Asian Bioethics Review

An unexpected encounter with the wife of a stroke patient reminded one of the authors of his self-image as an unwelcome neuro-ethical angel of death, often advising relatives against prolonging life because of the risk of unacceptable badness (RUB) associated with life-prolonging treatment or the lack of any substantial benefit to the patient from such treatment. The events referred to suggested two concepts underpinning many ethical discussions about the end of life: (i) the strength of the human spirit and (ii) the need for responsive, rather than reflective, equilibrium. The first seems folksy and quaint, but refers to the Aristotelian conception of spirit or what animates, enlivens, inspires and creates joy in a human being and, in that sense, resonates with the German Geist (as used, for instance, by Kant in his Anthropology). It also resonates with the notion of shen (spirit) in Chinese culture and traditional Chinese medicine, as first systematically articulated in the Yellow Emperor’s Classic of Medicine. The second concept seeks to reinstate into actual clinical life an interactive ethical justification based on the clinician-patient-family relationship too often forgotten when we use intellectual principles to guide our decisions.