developing countries build allopathic medical systems, what should their bioethics be? In this essay, we explore possible answers to this question, ultimately arguing that Western bioethics is insufficient to solve the problems that arise in the practice of allopathic medicine in non-Western contexts. As an example, we discuss recent conflicts over the use of mechanical ventilators in Thailand. Thailand is a center of cutting-edge allopathic medical care in Asia. It has a universal health-care system, which provides many Thais with access to mechanical ventilation. So many Thais are placed on mechanical ventilators at the end of life that it has become one of the largest drains on Thailand's universal health-care system [9]. Furthermore, the use of ventilators has become a source of vehement national debate, mostly as a result of several prominent political figures who received overly aggressive medical care at the end of life [10,11]. As in Western hospitals, the ascension of mechanical ventilation has introduced a host of difficult ethical dilemmas for doctors, families, and patients [12,13]. How will Thais go about solving these dilemmas? On which principles of bioethics will they rely? Most hospitals in Thailand have temples nearby where patients and families can grapple with the karmic landscape of illness and medicine To answer these questions, we start with a case that illustrates a common ethical dilemma about withdrawal of mechanical ventilation in Thai intensive care units. We then explore some concepts from Western bioethics to see if they help resolve this dilemma. Finally, we explain some of the local ethics behind the case and discuss the concept of a Thai bioethics to address the use of ventilators in Thailand.
Highlights
Over the past decade, several scholars have advocated for international standards in medical ethics and human rights [1,2,3]
We explore some concepts from Western bioethics to see if they help resolve this dilemma
The purpose of this exploration has been to illustrate the need for Thailand and other countries to develop bioethical systems using local concepts
Summary
There has been a recent fervor of discussion in many Western medical schools about culture and bioethics [8]. Like this figure at Wat U Mong Klang Wiang, are common sites for Thai Buddhists’ offerings (Photo: Scott Stonington) values beneficence (doing what is best for the patient) over autonomy (the patient’s prerogative to make decisions for himself) and wants to conceal the illness from his father In this analysis, the principles of bioethics are held to be universal—the son’s culture makes him value these principles in a unique proportion. Dr Nok’s refusal to remove the ventilator is not based on Gaew’s wishes; it is not based on what is best for Gaew; and it is not about what is most truthful, or what is best for Thais as a whole None of these fundamental principles of Western bioethics—autonomy, beneficence, non-maleficence, truth-telling, or justice—sufficiently explain Lek and Dr Nok’s dilemma. Gaew’s case makes it clear that one must examine local ethical concepts before uncritically importing Western bioethical tools
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