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.

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)

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)

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)

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 article investigates the pervasive influence of the pharmaceutical industry in Pakistan and primarily the attitudes of the medical community toward such interactions. We used an inductive approach informed by grounded theory principles to analyze interviews and focus groups with consultants, residents, medical students, and a pharmaceutical industry representative in Karachi and Lahore, and participant-observation data from two biomedical conferences. Data were then analyzed through a deontological and teleological ethical theoretical framework. Findings highlight the reasons leading to the continuation of (...) norms including weak regulations, physicians’ expectations of receiving favors, and limited exposure to bioethics education. Recommendations for practice, policy, and research are discussed. (shrink)

Health research for progress in the control and conquest of disease afflicting man is unquestionable. Concerns arise when motives other than the advancement of scientific knowledge and benefit for individuals and society are the driving force behind clinical trials. These conflicts of interests become even more pronounced when dealing with populations rendered vulnerable by virtue of poverty and ignorance. South Asia with its teeming millions represents one such region. This essay examines the reasons that make this population vulnerable to exploitation. (...) Informed consent in the process of research is an area where such conflicts are prone to arise. In order to ensure that conflicting interests of researchers and funding agencies are kept in check, the processes of informed consent and ethical review of research need to be strengthened. Suggestions are put forward to modify the consent process to match the needs of South Asia and to strengthen the ethical review process for safeguarding the rights of the study subjects. But perhaps the most important safeguard against exploitation is the virtuous researcher himself with noble intentions. (shrink)

Social media particularly Facebook has become a popular platform amongst medical professionals for both social and professional interactions. However, given the nature of such platforms, their use raises ethical concerns including violation of patient privacy and blurring of classical professional and patient-physician relationship boundaries. In order to investigate the pattern of Facebook usage among medical professionals in Pakistan, a mixed method study was conducted at five medical institutions in three different cities including Karachi, Lahore and Islamabad. 806 participants, including 87 (...) faculty members, 239 trainees and 350 medical students, responded to the quantitative survey. Results were analysed using Statistical Package for Social Sciences. For the qualitative arm, focus group discussions and in-depth interviews were conducted among [End Page 272] different groups, and analysed to draw out common themes. Results show that 44% of respondents found professional utility for Facebook. 36% of respondents had never changed their privacy settings and 44% indicated lack of confidence in current privacy settings of the medium. Respondents had posted identifiable patient content and non-identifiable patient content, with students and trainees posting such content more frequently than faculty. (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)