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Kyoto street, Gion neighborhood

Shades of grey between life and death: Neuro-ethics across the Pacific

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Program Quick Facts

  • Location: Kyoto and Osaka, Japan
  • Stanford Faculty Leaders: Dr. Karen Hirsch and Dr. Holly Tabor
  • BOSP Program Manager: Morgan Diamond [Email] [Schedule Appointment]
  • Program DatesJuly 29 - August 12, 2022
  • Academic Prerequisite: 

    All prospective students are required to take the three unit prerequisite course, “MED 142/HUM171: Modern Ethical Challenges in Neuroscience and Organ Transplantation” during the Spring Quarter 2021-2022 (Note - WAYS Ethical Reasoning credit given). Students that will be off-campus in Spring Quarter may still enroll in the prerequisite course and should make arrangements with the faculty to complete the course remotely.

  • Activity Level: Light. Activities may include city walking tours, easy/short hikes, museum and other site visits
  • Centers for Disease Control and Prevention: Health Information for Travelers to Mexico
  • US State Department Country Information: Japan International Travel Information
  • Visa Information: Consulate General of Japan

General Description

This program is designed to take advantage of the opportunity to expose students to the far-reaching implications of societal cultural differences. How can a person be dead in America but alive in Japan? Why does Japan have some of the lowest rates of life-saving organ transplantation in the world despite being a highly developed society with an expert health system comparable to the United States? This course will explore cultural, medical, legal and ethical perspectives of life and death and the impact of those on organ transplantation and the broader healthcare system in the United States and Japan. Our goal is for students to develop an appreciation for how history and societal constructs have a direct impact on ethics, laws, and healthcare systems.

Death is broadly considered an absolute biological event, yet the space between life and death is often blurry and influenced by cultural, medical, and legal forces. Fifty years ago, with the advent of critical care medicine, the concept of brain death was first proposed: that a brain which sustains such severe injury that it is irreversibly and permanently damaged and the organism as a whole can never regain function is sufficient criteria for death. While the construct of brain death is generally accepted in America by medical personnel, ethicists, lawyers, and society as a whole, recent high profile cases and media coverage have brought novel challenges to these constructs, including, but not limited to, what it truly means to be brain dead, how brain death is/should be determined, and the societal implications of those definitions. With those debates come questions about consciousness, severe neurologic impairment, organ donation, and allocation of scarce resources. This uncertainty is compounded by the nature of living in a global society where different cultures may have highly divergent values and perspectives on these issues.

This BOSP program will provide an in-depth exploration of neuro-ethical issues surrounding life and death in Japan and America. Participants will learn about the medical, ethical, cultural and legal dimensions of brain death and organ donation in two cultural contexts. The immersive international experience will include on-site experiences and intimate learning opportunities with interdisciplinary and international experts both in the US and Japan, as well as patients and families affected by these medical-ethical dilemmas. It will also include visits to Japanese cultural sites as well experiential learning about Japanese culture and food. 

Location

This program will take place in Kyoto and Osaka and nearby cultural sites. Drs. Tabor and Hirsch both have connections with Japanese colleagues who will provide excellent experiential opportunities for visiting students. 

Kyoto is the capital city of Kyoto Prefecture, in the Kansai region on the island of Kanshu. It was the seat of Japan’s imperial court from 794 to 1869. Kyoto is considered the cultural capital of Japan, and has numerous Buddhist temples, Shinto shrines, and palaces and gardens, many of which are listed collectively by UNESCO as a World Heritage Site. It is also the location of Kyoto University. During World War II, the city was largely spared from conventional bombing, and as a result it is one of the few Japanese cities that still have pre-war buildings.

Osaka is also in the Kansai region of Japan, and is the capital of Osaka Prefecture. It is considered one of Japan’s major financial hubs, and is the second largest metropolitan area, after Tokyo. Osaka is known for its food. It’s nickname is “the nation’s kitchen” and it has been called by some “the food capital of the world”. It is also home to the Hanshin Tigers baseball team, one of the oldest professional baseball clubs in Japan. 

