Anthropological Perspectives

Medical anthropologists focus on people's life worlds (the subjective experience or phenomenology of sickness and healing), their cultural systems of meaning (e.g., ideas about what causes disease and how it is diagnosed), and the material conditions in which experiences and beliefs are situated (e.g., local disease ecology). Medical anthropologists attempt to understand and describe the medical beliefs and practices of people whose cultures and life worlds are often very different from their own. They routinely are confronted with the problem of translating unfamiliar meanings and experiences into familiar (Western) terms and concepts without taking them out of context or subordinating them to Western assumptions about sickness, health, efficacy, autonomy, and the like (Lock and Gordon; Kleinman, 1988; Gaines).

The anthropological perspective makes it possible to examine and clarify bioethical issues from multiple cultural points of view. The current debate over the bioethics of organ harvesting—the surgical removal of transplantable body parts such as the heart, liver, and kidneys—illustrates why it is important to have a clear understanding of cultural points of view. For transplantation to succeed, organs must be removed either (1) from a living donor in cases in which the organ is not vital to the donor's survival (e.g., a single kidney) or (2) immediately after a donor's death, before the organs have begun to decompose.

In most Western societies the line between life and death in the context of organ harvesting is identified with brain death, the irreversible loss of higher brain functions. The decision to identify death with brain death is consistent with Western cultural notions: Selfhood is identified with the mind, and the mind is by convention situated in the brain. This arrangement has the practical advantage of leaving a working heart in a harvestable body, facilitating the collection of transplantable organs. Japanese culture, in contrast, recognizes a different relationship between selfhood and the body: The self is not identified with a single body region. From this perspective a brain-dead body with a functioning heart has not crossed the line from life to death and is not yet a harvestable resource (Lock, 2002). Clearly, cultural definitions of selfhood and personhood have a profound impact on people's responses to bioethical issues.

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