pp. 170-173 in Bioethics for the People by the People, Darryl R. J. Macer, Ph.D., Eubios Ethics Institute 1994.

Copyright 1994, Darryl R. J. Macer. All commercial rights reserved. This publication may be reproduced for limited educational or academic use, however please enquire with Eubios Ethics Institute.

Bioethical reasoning of medical students in the Philippines


Darryl Macer
Institute of Biological Sciences, University of Tsukuba, Ibaraki 305, JAPAN
Angeles Tan Alora
Southeast Asian Center for Bioethics, University of Santo Tomas, Espana, Manila, Philippines

1. Country Background

The Philippine archipelago is composed of 7107 islands (800 inhabited) lying between the South China Sea and the Pacific Ocean. It comprises a land area of about 300,000 square km spanning 1854 km from north-south with a coast line of 34,536 km. It is divided geographically and culturally into 14 regions (12 Christian and 2 autonomous non-Christian). There are 73 provinces, and 60 cities. Manila is the capital of the Philippines. Metropolitan Manila is the seat of administration, culture, art, education, commerce and industry.

Filipinos are basically of Malayan descent with some Chinese, Spanish, American and Arab ancestries. In 1990, the population was about 61 million with 49% living in urban areas. The median age was 19 years, 39.5% were 15 years of age or less and the dependency ration (0-14 years and 65+ years/15-64 year olds) was 75.3%. Pilipino is the country's official language, but 111 dialects are spoken. English is taught in schools and widely used in business. 70% of Filipinos speak English. 93% of Filipinos above 10 years of age can read and write.

The Philippines is the sole representative in this current survey of what could be called a "Catholic country". 83% of the population is Catholic, 5% Muslim (mainly Mindanao), 5% belong to two Philippine independent churches, and the rest mainly belong to the smaller Christian denominations and Buddhism. In fact there have been few surveys of bioethics or biotechnology in Catholic countries, though there have been biotechnology surveys in the Eurobarometer surveys of some European countries in which there is still a strong influence from the Roman Catholic church. In certain questions there was a distinctive response from the other countries, for example rejection of abortion, reflecting this. The University of Santo Tomas - Faculty of Medicine and Surgery has a strong and active Department of Bioethics which may have influence student responses. The students also were in close proximity to the independent Southeast Asian Center for Bioethics which is also located in the campus, so in this sense they have similarity to the Australasian and New Zealand samples which were also in a university possessing a bioethics centre.

Economically, the GNP/capita (1992) was US$835. The unemployment rate in 1991 was about 10%. 3.7% of the 1992 budget was allocated to health, and the 1991 average family expenditure was 1.8% of the income. The 1989 crude birth rate was 26/1000 and the crude death rate 5.4/1000. The population growth rate in 1990 was 2.35%. The infant mortality rate was 61/1000 live births. In 1991 there were 1663 hospitals with a bed capacity of 81,647 (54% government). The Department of Health had 7723 doctors, 1523 dentists, 10117 registered nurses and 12408 midwives.


2. Sample characteristics

The survey was conducted on first year medical students of the Faculty of Medicine and Surgery, University of Saint Tomas (UST) in Manila. These were all young in age, with only 1 out of 164 being married. The response rate was high, 70%. The sex ratio was balanced, and 86% were from urban areas.

99% said that they were Christian, and 89% said that religion was very important to them. This reflects the university population, and also the strong influence of the Roman Catholic church in the Philippines. 2% of the sample were Caucasian in origin, the other 98% were Asian.


3. Knowledge of science and attitudes to it

The students valued the contribution of science and technology to life (Q1ab). They were very interested in science (Q3), and had a positive view towards the impact (Q4). They were aware of the specific areas of technology (Q5-7), and were positive about computers, extremely negative towards nuclear power, and rather negative towards pesticides, genetic engineering. The sample was reasonably positive towards patenting of all items (Q30).

They were the most negative sample towards in vitro fertilisation (Q6, 7). Many expressed ideas that it was playing God, and few suggested it was curing disease. They especially rejected the use of surrogate mothers (Q1h), with 83% being opposed, almost three times higher rejection than the other samples.

The Philippine students were the most trusting of medical doctors (Q29), with 70% having a lot of trust, 15% higher than the next highest figure from New Zealand medical students, and in marked contrast to the 10% of Japanese medical students who said so. In general they were rather trusting as a sample.


