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 Health, Culture and the Human Body

Interculturality and Ethics in Health Care

İlhan İlkılıç1

In the last few years, the subject of culture in bio-medical ethics has
become more and more important in professional discussions, publica-
tions and research projects. Many different subjects have been discussed
and researched in this area, such as the meaning of culture in the con-
text of health care, the question of universal validity of ethical principles
in a globalized world and the necessity and possibility of a unified reg-
ulation of clinical studies by international guidelines and declarations.
In Germany, those topics have been handled more intensively since the
beginning of the 21st century, leading to the publication of books con-
cerning culture, bio-ethical topics and medical-ethical issues like eu-
thanasia (Gordijn and ten Have (eds. 2000), stem cell research (Bender
2005; Körtner und Kopetzki 2008; Joerden et al. 2009), the cloning of
human embryos (Roetz ed. 2006; Schicktanz 2003), organ transplanta-
tion (Holznienkemper 2005), and the beginning of life and its ending
(Körtner et al. ed. 2006; Rey-Stocker 2006). Many works approach these
topics from different religious beliefs or national perspectives and apply
a descriptive treatment to ethical problems. What was noticeable about
these studies and discussions was their comparative character and their
capability to compare bio-ethical questions under different religious as-
pects and ideologies.
In addition to these subject areas, the topic of health care, in an inter-
1 Istanbul University Faculty of Medicine, Dep. of History of Medicine and Ethics,
Hulusi Behcet Kütüphanesi Kat. 2, 34093 Istanbul / Capa, Turkey. E-mail: ilhan.
ilkilic@istanbul.edu.tr .

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Health, Culture and the Human Body

cultural sense, has reached significant importance and urgency. Because

of the worldwide migration, for existential but also economic reasons,
encounters between physician and patient which are members of dif-
ferent cultures and different religious beliefs have become an everyday
reality, mostly in Europe (Rechel 2011). It is not rare in an intercultural
physician-patient relationship that a series of misunderstandings, con-
flicts of interest and controversial decisions arise out of the different cul-
tural characterization of health-related phenomena. Practice shows that
there exists a correlation between the complexity of such conflicts and
the perceived strangeness of cultural values (Ilkilic 2000; Ilkilic 2002).
This article discusses characteristics of intercultural physician-pa-
tient relationships and highlights the ethically relevant aspects of these
human interactions. The topic will be clarified through the use of a re-
al-life case study dealing with death; central ethical questions will be
elaborated.
1. Physician-Patient relationship in an intercultural context
The intercultural physician-patient relationship constitutes encoun-
ters involving persons taking medical actions and subjects affected by
such actions who belong to different cultural spheres. One can only
speak of an intercultural physician-patient relationship if the physician
and the patient see themselves as belonging to different cultural realms.
This implies that the interculturality in a physician-patient relationship
cannot be determined extrinsically but rather more or less depends
upon the respective context.
Whether or not the ethical conflicts in an intercultural context are
qualitatively different from those occurring in an intracultural context,
and therefore need other way of dealing with them, is a rightfully asked
question in the discussion of interculturality in health care. The differ-
ent knowledge systems and the systems of thought and also the asym-
metrical character of the physician-patient relationship, in an intercul-
tural sense, lead to a differential perception of the medical condition
and to different interpretations of the situation (Brody 1997). Subjective
systems of interpretation concerning reasons and development of an ill-
ness, and their process through time, possible treatments and chances
of success commonly lead to divergent perceptions and different eval-
uations of the illness itself. However, similar phenomena also appear

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in an intracultural physician-patient relationship (Hartmann 1984).

