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Cultural Issues

Definitions and approaches

It could be argued that the bioethical principles described by Beauchamp and Childress reflect a Western approach to bioethics but according to Aksoy and Tenik (2002), “these principles are universal and applicable to any culture and society; these principles have always existed in different moral traditions in different ways.” In particular, the bioethical principles of the three main monotheistic religions (namely Judaism, Christianity and Islam) are not radically different although beliefs may differ between different local communities practising the same religion.

The main Jewish documents of reference are the Bible, the Talmud and the Responsa literature. In addition, there are established norms for laws and behaviour known as the Halacha (“the way”). In traditional Judaism, interpersonal relationships are important and people are expected to act as “responsible stewards” in preserving their bodies which belong to God. The doctor-patient relationship is not considered as a voluntary-contractual relationship but rather one based on the patient’s divine obligation to seek healing and prevent illness. A certain degree of patient-autonomy is nevertheless accepted within the relationship (Steinberg, 2008). There is an obligation is to do whatever is necessary to heal oneself and it is clear that life should not be taken before its time. The question which therefore arises is at what point the process of dying can be considered to have begun (Goldsand et al., 2001).

There are several branches of Christianity one of which is the Roman Catholic Church. Catholic bioethical reasoning is based on traditions expressed in the scriptures, the writings of the Doctors of the Church, papal encyclical documents and reflections by contemporary catholic theologians (Markwell and Brown, 2001). Catholics have a fundamental belief in the sanctity of life, the possibility of an afterlife and that each person is made up of a body and a soul. Consequently, as long as there is a living body, there is also a soul and hence a person. Whilst the four bioethical principles are compatible with catholic thinking, other concepts such as hope, love and faith may also influence end-of-life decision making. As far back as the 16th century a distinction was made between ordinary measures to preserve life and extraordinary measures. Failure to use ordinary measures was regarded as being morally equivalent to suicide which is rejected by the Catholic Church. However, determining what is ordinary and extraordinary in each situation is primarily considered as being the right of the patient and his/her family. Consideration of this issue can be influenced by financial issues and burden to others.

Islamic bioethics is based on the Shar’ia (Islamic law) which is itself based on the Qur’an and the Sunna. It stresses duties, obligations and the prevention of illness, but when this fails, Islamic bioethics provides guidance both to doctors and patients (Daar and Khitamy, 2001). Patients must not only be treated with respect and compassion but their physical, mental and spiritual wellbeing must also be taken into account. Nevertheless, when treatment becomes futile, it ceases to be mandatory (Shahid, 1995). According to Kao (2002), a greater emphasis is placed on beneficence than on autonomy especially at the time of death.

The Buddhist and Hindu belief in reincarnation may, according to Campbell (in Kennel-Shank, 2005), result in some people wanting to be conscious at the moment of death and therefore refusing analgesics. This seems to imply a greater emphasis on respect for autonomy than on beneficence or non-maleficence. On the other hand, Kishore (2003) explains that end-of-life decisions for Hindus must be understood within the Hinduistic concepts of Dharma, Karma and non-attachment, continuity, liberation, beneficence and compassion. He further states that when Hindus make decisions about end-of-life, they are considering life as a human body or human person but also as the “eternal and perpetual cosmic phenomenon passing from one body to another”.

Clearly, healthcare professionals, people with dementia and carers from ethnic minority and/or religious groups living in Europe may have priorities and approaches to end-of-life decision making which are different to those of the majority group. On the other hand, people who practice certain religions do not necessarily hold the official beliefs of that religion.



Last Updated: Friday 09 October 2009


  • Acknowledgements

    Alzheimer Europe gratefully acknowledges the support of the German Ministry of Health for the implementation of the Dementia Ethics Network.
  • Bundesministerium für Gesundheit