Empirical studies in bioethics, as well asclinical experience, demonstrate the existenceof inter- and intra-cultural diversity invalues and perspectives on end-of-life issues. This paper argues that while survey researchcan describe such diversity, explaining itrequires ethnographic methodology that allowsordinary people to frame the discussion intheir own terms. This study of attitudestoward euthanasia in Japan found that peopleface conflicts between deeply held values suchas life versus pain, self versus other, andburden versus self-reliance that make itdifficult to rely on a ``rational person''''approach to decision-making. (...) An inductiveethnographic approach grounded in people''s lifeexperiences can indicate the reasons forvariation in responses to surveys, and canclarify the nature of ethical conflict in aparticular cultural setting. (shrink)

Ethical questions about end-of-life treatment present themselves at two levels. In clinical situations, patients, families, and healthcare workers sift through ambivalent feelings and conflicting values as they try to resolve questions in particular circumstances. In a very different way, at the societal level, policy makers, lawyers, and bioethicists attempt to determine the best policies and laws to regulate practices about which there are a variety of deeply held beliefs. In the United States we have tried a number of ways to (...) resolve the societal-level issues. We have ignored them, argued to try to convince others of our beliefs, voted to let the majority determine what is right or wrong, and turned to the courts to decide, as in the cases of Karen Ann Quinlan, Nancy Cruzan, and Jack Kervorkian. Yet none of these approaches has yet left us with comfortable, unambiguous cultural norms about issues such as euthanasia and physician-assisted suicide, which are readily assumed by as they face individual and interpersonal dilemmas. (shrink)