pp. 98-99 in
Bioethics in Asia
Editors: Norio Fujiki and Darryl R. J. Macer, Ph.D.
Eubios Ethics Institute
Copyright 2000, Eubios Ethics Institute
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2.9. Bioethics in Thailand
Mahidol University, Thailand
I have only a limited time to talk about bioethics in one country, so I cannot tell much here, rather I refer readers to two papers I have written, one in the Journal of Medicine and Philosophy and one in the Encyclopedia of Bioethics. Here I would like to give a brief account of the birth of bioethics in Thailand, and some of the important bioethical problems we are facing today in modern medicine.
Bioethics was introduced into Thailand some 15 years ago. As you already know, the beginning of the 19th century was the period of Western colonization in Asia. During that time many Asian countries were colonized by Western powers. To protect herself, Thailand began to modernize her society along Western patterns. With insight and foresight of our king the country could keep its own independence (and was the only country in Southeast Asia that was not colonized). In the modernization process modern medicine was introduced in the late 19th century with the establishment of the first modern hospital in the country in 1886. It was from this hospital that Mahidol University developed. Both the hospital and its medical school followed the American models. And since at that time Western (modern) medicine has become predominant and gradually replaced our traditional medicine which had been practiced for hundreds of years.
There is no doubt that Thai people benefited a lot from modern medicine. But by following American medical models, Thai modern medicine has created many ethical problems that are difficult to deal with, for example, hospital-orientated medicine, research and specialized training has become predominant over primary health care and public health. The complex ethical problems concerning euthanasia, human experimentation, organ transplantation and the new reproductive technologies are also emerging as a result of using hi-tech medicine. The replacement of traditional medicine by modern medicine and the emergence of the new ethical problems contributed to the birth of bioethics in Thailand.
The other factor was the separation of modern medicine from morality and spiritual dimensions. Thai traditional medicine has Buddhist values as its main component. Many Thai doctors who are practicing modern medicine were trained in America and/or Europe and they brought with them to Thailand not only knowledge of modern medicine but also some of its accompanying values such as the free market ideology which values wealth over persons and human needs. If this tendency continues, modern medicine will create an inequitable society where only the rich get quality health care. Doctors would be like businessmen pursuing their own self-interest, and medicine would become a profit-making enterprise as in many countries in the West.
These two factors contributed to the Thai concern with bioethics. As mentioned before, in Thailand modern medicine is separated from traditional medicine and Buddhism. Modern medicine is analytic, i.e. it separates the physical from the mental, and the pathological part from the other parts of the human system, Modern medicine also lacks religious values and spiritual aspects. The main task of bioethics in Thailand is to coordinate a creative relationship between modern medicine, traditional medicine and Buddhism, so that medicine in Thailand could be holistic, scientific and humane and is able to serve the health needs of all people no matter they are rich or poor. This is an idealistic aspect of bioethics that we are striving for.
The other task of bioethics is to make doctors, nurses and the public aware of the involvement of modern medicine with bioethical problems. The public is emphasized because health care reform or improvement of the quality of health care services cannot be done without public participation. Bioethics not only brings bioethical issues to the attention of the medical profession and the public, it also encourages them to solve these problems within the framework of Thai culture built upon Buddhism. This means to apply Buddhist insight and ethical principles to the solutions and the problems. This emphasis is made because we have our cultural resources that could be used to deal with these bioethical problems. Thailand and other countries in the West which are using hi-tech medicine are facing similar bioethical problems. What is lacking in Thailand is a systematic reflection on these problems within Thai/Buddhist cultural framework.
Let me now turn to the areas of bioethical problems we are now facing in modern medicine. As indicated before, the use of hi-tech medicine has created many problems in areas of death and dying, organ transplantation, human experimentation and new reproductive technologies. These problems are challenges to Buddhist ethics and traditional Thai morality. Thai Buddhists are struggling to find Buddhist solutions. Although these problems are important the most urgent problem for Thai bioethicists is the problem concerning the allocation of limited health care resources. Seventy percent of the Thai population lives in rural areas where basic health care services are inadequate. These people are poor and in need of health care services more than affluent people in cities like Bangkok. But modern hospitals, doctors and nurses are concentrated in the urban sectors where more health care budget is allocated. This poses a problem as to how to establish an equitable health care system with fair distribution of limited health care resources to people of all sectors in society in proportion to their needs.
It may be concluded that bioethics in Thailand is a response to the need to foster greater conscientiousness and integrity in the practice of medicine. The bioethical problems Thai bioethicists are facing as a result of the use of hi-tech medicine are similar to those in other countries, but their solutions are different. The most urgent ethical problem for Thailand is concerned with distributive justice or the fair distribution of medical resources.
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