In Pakistan, as in many non‐Western cultures, decisions about a patient's health care are often made by the family or the doctor. For doctors educated in the West, the Pakistani approach requires striking a balance between preserving indigenous values and carving out room for patients to participate in their medical decisions.

The Islamic Republic of Pakistan has a population of more than 145 million people, about 95% of whom are Muslims . Although it has a few large cities such as Karachi, almost 65% of the country is still rural, with a per capita income of $408 per year. The overall literacy rate is estimated to be 41.5% but is much lower for women in many of the provinces. Pakistan has a complex culture with many ethnic groups and socioeconomic strata, but (...) overall the society is characterized by hierarchical systems in both private and public domains. The population is religious and family centered with the “family” understood as extending beyond the nuclear; it is not uncommon to have three generations residing under one roof or within close proximity to each other and pooling their resources. (shrink)

In theory, a commercial market for kidneys could increase the scarce supply of transplantable organs and give impoverished people a new way to lift themselves out of poverty. In‐depth sociological work on those who opt to sell their kidneys reveals a different set of realities. Around the town of Sarghoda, Pakistan, the negative social and psychological ramifications of selling a kidney affect not only the vendors themselves, but also their families, communities, and even the country as a whole.

ABSTRACT Although a preference for sons is reportedly a universal phenomenon, in some Asian societies daughters are considered financial and cultural liabilities. Increasing availability of ultrasonography and amniocentesis has led to widespread gender screening and selective abortion of normal female foetuses in many countries, including India. Feminists have taken widely divergent positions on the morality of this practice. Feminists from India have strongly opposed it, considering it as a further disenfranchisement of females in their patriarchal society, and have agitated successfully (...) for legislative prohibitions. Libertarian feminists on the other hand, primarily from the United States, have argued that any prohibition of the use of this technology is a curtailment of a woman's reproductive choices and a violation of her right to make autonomous decisions regarding procreation. Using India as an illustrative case, this paper argues that in the context of what prevails in some societies, an ethical argument that hinges on the principle of autonomy as understood in the West can be problematic. Furthermore, a liberal theoretical assumption that it is always better to have more rather than fewer choices may not hold up well against the realities of life for such women. Although feminists have little disagreement concerning substantive matters, it is in the area of strategy that differences of opinion have arisen, their moral reasoning and responses shaped by the culture, ethnicity, class and race to which they belong. A view that a single ‘orthodox’ feminism of any variety can embody the aspiration of all women reverts to the problematic issues in the evolution of the rationalistic, individualistic, ‘male’ ethics against which women have consistently raised objections. (shrink)

Despite the majority opinion of Muslim jurists that organ donation is permitted in Sharia, surveys indicate continuing resistance by lay Muslims, especially to donating organs following death. Pakistan, a country with 165 million Muslims, currently reliant on live donors, is considering steps to establish deceased donor programs which will require public acceptance and support. This article analyzes the results of in-depth interviews with 105 members of the public focusing on opinions and knowledge about juristic rulings regarding kidney donations, donor-family dynamics (...) in deceased donation decisions, and attitudes towards buying kidneys. The objective was to determine the influence if any of cultural and religious values, and norms of traditional family structures and kinships, on decisions to donate. Study participants view donation of kidneys, particularly from the deceased, through a different lens from that used by jurists and physicians, one that also does not conform to familiar paradigms defining ethical organ donation. A socially modulated understanding of Islam passed down the generations, and longstanding family-centric norms, shape the moral worldview of many rather than academic juristic rulings or non-contextual concepts of autonomy and rights. The results of this study also highlight that medical science may be universal but its application occurs within particularities of cultural and religious values, social constructs of the self and its relationship with others, and different ways in which humans comprehend illness, suffering, and death. These findings are of relevance both to transplant related professionals and bioethicists involved with this field. (shrink)

Despite the majority opinion of Muslim jurists that organ donation is permitted in Sharia, surveys indicate continuing resistance by lay Muslims, especially to donating organs following death. Pakistan, a country with 165 million Muslims, currently reliant on live donors, is considering steps to establish deceased donor programs which will require public acceptance and support. This article analyzes the results of in‐depth interviews with 105 members of the public focusing on opinions and knowledge about juristic rulings regarding kidney donations, donor‐family dynamics (...) in deceased donation decisions, and attitudes towards buying kidneys. The objective was to determine the influence if any of cultural and religious values, and norms of traditional family structures and kinships, on decisions to donate. Study participants view donation of kidneys, particularly from the deceased, through a different lens from that used by jurists and physicians, one that also does not conform to familiar paradigms defining ethical organ donation. A socially modulated understanding of Islam passed down the generations, and longstanding family‐centric norms, shape the moral worldview of many rather than academic juristic rulings or non‐contextual concepts of autonomy and rights. The results of this study also highlight that medical science may be universal but its application occurs within particularities of cultural and religious values, social constructs of the self and its relationship with others, and different ways in which humans comprehend illness, suffering, and death. These findings are of relevance both to transplant related professionals and bioethicists involved with this field. (shrink)