Nevertheless, it is not the essence of this relationship that changes but
its intensity due to cultural-moral concepts. In addition, cultural and
language barriers leading to additional misunderstandings and misin-
terpretations beyond those common in intracultural physician-patient
relationships can be found (Berger 1998). Furthermore, there are three
further phenomena which should be highlighted and which directly
shape interculturality and have ethical relevance. Those are language
barriers, cultural practice, and moral diversity, all of which will now be
outlined.
Language barriers play a significant role in the creation of intercul-
turality within a treatment situation. In a relationship where the partic-
ipants cannot communicate in their first language, leading to a reduced
accuracy of communication due to a lack of linguistic competence or
out of other reasons, a number of ethical questions may appear. In such
cases, an authentic physician-patient communication is in danger. Thus,
the necessary patient information cannot be provided at the ethically re-
quired minimum level of quality. Moreover, it is known from everyday
practice that members of the family may not translate and express an
unfavorable diagnosis and prognosis correctly to the patient in order to
reduce psychological pressure. Because of these and other reasons, lan-
guage barriers play an important role for the design of interculturality
and related ethical conflicts (Ferguson and Candib 2002).
An additional phenomenon exerting a great influence on the inter-
cultural physician-patient relationship is cultural practice. Under this
term we subsume all the traditional customs and/or religious beliefs
that the physician in charge is not familiar with. These include specific
guidelines of hygiene practice, behavior towards the opposite gender,
rituals during the care for the dying, practices of patient visits, religious
diet and more (Zuckerman 2002; Ilkilic 2012). As a result, a patient may
develop a negative attitude towards specific medicines or forms of ther-
apy and therefore rejects them, for example because of religious dietary
rules and prohibitions (Ilkilic 2000; Ilkilic 2002). While these are not the
most complex ethical conflicts that are characterized by interculturality,
they should nevertheless be handled with a culturally sensitive approach
of communication, and, if necessary, they should be overcome by addi-

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tional organizational measures (Searight and Gafford 2005).

Culturally characterized moral diversity between interaction part-
ners represents an important component in shaping and forming inter-
culturality in health care. Emphasis should be put on two dimensions
of moral diversity: Firstly, specific medical interventions are morally
valued differently in various cultures. Some examples are the rejection
of blood transfusions by Jehovah’s witnesses, a negative attitude to-
wards organ transplantations, mostly in Buddhist cultures, the Catholic
Church’s rejection of using embryos for stem cell research, the reluctant
attitude towards definitions of brain death by Jewish Orthodox groups
and others (Eisenberg a. Schenker 1997; Nevins 2005; Roetz (ed.) 2006;
Eskew a. Meyers 2009). Significant for this fact is that diagnostic and
therapeutic measures, as well as research methods, tend to be rated mor-
ally different because of cultural values, which can go as far as rejecting
the proposed intervention outright. Such a moral position, as expected,
leads to a practice where medical interventions, within a cultural group,
are often not used at all or in a significantly low number of instances, as
in the case of organ removal after brain death or the use of embryos for
stem cell research.
The second important criterion for moral diversity leads to a change
in the significance given to prima facie principles in medical practice,
which can be attributed to the difference in cultural values. Conflicting
definitions of the importance of the patient’s vs. the family’s autono-
my based on a culturally determined conception of the human being
and its practical implementation is an additional example (Blackhall
1995; Buryska 2001; Bowman 2004; McCormick 2011). This diversity
leads to complex ethical questions as soon as those principles get drawn
into ethical conflicts. The question now is if the interpretation of those
principles is different in an intercultural context as compared to an in-
tracultural setting. It can also be asked if those principles are relevant
for cultural conditionality and cultural invariance. Certainly, the list of
normative terms can be extended and additional terms, like those of the
patient’s best interests, the patient’s supposed will, lengthening of life,
and others could be taken into account.
Experts have already started a discussion about these problem areas,
which will be outlined shortly through two protagonists. US medical

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 Health, Culture and the Human Body

