Cross-validation of cultural tightness and looseness measures

Cultural sensitivity in brain death determination: a necessity in end-of-life decisions in Japan

Background

In an increasingly globalized world, legal protocols related to health care that are both effective and culturally sensitive are paramount in providing excellent quality of care as well as protection for physicians tasked with decision making. Here, we analyze the current medicolegal status of brain death diagnosis with regard to end-of-life care in Japan, China, and South Korea from the perspectives of front-line health care workers.

Main body

Japan has legally wrestled with the concept of brain death for decades. An inability to declare brain death without consent from family coupled with cultural expectations of family involvement in medical care is mirrored in other Confucian-based cultures (China and South Korea) and may complicate care for patients from these countries when traveling or working overseas. Within Japan, China, and South Korea, medicolegal shortcomings in the diagnosis of brain death (and organ donation) act as a great source of stress for physicians and expose them to potential public and legal scorn. Here, we detail the medicolegal status of brain death diagnosis within Japan and compare it to China and South Korea to find common ground and elucidate the impact of legal ambiguity on health care workers.

Conclusion

The Confucian cultural foundation of multiple Asian countries raises common issues of family involvement with diagnosis and cultural considerations that must be met. Leveraging public education systems may increase awareness of brain death issues and lead to evolving laws that clarify such end-of-life issues while protecting physicians from sociocultural backlash.

The culture of social comparison

Humans have the unique ability to coordinate behavior, economic exchange, political action, and social relationships across immense distances and times. To keep this level of coordination running smoothly, we often look to others as comparison standards for how to behave, think, and feel. A detailed understanding of the relation between social comparison and broad patterns of social life is lacking, however. The current research is a step in this direction—we show that social comparison is linked to cultural practices that promote strong norms and punishment for deviance (tightness) and those that promote relational self-construal (collectivism). These findings advance our understanding of the origins of social comparison and highlight the essential role of comparison for the development of social life.

Social comparison is one of the most ubiquitous features of human social life. This fundamental human tendency to look to others for information about how to think, feel, and behave has provided us with the ability to thrive in a highly complex and interconnected modern social world. Despite its prominent role, however, a detailed understanding of the cultural foundations of social comparison is lacking. The current research aims to fill this gap by showing that two prominent cultural dimensions, tightness–looseness and individualism–collectivism, uniquely explain variation in social-comparison proclivity across individuals, situations, and cultures. We first demonstrate the yet-undocumented link between cultural tightness and comparison proclivity across individuals, and further show that perceptions of ambient tightness and interdependence are uniquely associated with stronger social-comparison tendencies. Next, we show that these associations arise across social settings and can be attributed to properties of the settings themselves, not solely to individual differences. Finally, we show that both tight and collectivistic US states show a propensity to engage in Google searches related to specific social-comparison emotions, but that the tightness–comparison link arises from a unique psychological mechanism. Altogether, these findings show that social comparison—a fundamental aspect of human cognition—is linked to cultural practices based both in prevalence and strength of social norms as well as the tendency to construe the self in relation to others.