This essay provides a brief overview of the rise of organ trade in Pakistan towards the end of the last century and the concerted, collective struggle—of physicians and medical associations aided by the media, journalists, members of civil society, and senior judiciary—in pressuring the government to bring about and implement a national law criminalizing such practices opposed by an influential pro-organ trade lobby. It argues that among the most effective measures to prevent re-emergence of organ trafficking in the country is (...) increasing ethical live donations and above all, establishing sustainable, public supported deceased donor programs. To do this, the transplant community must recognize that organ transplantation is not merely a donor-recipient-physician transaction but a complex issue in which decisions to donate an organ are influenced by indigenous values and belief systems about human illness, life and death. (shrink)

Contemporary bioethics has evolved over the past 40 years predominantly as a “Western” construct drawing fundamental inspiration for its conceptual and methodological frameworks from secular, Anglo-American philosophical traditions. American bioethicists can be credited with playing a defining role in the globalization of this new discipline to the developing countries of the world, but in this process, in the words of LaFleur, “Bioethics has become international without becoming internationalized.” Among the criticisms leveled against the dominant American model of bioethics is that (...) in its focus on universalism it ignores local cultural and religious influences that are vital to the comprehension of the moral life in many societies. Medical sociologist Renée C. Fox and historian Judith P. Swazey have termed this as a form of “cultural myopia.”. (shrink)

It has been a little over three months since I returned. My day begins with an altercation with a new security guard who stops me as I drive up to the gate of the brand-new university hospital. He tells me that I am to use the other entrance, as only the chairman’s car is allowed through this gate. I inform him that I am the chairman. He peers at me suspiciously. The chairman sahib is a man not a woman, he (...) says. I put on a stern face and tell him that I am the chairman and he will get into trouble for not letting me through. He looks uncertain but eventually lets me drive in through the gate. I pick up my white coat and stethoscope from my... (shrink)

The arrival of the Covid‐19 pandemic in Pakistan necessitated that the Centre of Biomedical Ethics and Culture in Karachi realign its activities to changing realities in the country. As Pakistan's only bioethics center, and with no guidelines available for allocation of scarce medical resources, CBEC developed “Guidelines for Ethical Healthcare Decision‐Making in Pakistan” with input from medical and civil society stakeholders. The CBEC blog connected to the center's bioethics programs for students from Pakistan and Kenya shifted to Covid‐related issues specific (...) to the context of existing social and political realities within these countries. As part of its outreach activities, CBEC initiated a popular Facebook series, #HumansofCovid, as an experience‐sharing platform for health care professionals and members of the public. Narratives received vary from those by frustrated physicians under quarantine to those concerning street vendors left jobless and a transsexual person in whose opinion “social distancing” is not a new phenomenon for their communities. (shrink)

During the COVID‐19 pandemic, healthcare professionals around the world were driven by universal values of solidarity and duty to provide care. However, local societal norms and existing healthcare systems influenced interactions among physicians, and with patients and their families. An exploratory qualitative study design using in‐depth interviews was undertaken with physicians working at two public sector hospitals in Karachi, Pakistan. Using the constant comparison method of data analysis, several key themes were identified highlighting norms of kinship and interdependencies characteristic of (...) collectivistic societies that influenced professional interactions. The role of seniors in the hierarchical society of Pakistan played a major role in provision of care. Physicians reported numerous challenges in dealing with patients and their families amidst public denial fueled due to ill‐formed government policies. This included interruption of funeral rites which undermined public trust. The study provides insights into the local moral world of two healthcare institutions in Pakistan. (shrink)

The Covid-19 pandemic necessitated a shift to online teaching of bioethics, a field that relies on discourse and interactive teaching methods. This paper aims to highlight the challenges faced and lessons learned while describing the experience of having to shift to teaching bioethics online to students enrolled in the Postgraduate Diploma in Biomedical Ethics (PGD) and Master of Bioethics programs at the Centre of Biomedical Ethics and Culture (CBEC) in Pakistan. Opinions of students, mainly compromising mid-career healthcare related professionals, were (...) obtained through a survey (n = 13) and an in-depth group discussion via Zoom. Observations from core faculty (n = 7) were recorded through conducting a content analysis of monthly faculty meetings, enhanced by faculty narratives published in the Centre’s bi-annual newsletter. Faculty and students alike expressed unease with the online mode since it minimized chances of interaction with peers and faculty thus negatively affecting learning process. Juggling work responsibilities while taking synchronous online classes proved to be difficult for students particularly for clinicians, with unique issues for women. Faculty faced increased workload due to the necessity for development of innovative teaching methods and new assessment tools in order to maintain the standard of the academic programs. Despite the problems surrounding the online mode, students and faculty also acquired new skills during this period. Overall, there was a clear preference for on-campus learning, however against the backdrop of a pandemic, online mode was considered as the only viable option. (shrink)

Gabriel Rezende est à Jacques Derrida ce que Reiner Schürmann est à Martin Heidegger. Comme l’essai fondateur de Schürmann, Le principe d’anarchie. Heidegger et la question de l’agir, posait « la question du rapport entre théorie et pratique telle qu’elle résulte de la “déconstruction” » heideggérienne, celui de Rezende, Droit et normativité chez Jacques Derrida, pose celle des rapports entre éthique et morale telle qu’elle résulte de la déconstruction derridienne, c’est-à-dire d’une pensée «...