ethicist Ruth Macklin is of the opinion that fundamental ethical prin-

ciples, like “respect for the person” and “respect towards autonomy”,
can be applied to the analysis of cultural phenomena in health care and
can also be integrated into the decision-making process in an ethically
moderate way (Macklin 1998a; Macklin 1998b). Her approach to pa-
tient autonomy consists of an anthropocentric and individualistic idea
of humans, but also presupposes a universal and cultural invariance
(Macklin 1999).
This approach has been established within a given cultural tradition
and simultaneously requires a certain hierarchy between ethical princi-
ples. In this hierarchy, the patient’s autonomy occupies the highest posi-
tion. The universal use of this approach does not only require a cultural-
ly invariant use of patient autonomy, but also assumes the validity of the
previously mentioned hierarchy among the ethical principles. At this
point, it can be critically asked if it is realistic to expect this hierarchy in
all cultural areas.
In contrast to Macklin, Chinese medical ethicist Ruiping Fan denies
the universally binding nature of the “Western bioethical principles”
and doubts that their “abstract content”, can provide all cultures a moral
basis for evaluating actions in health care (Fan 1997). For Fan, the West-
ern principle of autonomy led to self-determination resulted, which
emphasizes the freedom of the individual, whereas the “Eastern-Asian
principle of autonomy” results in the family’s right to determination
(Fan and Tao 2004).The latter system stresses the value of a harmonious
interdependence within a family. Those Western and Asian definitions
of autonomy cannot be put at the same level, according to Fan, as they
imply different moral actions.
This particularistic approach promises a better consideration of cul-
tural phenomena in reaching an ethical verdict than a universalistic
approach. This is how a cultural practice, which can be derived from
moral values, can gain a necessary moral value in general. However,
in this concept the borderline between a culturally specific actual state
and a morally desired state of affairs can be blurred, which can lead to
an ethical criticism as in the example below: To add a normative value
to a common and valid cultural practice of a culture could be called a
culturalistic fallacy. In this sense, the moral value of a practice becomes

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intrinsic and does not need any further explanation and reflection. The
use of this approach in an ethical evaluation process would mean that
for every patient from a Chinese-Confucian tradition the autonomy of
the family has a central meaning and that the decision-making process,
which excludes the affected person, should be accepted and integrated
into medical practice. This would imply an ethical paternalism that for
good reasons is not acceptable in a value-pluralistic society. Further-
more, an unadulterated use of this approach would require an unrealis-
tic degree of moral homogeneity within a population group.
After this discussion of the normative qualities of interculturality in
the physician-patient relationship, a case study will illustrate these as-
pects in more detail.

Case
A 35-year-old man had been critically injured in a serious traffic ac-
cident. The patient had been admitted with multiple traumas, and his
diagnosis included concussion and subarachnoid hemorrhage. After
three weeks in intensive care, the condition of the patient deteriorat-
ed drastically and brain death was ascertained. The patient’s condition
indicated the possibility of organ donation. The patient had not docu-
mented a living will, nor did he possess an organ donor card. The pa-
tient had eight siblings (four brothers and four sisters); his father was
deceased. The patient’s mother lived in Germany. One of his brothers,
not the oldest one, had been appointed, as was declared, the legal guard-
ian of the patient; he spoke a very good German.
The family members were given the infaust diagnosis, upon which
two conversations were conducted with them. The first one was car-
ried out upon the request of the patient’s partner without involving the
other family members. In this conversation, inquiries were made as to
the presumed attitude of the patient towards organ donation, to which
the partner could give no concrete response. He had been an obliging
person, however, she reported. She declared that she did not want to
be involved directly in making a decision on whether he would donate
organs or not. She claimed it would be better if his siblings and mother
made this decision.
Afterwards a conversation took place with four of the patient’s broth-
ers (including his legal guardian) and two cousins. In this conversation,

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 Health, Culture and the Human Body

