1. Karma and Kindness Medical 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 Ethical – Two ethical principles dictate opposite actions Self-Interest – The decision maker’s interest conflicts with ethical action Self-Interest – The decision maker’s interest conflicts with ethical action Practical – Ethical action is clear, but logistics get in the way 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 Autonomy – Patients have the right to make informed decisions about their own health Beneficence – Do what is best for the patient Beneficence – Do what is best for the patient Non-Maleficence – Do no harm Non-Maleficence – Do no harm Truth-Telling – Never lie or conceal information Truth-Telling – Never lie or conceal information Justice – Treat patients equally and fairly Justice – Treat patients equally and fairly

6. Characters Gaew – Thai Construction Worker Gaew – Thai Construction Worker Ends up in ICU with no cortical activity Ends up in ICU with no cortical activity Kwan – Gaew’s Wife Kwan – Gaew’s Wife Tong – Gaew’s Physician Tong – Gaew’s 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 Gaew’s Case?

9. What Kind of Dilemma? Kwan Kwan Practical Dilemma Dr. Tong Dr. Tong Relieving Suffering vs. Karmic Consequence

10. The Quest for a Thai Bioethics

11. Acknowledgements Advisors Advisors Vincanne Adams (Anthropology) Vincanne Adams (Anthropology) Steve Pantilat (Medicine, Ethics) Steve Pantilat (Medicine, Ethics) Sharon Kaufman (Anthropology) Sharon Kaufman (Anthropology) Paul Rabinow (Anthropology, UCB) Paul Rabinow (Anthropology, UCB) Mark Mancall (History, Stanford) Mark Mancall (History, Stanford) Thai Institutions Thai Institutions Ministry of Public Health Hospitals: Siriraj, Ramathibodi, BCC, Pitsanulok, Ratchaburi Funding Funding MSTP Pacific Rim Research Program Office of International Programming