4. Environmental concerns

There was overwhelming agreement (97%) with the statement that the natural environment has a valuable property that humans should not tamper with (Q1c), being the highest of all samples. There was less positive, though still strong support with the animal rights statement (Q1i). This suggestions some differentiation, and also may reflect a Catholic viewpoint. The results of the environmental questions (Q2) were consistent with this positive view towards nature, with 76% saying that they had changed their lifestyle in order to protect the environment (Q2d), 70% saying that they had contributed money to an environmental cause (Q2c), the highest proportions of any sample. However, recycling appears not to be established yet (Q2f).

The students answered the open questions about nature and life using more pictures than any other sample except the Thai one, and therefore we must look at those pictures in order to understand their positive image. Many drew scenic pictures, often with a volcano - Mt Pinatubo may be famous outside of the Philippines also. However, only 1-2% said something frightening about nature. A number made comments about God in these two questions, and nearly a quarter did so in the question of the image of life.


5. Biotechnology - nonhuman

The students were rather positive about biotechnology, among the science developments (Q5-7), with 71% saying it was worthwhile. 65% accepted plant-plant gene transfer (Q9), and 42% accepted animal-animal (Q11), however, they strongly rejected animal-plant (Q10) or human-animal (Q12) gene transfer.

88% were aware that genetically modified organism were being used to produce foodstuffs (Q13), and they were the student sample with the highest degree of concern about food or medicine made from them (Q14). There was rather general concern with all items, though about 60% of the total students gave no reason for their response. The result is consistent with 82% saying that they had stopped eating a food because of concerns over its safety (Q2e), the highest response seen in any sample.

There was strong support for the specific examples of genetic engineering (Q31), for all items, including the control answer of "sports fish", which 54% accepted. In this answer the response was rather similar to the earlier United States sample (OTA, 1987). The general support for genetic engineering products seems to be high, despite the rejection of gene transfer between plants and animals in Q9.


6. Genetic diseases and AIDS

There was least support among all the samples for abortion (Q1f, 8% for, 92% against), selective abortion of fetuses with congenital abnormalities (Q1g, 7% for, 83% against), and for prenatal genetic screening in the Philippines (Q16 - general, 61% yes, 26% no; Q17 - personal, 53% yes, 32% no). This view is consistent with Roman Catholic teaching of the right to life of the fetus, though the spontaneous comment that the "fetus has a right to life" (Q16, 17) was actually less common than among New Zealand medical students. However, 45-47% of Philippine students did not state the reason for their decision about prenatal genetic screening, suggesting that a large number of these may consider the answer obvious. Another 8% said it was "Playing God" in response to the personal question. On the other hand, one half of the students said that they would use prenatal genetic screening (Q17), and a similar proportion to other samples wrote comments suggesting economic benefits of such screening (Q16), and also supporting the funding of such screening under government funding.

In the questions regarding privacy of genetic disease or HIV (Q21, 23), which asked who deserves to know that information, the Philippine students gave the highest "yes" response in almost all cases of any sample. Over 90% believed that members of the immediate family should know, suggesting the family is very important to these students and in the Philippines. 38% said that they knew someone with a genetic disease (Q19), and 36% said they knew someone with a mental disease (Q24), both rather low values. The major genetic diseases cited were Down's syndrome, also a number of Turner's syndrome, possibly for experience in the medical school.

The students were quite sympathetic and understanding of people with both genetic and mental diseases (Q20, 25). A few students said they would pray for the people, reflecting the strong religious beliefs. The students were particularly sympathetic and positive towards people with HIV (Q22), as seen in the number of sympathetic comments, and the few who had negative comments.


7. Gene therapy

There was strong support for gene therapy, with 78% willing to undergo it themselves, and 81% willing for their children to undergo gene therapy to cure a usually fatal disease (Q26, 27). A reasonably high number expressed worries about the risks of the treatment for themselves (12%) or children (10%), while there were very few concerns that it was playing God or unnatural. Otherwise the comments were generally similar to other samples.

Support for gene therapy for specific cases was strong, and there was moderately high support for enhancement uses (Q28efg) as well as strong support for therapeutic uses. 48% agreed with using gene therapy to make people more ethical, if we could ever perform such gene therapy. 49% supported improving the intelligence of children in germline gene therapy. This result is also consistent with the question on genetic engineering of sports fish (Q31), for which there was also strong agreement for, as discussed above.


8. Conclusion

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These students clearly showed some influence from Catholic teaching and the strong family unity. They also show a good degree of concern towards the sick, and a positive view towards therapy and technology. Their view of technology appeared to be so positive that they accepted some enhancement, beyond therapy.

They showed particular concern about abortion, consistent with Catholic teaching, and in vitro fertilisation, and also some concern about foodstuffs made from genetically modified organisms. They had a positive view towards the environment, and many had contributed some time and change in lifestyle.


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