the issue of organ donation was raised as well and inquiries were made
to establish the presumed will of the patient regarding this issue. His rel-
atives claimed that this topic had never been raised before. The guardian
said that agreeing to organ donation would not be acceptable or rea-
sonable for the family members because according to Islamic belief, the
human organs are viewed as being merely loaned by God, and for this
reason it would not be permissible to donate them. Furthermore, he
continued, agreeing to this intervention would not be possible at all on
account of the patient’s mother, and it would be impossible to enforce a
decision to donate organs without her permission. In this conversation
issues were raised such as who was to receive the organs and what the
body would look like after the organs had been removed.
Afterwards the family members requested some time to reflect. They
wanted to discuss the issue with their mother as well; she was reportedly
in the hospital ward but, according to the guardian, she had made a
conscious decision not to take part in the conversation. Approximately
30 minutes after this discussion, the patient’s legal guardian entered the
physician’s office and declared that the family members unanimously
rejected an organ donation, whereupon the treating physician and the
physician representing the German Foundation for Organ Transplants
showed understanding for their decision.
After the talk, the family had a sufficient amount of time to bid fare-
well. At that time, there were about twelve people in the patient’s room,
including an imam. At that point, a wish was expressed to wait a little lon-
ger, because another relative was on his way to the city. This request was
granted by the treatment team. Later on, the guardian went to the doctor
in charge and told him that they were ready. In addition he requested that
he and the family members would be present when “the machines are
turned off ”. This wish was granted by the treatment team, too.
After the monitor and the respirator were turned off, the physician
extubated the patient in the presence of the brothers, briefly explained
the situation and then left the room again. After approximately one hour
the family made their final farewell and left the hospital ward. While
leaving, they expressly thanked the treatment team for the way they had
dealt with the situation on this day.

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Health, Culture and the Human Body

Case discussion
The above case describes a situation where family members of a
brain-dead patient, a Moroccan-Muslim, were asked about organ re-
moval in the sense of an extended consent solution. After an intensive
conversation with the transplantation surgeon, the legal guardian, one
of the patient’s brothers, and the family members unanimously rejected
the request of organ removal for religious reasons. In this case, it can be
said that there is an ethical conflict of ideas between the family members
and the transplantation surgeon or the community of potential benefi-
ciaries which could had received the explanted organs.
This kind of family members’ negative attitude towards organ re-
moval is also known in intracultural contexts and therefore cannot be
classified as exceptional. With the case analysis, I will try to concretize
the cultural phenomena, by making use of the discussed classifications,
which are ethically relevant and therefore should be taken into consid-
eration in the ethical evaluation of this case.
At first sight, language barriers are not in the focus of interest and
they will not play an important role in this case. However, it should be
mentioned that there had been hardly a communication between the
patient’s mother, who seems to be an important figure in die decision
process, and the doctors in charge or the transplantation surgeon. Such
a communication would have been unproblematic due to the transla-
tion skills of her children. She declined any direct confrontation with
the treatment team, maybe with out of concern that she might lose her
decision-making power in such a conversation. It would have been im-
portant to know what the real reason for her seclusion was, because she
had a key role in forming the opinion of the other family members.
In regard to cultural practice, firstly, emphasis should be put on the
exceptionally high number of persons involved in the decision process,
including up to ten family members. There had also been a faith-specific
care for dying administered by the imam called by the family. Practic-
es of specific rituals of death, for instance Quran recitation, and oth-
er cultural practices were new to the treatment team. At this point, it
should be underlined that it would not have been possible to exercise
such cultural practices, had it not been for the availability of the neces-
sary infrastructure (like single rooms in the intensive care unit) and the

704
 Health, Culture and the Human Body

openness of the treatment team. In regard of moral diversity, the value

of the patient’s presumed will and the relationship between patient and
family autonomy were the key factors for the parties involved. After the
family members had been informed about the conclusive brain death
diagnosis and its unfavorable prognosis, the family was confronted
with the topic of organ removal. Here, it was explicitly asked what the
patient’s presumed opinion towards organ removal was. Although the
family told that this topic never had been subject of any conversation,
this was not a central question in the subsequent decision process. For
the family, the presumed patient’s will did not matter for the course of
the decision process, whereas it did for the transplantation physician. A
reason for the family’s rejection to remove the organs was an argument
from Islamic belief which states:
“Organs are, due to Islamic belief, God’s loan and therefore we can-
not accept an organ removal.”
The family’s argument does exist in the Islamic discussion; however,
it is not supported by a strong majority. The definition of brain death
and the removal of organs from a brain-dead person are accepted in the
Islamic world and for the majority of Muslim jurists, even though not
uniformly. The topic brain death was discussed at the 3rd International
Conference of Islamic Jurists held in Amman, Jordan, in 1986. We read
in the resolution of this conference: “A person (is) considered legally
dead and all the shariah’s principles (Islamic Law) can be applied when
one of the following signs is established:
(i) Complete stoppage of the heart and breathing which are decided
to be irreversible by doctors.
(ii) Complete stoppage of all vital functions of the brain which are de-
cided to be irreversible by doctors and the brain has started to degenerate.
Under these circumstances it is justified to disconnect life support-
ing systems even though some organs continue to function automat-
ically (e.g. the heart) under the effect of the supporting devices.” (cit.
Hassaballah 1996, p. 965).
Because the family’s decision did not match the majority opinion
in the intra-Islamic discussion, one may ask about the reason for this
difference. These institutional statements, like the resolution from Jor-
dan about the topic of brain death, are based on a well reasoned posi-

