Asian Bioethics Review最新文献

Indonesian law assures the right of its citizens to access health services for abortion procedures under strict criteria. The enactment of Law No. 1 of 2023 about the Criminal Code (KUHP) changed previous regulations regarding the time the abortion is allowed. Abortion is closely related to ethical and moral considerations. The central ethical and moral debate about abortion, especially in Indonesia, revolves around when a fetus is considered a human being and how this aligns with the Indonesian Medical Code of Ethics (KODEKI). On the other hand, the safety and welfare of pregnant women should also be considered. Therefore, all medical and healthcare professionals must understand all aspects of the ethics and laws regarding abortion that apply in Indonesia.

The first implantation of a brain chip into a human paralysis patient by Neuralink demonstrated much potential for treating debilitating neurological diseases and injuries. Nevertheless, brain chips can also be implanted in healthy people to provide an interface between the human brain with computers, robotic machines, and novel artificial intelligence platforms, which generates new ethical issues. The focus here is on the development of brain chip implants that can significantly improve memory, intelligence, and cognition, thereby boosting performance in national examinations for university admissions and securing civil service jobs, thus providing a “game-changer” and “shortcut” for many students and parents. Given that Islam is a major world religion, constituting a significant portion of the global population, it is crucial for the biomedical industry to comprehend Islamic perspectives on emerging medical technologies, which will enable it to more effectively cater to a substantial and growing demographic. We thus critically examine whether the application of brain chip technology to enhance academic performance in highly competitive examinations is consistent with Islamic principles. Based on the Islamic jurisprudential framework, such an application for intellectual enhancement of normal and healthy people without any mental impairment may conflict with the injunction to preserve intellect (Hifz al-Aql) and “consideration of consequences” (murāʿāt al-ma'ālāt) in Islam. It may also be viewed as tampering with Allah’s creation (Taghyir Khalq Allah). Gaining such unfair advantages in competitive examinations will likely be viewed as unethical, by transgressing the core Islamic precepts of Amanah (trustworthiness), Al-‘Adl (justice), Ikhlas (sincerity), and Mujahadah (striving).

Advances in fetal cardiac ultrasound technologies and refinements in cardiac catheterization techniques have made fetal cardiac intervention a reasonable option for fetuses with cardiac abnormalities such as fetal aortic stenosis and fetal hypoplastic left heart syndrome. These procedures — fetal aortic balloon valvuloplasty and fetal atrial stenting — are performed on the physical body of the mother for the benefit of the fetus, and yet carry risks to both mother and fetus. This paper reviews the ethics of fetal cardiac intervention in fetal left heart disease. It provides the ethical underpinnings for the development and performance of these procedures and outlines a practical ethical framework for counselling families in the face or these cardiac abnormalities. There is a need for careful case selection and a need to review these cases after fetal cardiac intervention. The establishment of registries to collect pre-procedural data and to monitor short and long-term procedural outcomes is expected to strengthen the evidence for ethical decision-making.

Pediatricians and parents have co-fiduciary obligations to decide on medical treatment for a child. When life-sustaining treatment is no longer beneficial in seriously ill infants, most pediatricians in Malaysia support parents in a shared decision-making process. Occasionally, it can be challenging to decide what is best, whose decisions to make, and how to navigate uncertainties, value conflicts, and social justice issues that arise. Some of the pediatric ethics themes in Malaysia include moral distress due to professional obligation, the moral significance of withdrawing versus withholding life-sustaining treatment, decision-making for infants with elusive diagnoses or prognostic uncertainties, and infants of forced migrants with sociopolitical barriers to care. Several cases will be described to illustrate these ethical issues, as well as the pediatric ethics framework and approaches that can be considered to decide what is best for these infants. Pediatricians feel obligated to do their best, treat every child and family the same, and feel morally distressed if unable to do so. They can consider gathering more information and perspectives and utilize these frameworks to consider what is best for a child. In moments of conflict, respectfully seeking opinions, values, and concerns from the family through open communication is crucial to resolving disagreements. Clinical ethics deliberation can provide clarity in challenging moments and suggest ethically acceptable options. Clinical ethics mediation can facilitate difficult conversations and bring resolutions and closure for stakeholders. Within these moral spaces, the responsibility of heavy decision-making can thus be shared and reflected upon.

