In early 2017, Nevada amended its Uniform Determination of Death Act, in order to clarify the neurologic criteria for the determination of death. The amendments stipulate that a determination of death is a clinical decision that does not require familial consent and that the appropriate standard for determining neurologic death is the American Academy of Neurology’s guidelines. Once a physician makes such a determination of death, the Nevada amendments require the withdrawal of life-sustaining treatment within twenty-four hours with limited exceptions. (...) Neurologists have generally supported Nevada’s amendments for clarifying the diagnostic standard and limiting the ability of family members to challenge it. However, it is more appropriate to view the Nevada amendments with concern. Even though the primary purpose of the UDDA is to ensure that all functions of a person’s entire brain have ceased, the AAN guidelines do not accurately assess this. In addition, by characterizing the determination of death as solely a clinical decision, the Nevada legislature has improperly ignored the doctrine of informed consent, as well as the beliefs of particular faiths and cultures that reject brain death. Rather than resolving controversies regarding brain death determinations, the Nevada amendments may instead instigate numerous constitutional challenges. (shrink)

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Contemporary bioethics education has been developed predominately within Euro-American contexts, and now, other global regions are increasingly joining the field, leading to a richer global understanding. Nevertheless, many standard bioethics curriculum materials retain a narrow geographic focus. The purpose of this article is to use local cases from the Asia-Pacific region as examples for exploring questions such as ‘what makes a case or example truly local, and why?’, ‘what topics have we found to be best explained through local cases or (...) examples?’, and ‘how does one identify a relevant local case?’ Furthermore, we consider the global application of local cases to help extend the possible scope of the discussion, opening new avenues for the development of practical bioethics educational materials. We begin with a background description and discussion of why local cases enhance bioethics education, move to an overview of what is currently available and what is not for the region, and then outline a discussion of what it means to be local using example cases drawn from Hong Kong, Australia, Pakistan, and Malaysia. We are not creating a casebook but rather constructing by example a toolbox for designing active and dynamic learning cases using regional diversity as contextualised cases with generalised principles. (shrink)

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It is not possible to talk about bioethics without recognizing the plurality inherent in it. In this sense, the notion of person is important due to its multiplicity of possible interpretations depending on its cultural context. This fact is highlighted in the case of organ transplantation in Japan. While there are many critiques against this procedure from scholars in various fields, those that deal with the problem of brain death are especially problematic. This is because the definition of person that (...) is invoked in such debates does not seem to coincide with how the notion of person has been understood in the Japanese tradition. Hence, investigating the Japanese concept of ningen could be helpful in not only partially clarifying some of the attitudes that exist in Japan towards the notion of brain death, but also to illustrate the need to recognize the plurality of views in modern bioethics. (shrink)

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Background As cultural contexts have gained increasing relevance in medical decision-making, the current mainstream definition of autonomy is insufficient. A viable alternative framework, relational autonomy posits that agents’ actions are influenced by and embedded in society and culture rather than occurring in isolation. To test the concept’s applicability, we examine whether Asian Americans in the study’s sample operationalize relational autonomy as a decisional approach in hypothetical scenarios about organ donation, a practice for which there is considerably lower enthusiasm compared to (...) other racial groups in the US. Methods A national sample of Asian American adults were recruited from a Qualtrics research panel. Participants completed a Think-Aloud interview containing scenarios in which they decide whether or not to: (1) become a registered donor at the motor vehicle department; (2) authorize organ donation for a close relative who unexpectedly died. The interview first elicited candid reactions to the scenarios, followed by probing participants’ rationale of their initial responses. Participants’ final decision to each scenario (whether or not to register; whether or not consent to surrogate authorization), as well as participants’ decisional approaches (individualistic vs. relational) were coded using the constant comparison method. Results The sample (n = 40) mirrored the largest proportions of Asian Americans in the US; the plurality identified as Chinese (35%), Filipino (27.5%) and Indian (25%). In response to the organ donor registration prompt, a majority of respondents (57.5%) expressed they would employ the mainstream decisional approach of individualistic autonomy, and 42.5% would make the decision with a relational approach. In contrast, when responding to the surrogate authorization prompt, the majority (77.5%) described a relational approach when making the decision, to preserve familial harmony and honor their cultural heritage. Conclusions Use of individualistic and relational autonomy frameworks are situational for some individuals. Participants acknowledged the impact of personal, cultural, and societal elements on their decisional approach. The concept of relational autonomy has utility through its versatility in complex decision-making events and by accounting for multiple stakeholders without privileging the autonomy of a single decision-maker over others. Clinical trial number Not applicable. (shrink)

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There appears to be a conflict between global bioethical principles and the local understanding and application of these principles, but this conflict has misleadingly been characterized through the east–west dichotomy. This dichotomy portrays bioethical principles as western and as alien to non-western cultures. In this paper, I present reasons to reject the east–west dichotomy. Using the discussion around the principle of informed consent as an example, I propose that while bioethical values are common, bioethical governance must display a certain flexibility (...) akin to Aristotle’s metaphor about the Lesbian rule. Such flexibility combined with a deeper understanding of the lived experiences of bioethical subjects might lead to the purging of tensions between global and local, giving us Glocal Bioethics. (shrink)

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This perspective article examines the ethical implications of Manila City Ordinance No. 8793, also known as the “Sanitation and Disinfection Code of Manila.” This ordinance mandates centralizing health screenings through the Manila Health Department for all city employees working in government and private institutions. While the ordinance aims to centralize public health measures to enhance disease control in the city, it raises concerns regarding individual autonomy in relation to public health. In this article, I will highlight how the ordinance’s stringent (...) requirements potentially infringe individual autonomy and, worst of all, disproportionately affect low-income workers. To do this, I will explore the possible tension between public health and the principle of autonomy in enacting this ordinance. This article hopes to contribute to the broader discourse on public health ethics, particularly in contexts where policies set to attain their goals might unintentionally infringe on individual autonomy and exacerbate existing equality. (shrink)

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