705
Health, Culture and the Human Body

tion; however, it is not binding for all Muslims (Al-Mousawi et al. 1997;
Krawietz 2001; Bedir and Aksoy 2011). This is why it is important to
know which position and argument was the starting point for the family
to help them decide. Additionally, it is possible that there had been ad-
ditional reasons for the family deriving from local conditions and prej-
udices. For example, there are enormous provisos against organ remov-
al in Germany, mostly among Muslim relatives, which are not entirely
explainable through theological arguments. Prejudices play a big role,
such as the fear that because of an organ donation, medical measures
could be withheld. Another prejudice is that being a “Non-German”
could affect patient care in a negative way. Those unfounded worries
should be taken into account during a conversation about organ remov-
al with the family members of a brain-dead Muslim patient. Maybe the
question of the family members “who will get the organs” should be an
indicator to build on during the conversation.
An additional point in terms of moral diversity is the function and
role of the legal guardian in this case. This person, who spoke German
very well, had only a mediator role between the family members and the
physicians. The function of this person to represent the brain-dead pa-
tient’s interests did not seem to be important in the decision process. His
limited decision-making power became visible when he stressed that it
would be against the mother’s intention to agree to an organ removal.
It became clear that the mother’s position was characterized by tradi-
tional hierarchical structures and not defined by tasks and responsibility
assigned by the law. This attitude showed that in this case the patient’s
autonomy and the binding nature of the patient’s presumed will did not
have the highest priority.
In the beginning of this case analysis it was noted that in German
hospitals the rejection of organ removal by family members is not a spe-
cific intercultural situation.2 In our analysis, we have identified some
cultural phenomena which have ethical relevance. These characteristics
should be perceived, understood and rated to create a culturally sensi-
tive and ethically appropriate attitude.

2 Although we do not have concrete statistical data about this, it is obvious that
the willingness to donate is noticeably lower among people with a migration
background.

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 Health, Culture and the Human Body

Conclusion
When it comes to interculturality in medical practice, from an eth-
ical point of view the following question arises: Are there any essential
differences between an intercultural and an intracultural physician-pa-
tient relationship which should be taken into consideration in the argu-
mentation and evaluation of an ethical analysis and be integrated into
the ethical decision process?
If someone tries to solve the question only in reference to the forms
of conflicts, for example therapy limitation versus maximal therapy, we
will realize that there are no categorical differences between intracultural
and intercultural contexts. As in our case, the rejection of organ removal
from a brain-dead person by his or her family members and the resulting
conflict of interest among the people involved is also common in an in-
tracultural context. However, in an intercultural context there are several
arguments for the decision that seem to be strange, as they do not exist in
the cultural area of the treatment team. Those attitudes and arguments are
either related to specific faith principles or refer back to cultural practices
that in this form are not comprehensible or appear exceptional from the
moral conception of the treatment team. This is the reason why this con-
flict does distinguish itself from intracultural conflicts, if not categorically
then by degree. In my opinion, gradually different ethical conflicts in an
intercultural contexts are those that also occur in an intracultural con-
text (which means that physician and patient belong to the same cultural
area), but are not cultural practices and therefore achieve a new ethical di-
mension through interculturality. Therefore, what matters is not the type
of conflict but the culture-specific argumentation or attitude which leads
to the conflict of decision-making and interests.
For the creation of an ethically appropriate way of handling these
ethical conflicts in an intercultural context it is necessary and indis-
pensable to understand the perception, understanding and evaluation
of these cultural phenomena.

