pp. 397 in Bioethics in Asia

Editors: Norio Fujiki and Darryl R. J. Macer, Ph.D.
Eubios Ethics Institute

Copyright 2000, Eubios Ethics Institute All commercial rights reserved. This publication may be reproduced for limited educational or academic use, however please enquire with the author.

F14. Panel Discussion on Medical Genetic Services and Bioethic Trends in Different Countries.

Ishwar C. Verma.

Department of Medical Genetics, Sir Ganga Ram Hospital, New Delhi, India.

The society expects individuals to act within certain norms conforming to the culture, religion and law of the land. The individual wishes to improve his health or his family life , while the doctor is motivated by monetary gain. Due to these variable expectations it is not surprising that conflicts arise in the pursuit of these objectives.

The geneticist gives advice based on the principles of beneficence, justice and autonomy to enable the patient to take suitable action to cope with genetic disease in the family. However in spite of individual and societal variations in different countries, it is possible to discern a universal code of ethics in medical genetics. As Dr Boulyjenkov will tell you the W.H.O. is engaged in this very task. This provides the justification for gathering information on ethical practices in different countries. In this session we will hear viewpoints from different countries on the ethical views in the practice of medical genetics.

Poverty is the root cause of many unethical practices. However the poor man who is struggling to make a living does not consider these to be unethical, for example donating a kidney in return for money , because this enables him to survive and improve the lot of his family, while giving life to some one else. The society and the government see these as unethical and the government in India enacted laws to control organ transplantation, and to bring in the concept of brain death to ensure the availability of organs for transplantation. Japan has been very late in accepting the concept of brain death, so that in spite of having excellent surgeons this form of treatment found poor acceptance.

One of the greatest ethical conflicts in both developing and developed countries is the inequality of medical services for the poor and the rich, and the rural and urban populations. The governments of each country try to do their best in order to remove these barriers, but financial constraints persist leading to inequality.

Illiteracy is another modifier in the practice of ethical principles. In an educated society one can give non-directive counseling, but this does not work out in illiterate societies. So some differences in the practice of medical genetics would have to be acceptable keeping in view the local socio-economic and religious conditions. Notice that abortion is not an important issue in developing countries while it continues to dominate the scene in USA. It has its own problems in some muslim countries where prenatal diagnosis of genetic disease has not taken off and remains inaccessible to vast populations because of the perceived religious taboo against abortion.

The advent of new technologies has resulted in a remarkable change in the practice of medical genetics. These lead to conflicts because the classical ethical principles had evolved when these technologies were not available. For example with the advent of amniocentesis and the discovery of the discovery of Y chromosome fluorescence the technology started to be used for sex selection in India and other developing countries. On many occasions this lead to female foeticide. The Government of India had to bring in legislation to control this undesirable practice.

This session thus promises to be interesting by presentation of different viewpoints, and bringing home to you the message of tolerance - the central tenet of all religions.


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