This paper provides an ethical reflection on “children’s autonomy” from the perspective of cross-cultural bioethics based on theories related to Asian values. The author supports the premise of “children’s” autonomy and explores the differences between Western and non-Western cultures regarding claims of children’s autonomy. By comparing the legal regulations on children’s medical decisions in the USA, the UK, Japan, and Taiwan, the paper illustrates the national legal differences in children’s decision-making, even under the influence of similar Asian cultural values. The author further explains, adopting Tsai’s “Confucian two-dimensional personhood theory” and Markus and Kitayama’s “Construal of Self” theory, that although Asian countries like Taiwan have historically been influenced by relational personhood dimension and interdependent self-construal orientation, individual autonomy and children’s medical decisions are significantly affected or limited by family or parental determinism. However, under the influence of global human rights values and universal bioethical principles, the conceptions, legislations, and practices have evolved towards respecting individual rights and autonomous choices. Hereby, Tsai’s two-dimensional personhood theory can balance the tension between individual autonomy and family determinism, as well as between children’s autonomy and paternalism. This theoretical framework can provide a rational resolution to the long-standing cross-cultural bioethical controversy regarding individual autonomy and family determinism, and offer insights and solutions for pediatric ethics and children’s medical decisions under Asian values.

This article explores the communication challenges faced by health professionals working with patients from high-context cultures (i.e. those that emphasize non-verbal communication), particularly in Southeast Asia, and proposes strategies to enhance interaction and patient care. Attention should be put on the impact of cultural dimensions such as high power distance and collectivism on patient behaviour and decision-making. In high power distance cultures, patients may be passive and reluctant to voice concerns, while collectivistic values often influence decisions through family or community input. To address these challenges, communication guides designed to improve interactions include observing subtle non-verbal and para-verbal cues, practicing active listening, encouraging patient participation, providing adequate consultation time, and discussing care plans collaboratively. Additionally, using familial terms of address and incorporating Kleinmann’s eight questions are recommended to bridge cultural gaps and facilitate a better understanding of patients’ perspectives. The proposed strategies aim to foster a culturally sensitive and patient-centred approach, enhancing communication, improving patient satisfaction, and leading to better health outcomes. By implementing these practices, health professionals can navigate cultural complexities more effectively and deliver high-quality, respectful care.

Since the human genome was sequenced in 2003, exploding knowledge and new technologies in the field of genomics have given rise to the new field of precision medicine, whereby treatment is individualized to patients based on their genomic information. However, as with any new scientific advancement and technology, precision medicine has the potential to improve health outcomes but raises ethical questions, particularly in children. Using pediatric precision oncology as an example, this paper focuses on the ethical issues in the integration of genomic information in the management of children with cancer. Pediatric precision oncology encompasses the use of the child’s cancer genomic information and sometimes germline genomic information to aid in diagnosis, risk stratification, and prognostication, as well as “precisely” treating the cancer using genomically guided targeted therapies. The main ethical issues discussed in this paper include the difficulty in obtaining informed consent from parents and assent from the child, due to information overload, emotional overwhelm, cognitive biases, among others; the ambiguity between research and clinical care, leading to therapeutic misconception and mis-estimation; the utility of this novel technology and its impact on scarce resources; and the potential to widen health disparities thus affecting justice. Recognizing and addressing these ethical challenges will help guide the responsible implementation and integration of precision medicine into routine pediatric clinical care.

In our day-to-day clinical practice, we face several ethical dilemmas. Although we have a moral conscience, we are constrained by many factors in executing the right decision. It is in this context that courage to stand up for one’s ethical values and make the right decision, even if we get penalized, is important. Four case scenarios from a large tertiary care hospital which provides care to patients belonging to all socioeconomic strata are described. The institution offers subsidized/free treatment to “deserving patients”, and this subsidy is entirely decided upon by the treating medical team. With limited resources for subsidized treatment, we are often in a dilemma as to how much of financial support should be given and how to prioritize beneficiaries between those with acute illnesses versus those with chronic disabilities/cognitive impairment. With access to advanced investigations and treatment modalities, management individualized to patients becomes a daily challenge for the medical team. The ethical dilemma associated with these case scenarios and the moral courage shown by the decision makers in each case are discussed. Clinicians often rely on “phronesis”—the ethical decision-making grounded in an accumulated wisdom—when confronted with ethical dilemmas. The professional virtues such as compassion, discernment, empathy and integrity form an integral part of decision-making intertwined with the basic ethical principles of beneficence, nonmaleficence, autonomy and justice. Moral courage is often required to implement these virtues especially in the face of the opposing pragmatic realities of clinical practice.