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Health, Culture and the Human Body

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 Health, Culture and
Health, Culture and
the Human Body Health, Culture and the Human Body
the Human Body
Epidemiology, Ethics and History of Medicine,
Epidemiology, Ethics and History of Medicine,
Epidemiology, Ethics and History of Medicine,
Perspectives from Turkey and Central Europe Perspectives from Turkey and Central Europe Perspectives from Turkey and Central Europe

Migration and Health, Infectious Diseases, Beginning İlhan İlkılıç, Hakan Ertin, Rainer Brömer, Hajo Zeeb (Eds.)

İlkılıç, Ertin, Brömer, Zeeb (Eds.)

of Life/Reproductive Medicine, End of Life, Human
Body, and Interculturality and Ethics – these six main
themes have been studied from historical, ethical,
and epidemiological perspectives, keeping the sister
disciplines in a transdisciplinary view.

The contributions reflect the themes of two meetings

in Mainz/Germany and Istanbul/Turkey. The book is
attempting at a synthesis of the different perspectives
and methodological approaches with a focus on Central
Europe and Turkey. The authors and editors have revisited
the field and bring together a more comprehensive
approach to Health, Culture and the Human Body.

1
BETİM CENTER PRESS BETİM CENTER PRESS
9 786058 695719
Health, Culture and
the Human Body
Epidemiology, Ethics and History of Medicine,
Perspectives from Turkey and Central Europe

Editors
İlhan İlkılıç
Hakan Ertin
Rainer Brömer
Hajo Zeeb

Betim Center Press

 Health, Culture and
the Human Body
Istanbul 2014

Editors
İlhan İlkılıç, Hakan Ertin, Rainer Brömer, Hajo Zeeb

Publisher
Hayat Foundation for Health and Social Services

Contact
Kızılelma Cad. Topçu Eminbey Çıkmazı Sk. No. 30
Fındıkzade, Fatih / İstanbul
0212 588 2545 Fax. 0212 632 8579
www.betimcenter.org

Production
Selika

Design Application
Ahmet Yumbul

Printing and Binding

Pınarbaş Matbaacılık Ltd. Şti.

ISBN
978-605-86957-1-9

© 2014

Bütün hakları saklıdır.

Yazılı izin olmadan, tanıtım amaçlı
kısa alıntılar dışında hiçbir yolla çoğaltılamaz.
TABLE OF CONTENTS
Preface 08
MIGRATION AND HEALTH
History

Medical selection in the recruitment of migrant workers (“Gastarbeiter”)

Sascha Topp 19

The Historical Development of Health-Conditions Among Female

Immigrants from Turkey in the Federal Republic of Germany
Asli Topal-Cevahir 39

The Political Making of Care Worker Migration: The Austrian Example

Lukas Kaelin 63

Epidemiology

The Role of Illness Perceptions in The Health Care Provision of Turkish

Migrants
Patrick Brzoska, Yüce Yılmaz-Aslan, Oliver Razum 79

Storytelling for and Along with Turkish Caregivers in Germany: the saba
Study
Susanne Glodny, Yüce Yılmaz-Aslan, Oliver Razum 99

Contested Medical Identities, Migration of Health Care Providers and

Middle Eastern Students at Western Universities
Frank Kressing 113

Health Policies and Cultural Sensitivity in the Care for Elder Turkish
Migrants in Austria and Germany and the Role of Turkish Migrants
Nevin Altıntop 127

Medically Unexplained Physical Symptoms Among Turkish Migrant

Merlijn van Schayk, Karen Hosper 137
Ethics

Medical Care for Migrants Without Health Insurance in Germany and

the Role of Civil Society
Fiene Wolf, Christa Blum, Jakov Gather, Hannah Windeln,
Eva-Maria Schwienhorst 167

