Karma and Kindness Medical Ethics in Thailand

1
Karma and KindnessMedical Ethics in Thailand

• Scott Stonington
• MD/PhD Student Medical Anthropology

2
Thailand and the Mechanical Ventilator

• A New Political and Ethical Problem

3
Dilemmas

• Ethical Two ethical principles dictate opposite
  actions
• Self-Interest The decision makers interest
  conflicts with ethical action
• Practical Ethical action is clear, but
  logistics get in the way

4
Questions

• 1) What kind of dilemma does withdrawing the
  ventilator present to the characters?
• 2) What bioethical principles do they use to make
  their decisions?

5
Principles of Western Bioethics

• Autonomy Patients have the right to make
  informed decisions about their own health
• Beneficence Do what is best for the patient
• Non-Maleficence Do no harm
• Truth-Telling Never lie or conceal information
• Justice Treat patients equally and fairly

6
Characters

• Gaew Thai Construction Worker
• Ends up in ICU with no cortical activity
• Kwan Gaews Wife
• Tong Gaews Physician

7
Culture and Bioethics in the United States

• We assume that the principles of Western
  bioethics are universal

8
Which bioethical principles are at work in Gaews
Case?
9
What Kind of Dilemma?

• Kwan
• Practical Dilemma
• Dr. Tong
• Relieving Suffering
• vs.
• Karmic Consequence

10
The Quest for a Thai Bioethics
11
Acknowledgements

• Advisors
• Vincanne Adams (Anthropology)
• Steve Pantilat (Medicine, Ethics)
• Sharon Kaufman (Anthropology)
• Paul Rabinow (Anthropology, UCB)
• Mark Mancall (History, Stanford)

• Thai Institutions
• Ministry of Public Health
• Hospitals Siriraj, Ramathibodi, BCC, Pitsanulok,
  Ratchaburi
• Funding
• MSTP
• Pacific Rim Research Program
• Office of International Programming