Promoting a Global Appreciation of Asian Narratives

In this issue, we take advantage of the opportunity provided by the materials in the Case Corner to reiterate the Asian Bioethics Review’s objective of promoting a global appreciation of Asian narratives. The case study that is the subject of commentaries arose in the context of Singapore but it could very well have arisen somewhere in the West (or anywhere else) and still have been addressed in roughly the same way using the same commentaries. The narrative illustrates the diversity of perspectives from which healthcare processes or events could be viewed, analysed and understood. It also shows the global richness of bioethical discourse to which the ABR has striven to contribute.

The initial presentation of the case highlighted autonomy as an issue, but an issue to be appreciated in a way that goes beyond teasing out and implementing the patient’s expressed preferences. The two main considerations mentioned by the patient as being important for his care turned out to be in conflict. And as the patient’s hallucinations intensified, they got in the way of his ability to engage in decision-making. It was difficult to ascertain what care options he would have preferred under the circumstances, which he did not appear to anticipate when he expressed his wish to remain alert for as long as possible and to be nursed in his own home in the bosom of his family. One could see that as a moral agent, the patient had evolved quickly and the situation in which he was caught was not amenable to an unequivocal decision based solely on the considerations he mentioned as important.

One commentary recalls how one may identify and view the issues related to the case from a perspective of care ethics. The appreciation differs from that which may be encountered in mainstream bioethics where the individual moral agent often is objectified and stripped of the subjective relationships with family and friends. Other commentaries remind us of the legal intricacies facing doctors when they make decisions about end-of-life care. There are also iterations of the roles that physicians and nurses must play as professional providers of healthcare in a context in which family members similarly have role-based duties and responsibilities as personal caregivers or surrogate decision-makers.

The complexity emerging from theoretical incongruities was aggravated by personal and familial considerations. These considerations would have been barely known to healthcare staff had they not made a deliberate effort at discovery. Also making an impact were social and cultural values that could be seen as conflicting, overlapping and deceptively entangled. The Singaporean patient who was the subject of the case was born of a Chinese father and an Indian mother. He was educated in England but managed to hold on to his ethnic values by agreeing to an arranged marriage after returning from his foreign studies. After getting widowed, he remarried. His second wife’s views regarding his end-of-life care differed from that of his daughters from the first marriage. The son did not agree with the daughters but his own circumstances introduced another factor into the narrative since he appeared to be driven by his own agenda to have an opportunity to talk to his father before the latter eventually died. Many subjective variables were finding their way into the decision-making process but, as in many cases of the sort, there was no established formula for determining their individual weight or measuring their relative importance.

To a family member or a healthcare provider trying to come to grips with the situation, the overlaps and entanglements among seemingly conflicting perspectives and values would have looked like barriers needing to be kicked aside or mazes to be negotiated cleverly until one found the correct way to get to the desired end from a defined starting point. However, a closer look would have revealed that these “barriers” could not be brushed aside because they were an essential feature of the narrative. When faced with cases of this sort, those searching for one correct endpoint or seeking to clear their way to enlightenment by kicking thorough...