Fig. 3.1
Axial T1 gadolinium-enhanced MRI of 69-year-old man (a physician) with progressive upper brain stem glioblastoma who requested help with assisted suicide. His request was denied as he lived in a jurisdiction where it is illegal
3.22 Approach to the Case
The fifteenth century Latin text Ars Moriendi provided guidance to achieve a good death. The response to our patient’s request is subject to geographically where he is located. A minority of countries/states allow assisted suicide particularly in Europe and the USA (Lavery et al. 1997; Steck et al. 2013), and many others are attempting to do likewise (Quebec to proceed with “dying with dignity” legislation 2013). In these jurisdictions patients, and specifically those with malignant brain tumors, appear to be open to discussing the legalization of assisted suicide (Lipsman et al. 2007). In other cultures such as the devoutly Muslim countries, assisted suicide is not possible, nor is even the conversation about it. It is clear that culture and geography play a large role in the legality and/or moral acceptability of assisted suicide.
3.23 Conclusion
There is clearly ethical relativism in that what is considered morally acceptable or desirable in one culture/country/religion may be ethical unacceptable or undesirable in another. The above examples are by no means exhaustive but give a glimpse of how neurosurgeons all over the world may confront situations which are foreign to their way of thinking and to which they must strive to be as flexible and sensitive as possible. Examining multiple patients in one physical space would be unthinkable in the developed world but is morally acceptable in the parts of the developing world. While it would be morally unacceptable for a surgeon not to transfuse an average patient with excessive blood loss, it would be wrong and even illegal for him/her to transfuse a patient who is Jehovah’s Witness against their expressed wishes. No matter how difficult to comprehend some situations may be, we must remember that at the center is an ill human being and a suffering family.
Ethical relativism can be defined as the theory which claims that because different societies have different ethical beliefs, there is no rational way of determining whether an action is morally right or wrong other than by asking whether the people of that society believe it is right or wrong (Bowman and Hui 2000; Coward and Sidhu 2000; Daar and al Khatamy 2001; Ellerby et al. 2000; Goldsand et al. 2001; Markwell and Brown 2001; Pauls and Hutchinson 2002). Ethical relativism posits that there are no ethical standards that are absolutely true and that apply to people of all societies. Instead, relativism holds, something is right for the people in one particular society if it accords with their moral standards and wrong for them if it violates their moral standards.
Given that we live in and are surrounded by many different cultures and the distances between countries and places have diminished by the revolution in immigration, communication, and information, every effort should be made to understand and accept others. Diversity is reality and an inevitability and is to be celebrated, and hospitals present a good example of such a multicultural community, in which everyone comes together to all work for one goal – the best interest of the patient.
References
Bernstein M (2007) Magic touch. Handling patients in a touchy age. Parkhurst Exch 15:22–23
Bernstein M, Upshur R (2008) Beware patients bearing gifts. Parkhurst Exch 16:72–73
Bowman KW, Hui EC (2000) Bioethics for clinicians: 20. Chinese bioethics. CMAJ 163(11):1481–1485PubMedCentralPubMed
Coward H, Sidhu T (2000) Bioethics for clinicians: 19. Hinduism and Sikhism. CMAJ 163(9):1167–1170PubMedCentralPubMed
Daar AS, al Khitamy AB (2001) Bioethics for clinicians: 21. Islamic bioethics. CMAJ 164(1):60–63PubMedCentralPubMed