| The science and technology of live, related renal transplantation in the Islamic Republic of Pakistan are identical to those in the West, but the application of this universal science occurs in a particularized world, one with an epistemology of moral behavior that is different from that of many industrialized countries. In Pakistan's collective, hierarchical culture the sense of what constitutes right and wrong in life is drawn through religious beliefs and values, and longstanding traditions. These include a focus on the obligations of family to kin and physicians to patients, rather than an emphasis on a secular concern with autonomy and legal rights of individuals. For many, the extended family remains central in life, and family ties make interpersonal processes the source of vital decisions. The family is the microcosm of societal moral order and a family paradigm pervades many interactions in Pakistani society. Within healthcare systems physicians are revered and frequently "adopted" as family "elders" who know what lies in the best interest of the patient.; This study is based on my ethnographic fieldwork conducted over a three month period in Karachi in the country's busiest transplantation hospital. The staff of this institution accepts only genetically related members of the extended family as kidney donors. The participants of this research are patients in renal failure, the donors, their families, and the healthcare professionals involved in their care. The aim of my research is to go beyond "brute data," and to present a "thick" account of the cultural including the religious, and other contextual factors that influence decision making processes as to who should donate a kidney, who should not, and why. It is a study of inextricably enmeshed lives, and the complex kinship systems that can provide support and solace but also serve as a source of tyranny and coercion of vulnerable family members.; The study analyzes the professional moral code of the healthcare professionals of the institution that is informed by indigenous cultural and Muslim norms of physician-patient relationships, and differs in significant ways from that in many Western societies. It is a code that perceives patients as victims, is fuelled by a sense of obligations, a "ferocious benevolence" towards those needing a kidney transplant, and peripheralizes issues of autonomy and individual rights. |