INFECTIOUS DISEASES
History

European Physicians/Specialists During the 1893–95 Cholera Epidemic

in Istanbul
Nuran Yıldırım, Hakan Ertin 189

“Ethnology and Dermatology”. Lorenz Rigler and Alfred Marchionini in

Turkey (1842-56 and 1938-48 respectively)
Werner Friedrich Kümmel 217

Syphilis Control in the Age of Abdülhamid II

Nil Sarı 231

“Afflicted by God.” Ernst v. Düring and Endemic Syphilis in Anatolia

Around the Year 1900
Werner Friedrich Kümmel 257

Düring Pasha’s Services for the Ottoman Empire

Nuran Yıldırım 269

The Impact of Syphilis on the Military Capacity of the Ottoman Army

During the First World War
Murat Yolun 291

A Sanitary Journal for Common People: Yaşamak Yolu

Ceren Gülser İlikan Rasimoğlu 299

Epidemiology

Awareness of Sexually Transmitted Diseases Among Adolescents with

and Without Migrant Backgrounds in Bremen, Germany
Florence Samkange-Zeeb, Saskia Pöttgen, Beate Schütte, Hajo Zeeb 313

Current viral hepatitis B status and policy in Turkey and the relevance to
major immigration countries
Mehlika Toy 327
Doctors’ and Parents’ Perspectives on Communication Regarding HPV
Vaccination in Bulgaria
Elitsa Dimitrova, Yulia Panayotova, Irina Todorova,
Anna Alexandrova-Karamanova 341

Ethics

Integration of People With HIV/AIDS to Social Life: AIDS in Turkey and

Socio-ethical Reflections
M. Kemal Temel, Hakan Ertin 365

BEGINNING OF LIFE/REPRODUCTIVE MEDICINE

History

The Stone Tekija as a Cultic Place for the Cure of Infertility and the
Prevention of Various Diseases: Exploring Macedonian Folk Medicine
Dragica Popovska 379

Epidemiology

Advances in Perinatal and Neonatal Care for High-Risk Newborns:

Ethical Implications - a German Perspective
Herwig Stopfkuchen 393

Ethics

The Dignity of the beginnings of Human Life

Hans-Martin Sass 403

End-of-life decisions at the beginning of life

İlhan İlkılıç 433

Contemporary Cultural and Clinical Conflicts at the End-of-Life in

Neonatology Ethics
Ayesha Ahmad 447

The prohibition of egg donation as an issue of medical ethics

Clemens Heyder 463

Abortion According to the Turkish Law

Hakan Hakeri 483
END OF LIFE
History

Concepts About Death Throughout Turkish History. A Historical

Perspective of Religious Ethics in Connection with a Dying Patient
Nil Sarı 497

Epidemiology

Psychological, Religious, Legal and Folkloric Dimensions of Death

Tuğba Gencer, İbrahim Başağaoğlu 525

Ethics

End-of-Life-Decisions in Germany: Crucial Aspects of the Medico-

Ethical Debate and Clinical Practice
Monika Bobbert 547

Ethical Evaluation of the Pharmacy Services for Geriatric Patients

Sözen Şahne, Sevgi Şar 567

Be Healthy to Live – Live to be Healthy? Bioethics, Biopolics in Aging

Society
Petra Kutscheid 577

Advisory Ethics Committees for Artificial Nutrition and Hydration in

Patients
Hanzade Doğan 589

Ethics of (Palliative) Care and the Question of Euthanasia

Dejan Donev, Željko Kaluđerović 603

Demise and Death from the Perspective of Philosophy of Law; Especially

Violations of Dignity
Altan Heper 617

Legal Situation of Organ and Tissue Transplantation in Turkey

Yener Ünver 631
 HUMAN BODY
History

Representations of the Female Body in Feminist Zines

Melanie Boeckmann 659

Epidemiology

Exploring the Role of Narrative Therapy in Obesity: Overcoming Body

Image Disturbances
Somayeh Sadat McKian 667

INTERCULTURALITY AND ETHICS

Epidemiology

The Need for Cultural Competence in Health Care: The Case of Roma
Population in Poland
Agata Strządała 683

Ethics

Interculturality and Ethics in Health Care

İlhan İlkılıç 697

Cross-Cultural Ethical Conflicts in Health Care. Developing Cultural

Competence in Health Care Personnel and Ethics Consultants
Tatjana Grützmann 711

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