SummaryThis paper examines the official abortion statistics for South Australia since the legalization of abortion in January 1970. The incidence of abortion is shown to be increasing steadily—in 1976 more than half of the extramarital pregnancies were terminated and the overall ratio of abortions to live births was nearly 1:6. Most abortion patients were single, young women. Comparison of fertility levels in South Australia with the rest of Australia shows that the fertility decline has been much more rapid in South (...) Australia, suggesting that unless the South Australian women are more efficient users of contraception than other Australian women, a significant proportion of the fertility decline in South Australia has to be attributed to legalized abortion. (shrink)

Resenha de: Blumenbach, J. F. Sobre o impulso de formação e a geração. Tradução, introdução e notas de Isabel Coelho Fragelli. Revisão técnica de Luciana Valéria Nogueira. Santo André: Editora UFABC, 2019.

A intenção deste texto é articular dois temas pouco trabalhados juntos nas interpretações de Kant, embora sejam, segundo nosso entendimento, de fundamental importância para uma plena compreensão da filosofia kantiana e do conhecimento filosófico em geral: a disciplina da razão pura e a filosofia teórica. Pretendemos nos utilizar de algumas outras noções, no entanto, para responder a seguinte pergunta: é possível a formação sem a disciplina filosófica? Isto é, seria possível uma formação teórica sem uma disciplina ou uma “contribuição negativa” (...) proveniente da filosofia? O conceito de formação está, segundo gostaríamos de defender, de um ponto de vista teórico, associado intrinsecamente à disciplina da razão. Assim, indicando como esta é, em geral, relacionada, nas interpretações de Kant, apenas com a pedagogia e com a filosofia prática, gostaríamos de, indo no sentido contrário, tratar do lugar da disciplina da razão em relação ao conceito de formação em seu sentido teórico, isto é, de fundamentação do conhecimento. A disciplina da razão pura revela-se, portanto, uma condição necessária para o filosofar e para a formação do conhecimento em geral. (shrink)

In this article, I will try to explain the meaning of the word zihâr, translated as oath of the back, trying only to situate it in its context and to bring an elucidation of the subject`s origin. The zihâr is a type of repudiation used by a husband against his wife in the times of gâhiliyya (the ante-Islamic period), by using a solemn divorce formula which consists in saying: "let (her) be from now on as the back of my mother". (...) Therefore, backing up on this formula, I want to try to clarify this concept. (shrink)

In this article, I will try to explain the meaning of the word zihâr, translated as oath of the back, trying only to situate it in its context and to bring an elucidation of the subject`s origin. The zihâr is a type of repudiation used by a husband against his wife in the times of gâhiliyya (the ante-Islamic period), by using a solemn divorce formula which consists in saying: "let (her) be from now on as the back of my mother". (...) Therefore, backing up on this formula, I want to try to clarify this concept. (shrink)

Official statistics on abortion in South Australia for the period 1971–86 are analysed in terms of incidence, age of patients and nuptiality, reasons for abortion, method of termination, period of gestation, previous abortions and concurrent sterilisation. Demographic implications are discussed and recommendations are made for more education and counselling, especially for younger and unmarried women for whom the incidence of abortion seems to be rising.

Children’s sociocultural experiences in their day-to-day lives markedly play a key role in learning about the world. This study investigated parent–child teaching during early childhood as it naturally occurs in the home setting. Thirty-nine families’ naturalistic interactions in the home setting were observed; 1033 teaching sequences were identified based on detailed transcriptions of verbal and non-verbal behavior. Within these sequences, three domains of learning (knowledge, skills, and dispositions) and subtopics were identified and analyzed in relation to gender, child birth order, (...) context, teaching strategies, and learner response. Findings show knowledge, skills, and dispositions were taught equally, marked by the most prominent subtopics taught within each domain, including cognitive (skill), game rule (knowledge), and social rule (disposition). Further, mothers and fathers were found to teach their children equally, however, fathers taught knowledge more than mothers, whereas mothers taught dispositions more than fathers. Differences between domains of learning and subtopics also existed between mother’s and father’s teaching based on child birth order and gender. This study also assessed the contrast between teaching knowledge, skills, and dispositions by context, parent teaching strategies, and child learner response. Results support the notion that family interactions in the home setting set a stage for children’s rich informal learning experiences. Vygotskian sociocultural conceptions underpin this research and findings are discussed using this central theoretical lens. (shrink)

Medical professionals providing humanitarian aid in times of crisis face complicated ethical and clinical challenges. Today, humanitarian aid is given in accordance with existing guidelines developed by international humanitarian organizations and defined by international law. This paper considers the ethical aspects and frameworks of an atypical humanitarian project, namely one that provides medical support through an Israeli civilian hospital to Syrian Civil War casualties. We explore new ethical questions in this unique situation that pose a serious challenge for the medical (...) community and conventional ethical norms, a challenge Israeli medical staff meet on a daily basis. Before discussing the ethical challenges, we give a description of the project and its unique status. (shrink)