PLoS Medicine | www.plosmedicine.org 1679 Essay

Over the past decade, several scholars have advocated for international standards in medical ethics and human rights [1–3]. Others have countered that such standards risk ignoring important cultural differences in the way people conceptualize medical decision-making [4–8]. Within this debate hangs a question for international bioethics: as developing countries build allopathic medical systems, what should their bioethics be? In this essay, we explore possible answers to this question, ultimately arguing that Western bioethics is insuffi cient to solve the problems that arise in the practice of allopathic medicine in non-Western contexts. As an example, we discuss recent confl icts over the use of mechanical ventilators in Thailand. Thailand is a center of cutting-edge allopathic medical care in Asia. It has a universal health-care system, which provides many Thais with access to mechanical ventilation. So many Thais are placed on mechanical ventilators at the end of life that it has become one of the largest drains on Thailand’s universal health-care system [9]. Furthermore, the use of ventilators has become a source of vehement national debate, mostly as a result of several prominent political fi gures who received overly aggressive medical care at the end of life [10,11]. As in Western hospitals, the ascension of mechanical ventilation has introduced a host of diffi cult ethical dilemmas for doctors, families, and patients [12,13]. How will Thais go about solving these dilemmas? On which principles of bioethics will they rely? To answer these questions, we start with a case that illustrates a common ethical dilemma about withdrawal of mechanical ventilation in Thai intensive care units. We then explore some concepts from Western bioethics to see if they help resolve this dilemma. Finally, we explain some of the local ethics behind the case and discuss the concept of a Thai bioethics to address the use of ventilators in Thailand. A Case Scenario The following fi ctional case is based on 30 ethnographic interviews an