In both Kyoto and Osaka, we will visit academic centers, medical schools and hospitals and interact with Japanese bioethicists and physicians. We will also engage in numerous cultural trips and activities, including temples and shrines, including an overnight visit to Koumyouin Temple.

Living and Travel Conditions

Please note, both Kyoto and Osaka can be very hot and humid during the summer, when the program will take place. Many of the places we will work and visit will be air conditioned, but not all, and students should be prepared to face non-California summer conditions. Temperatures average in the high 80s to low 90s, but can get hotter, with high humidity and frequent rains. 

Students will stay in hotels in Kyoto and Osaka, and spend one night in the Koumyouin Temple in a ryokan, where they will sleep on tatami/futon mattresses on the floor. Students should expect to share rooms and bathrooms.  

If any of these conditions are likely to present a challenge, you are encouraged to contact BOSP well in advance: accommodations will be made to the extent possible.

Faculty

Dr. Karen Hirsch

Dr. Karen Hirsch has a medical degree from Stanford University and completed neurology residency at Johns Hopkins and neurocritical care fellowship at the University of California, San Francisco. She returned to Stanford University as faculty in 2012. Dr. Hirsch’s clinical practice focuses on the care of patients with severe neurologic injury in the intensive care unit, including traumatic brain injury, stroke, aneurysms, and cardiac arrest. She runs an independent research program studying brain injury after cardiac arrest and prognosis for coma recovery and has grant funding from the National Institutes of Health. Dr. Hirsch is also the physician faculty liaison to the organ procurement organization Donor Network West, working with colleagues in Ethics (including Dr. Tabor) and legal to ensure seamless and compliant collaboration for organ transplantation at Stanford. In addition to her work at the medical school, Dr. Hirsch greatly enjoys working with Stanford’s bright undergraduate students - she is a Resident Fellow in Soto and has co-taught MED142/HUM171 with Dr. Tabor for the last two years. 

Dr. Holly Tabor

Dr. Holly Tabor has a PhD in epidemiology and a minor PhD in genetics from Stanford University, and an A.B. in History and Science from Harvard. She was a postdoctoral fellow in bioethics at the Stanford Center for Biomedical Ethics, and was Assistant and then Associate Professor of Pediatrics at the University of Washington and the Treuman Katz Center for Pediatric Bioethics at Seattle Children’s from 2008-2016. Since 2016, she has been an Associate Professor of Medicine and the Associate Director for Clinical Ethics and Education at the Stanford Center for Biomedical Ethics at Stanford University. Her research focuses on ethical issues in genetic and genomic medicine and research, as well as health disparities and inclusive health for patients with disabilities. She is Co-Chair of the Stanford Hospital Ethics Committee and oversees the clinical ethics consult service at Stanford Hospital and coordinates all educational activities for undergraduates, medical students, graduate students, residents and fellows through the bioethics center. She has also been a faculty advisor to Stanford undergraduates and co-taught MED142/HUM171 for the last two years.

Prerequisites and Expectations

This program is intended for students with a diverse range of backgrounds and interests, including but not limited to neuroscience, pre-law, philosophy, medicine, bioethics and East Asian studies/languages/cultures. Students do not need to have advanced knowledge, but should be able to describe their coursework or experiences that led them to apply for this program. Students should be able to work productively, efficiently and collaboratively in a small group setting. 

This course will discuss topics and emotions around brain injury, disability, dying and death. These discussions may be upsetting for some people, especially those with personal experiences in this area. The course directors will be available to support reflection and discussion, but applicants should consider carefully if they will be able to manage these kinds of discussions and assignments. If there are questions about this, they are encouraged to reach out to Drs. Hirsch or Tabor.

All prospective students are required to take the three unit prerequisite course, “MED 142/HUM171: Modern Ethical challenges in Neuroscience and Organ Transplantation” during the Spring Quarter 2021-2022.

Grading Basis

Letter grade