pp. 161-164 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 in Thailand

Peerasak Srinives, Prasert Chatwachirawong,
Faculty of Agriculture, Kasetsart University, Kamphaeng Saen, Nakorn Pathom 73140, THAILAND
Miho Tsuzuki & Darryl Macer
Institute of Biological Sciences, University of Tsukuba, Ibaraki 305, JAPAN

1. Country Background

Thailand has a population of 59 million people with an average per capita income of US$1500 per annum. The average income of those living in urban areas (industry and service sectors) is 3 times more than those living in the rural areas (agriculture sector). About 60% live in rural areas. Most Thai people are aware and experience the 'globalisation' of communication and trading, this new sciences and technologies are known to many of them. Although Thailand is a democratic monarchy, the military sometimes play significant political roles.

Thailand is a strongly Buddhist country, with rising living standards and a rapidly developing economy. It is therefore of particular interest in questions of whether there is clear religious differences in reasoning. We also have the benefit of there being some published studies from surveys by Ratanakul (1992, 1994) on medical genetics questions. These surveys allow a better picture of the reasoning of Thai people.

2. Sample characteristics

The survey was first attempted in English among scientists and students, however a very low response rate was obtained (67/500), especially because of difficulties with English language. Because the responses seemed to be interesting however, we decided to translate the questionnaire into Thai and conduct a public survey. This was also in light of the fact that the previous reported surveys (Ratanakul 1992, 1994) were among specialised groups.

The response rate was much better, and 1,114 questionnaires were returned from 2700 copies distributed (41%), but only 866 of them (32%) were complete and used. The response was nation-wide, but there was still strong bias towards more highly educated people in the sample as can be seen in the data tables from the number with postgraduate education. Responses from 53 of the 59 provinces and regions of Thailand were obtained, with a wide distribution (among the public, 26% did not state address, 15% were from the Northern region, 17% from the Central Plain region, 15% from Bangkok, 7% from Nakhon Pathom, 5% from the Southern region, and 15% from the North-Eastern region. In the analysis of these surveys we have grouped both sets of surveys together into samples based on students and others. The comments in Thai were translated into English, and categorised in Thailand (P.S., P.C.), then sent to Japan for checking (D.M.) and data input (M.T.).

The students from ten universities and colleges in major provinces were sampled. The questionnaires were sent through the staff of the colleges, so the response rate was higher than the general samples (over 50%). For the public, the response rate was high among government officials (about 45%) but low among private employees (about 25%). The response rate appeared to be correlated with education, with those having less than a Bachelor's degree responding less than those with a degree - this was especially seen in the number of incomplete surveys, which were not included in this analysis. The response was higher in questionnaires distributed among members of societies rather than among common household mailing, as may be expected. The age, sex, marital status, and children were mixed, and half were from rural areas, reflecting the rural nature of Thailand. Many Thai women hold permanent jobs, yet they may also be expected to perform many household duties.

99% said that they were Buddhist, and most said that religion was very (46%) or somewhat (44%) important to them. The students were more religious. This is consistent with the strong religious beliefs in Thailand. 92% said they were Asian, with 8% giving other origins (e.g. Thai, a response much more common among university students).

3. Knowledge of science and attitudes to it

They valued the contribution of science and technology to the quality of life (Q1a), however 41% disagreed that most problems can be solved by applying more and better technology (Q1b). They were interested in science (Q3), and had a positive view towards the impact (Q4), which is not surprising given that many were postgraduates. They were well aware of the specific areas of technology (Q5-7), with gene therapy and genetic engineering being least familiar. They were positive about computers, and biotechnology. They were most worried about nuclear power and pesticides. The sample was very positive towards patenting of all items (Q30).

They were positive towards vitro fertilisation (Q6, 7). Most said it was curing disease. They agreed with the use of surrogate mothers (Q1h).

They were most trusting of University professors, but did not trust medical doctors or companies (Q29). They were next to Japan is being least trusting of medical doctors, however, they were one of the most trusting samples towards the government suggesting a positive view of the government. Many of the sample were government employees, which may have had some effect. The question in Thai excluded "environmental groups".

4. Environmental concerns

There was more disagreement (33%) with the statement that the natural environment has a valuable property that humans should not tamper with (Q1c), than in other samples. This may be due to the educated nature of the sample. There was however still strong support with the animal rights statement (Q1i), consistent with Thai Buddhist beliefs. The results of the environmental questions (Q2) suggested a more positive view towards nature, with 79% saying that they had changed their lifestyle in order to protect the environment (Q2d), 75% saying that they had contributed money to an environmental cause (Q2c), among the highest proportions of any sample. However, recycling was not so common as this would suggest (Q2f). 97% said they had saved energy, like Australasia. The students showed similar attitudes to the public.

The open questions about nature and life were varied as in all samples, and only some of them were translated for reproduction in this book. The outstanding feature was the huge proportion of pictures compared to other countries, and we could not reproduce all of them in this book. The reasoning was generally similar. In August the Queen of Thailand began a project called "Forests love water", which could have raised the environmental concern of the respondents prior to the survey.

5. Biotechnology - nonhuman

The sample was extremely positive about biotechnology, among the science developments (Q5-7), with 90% saying it was worthwhile, the highest of any sample. 82% accepted plant-plant gene transfer (Q9), and 68% accepted animal-animal (Q11), and there was still 48% who supported animal-plant (Q10) or 29% supporting human-animal (Q12) gene transfer. This may also represent some of the sample biased, as some were familiar with this research being researchers. In Q9 and Q10 rice was used instead of potato, so it is even more striking that they accept the changing of their staple food.

86% were aware that genetically modified organisms were being used to produce foodstuffs (Q13), and they did not express much concern about food or medicine made from them (Q14). There was rather less concern with all items than in general. 85% said that they had stopped eating a food because of concerns over its safety (Q2e), almost the highest response seen in any sample, which suggests that they have a positive image of foods made from biotechnology. This may be related to their negative image of pesticides.

There was strong support for the specific examples of genetic engineering (Q31), for all items, including the control answer of "sports fish", which 58% accepted. This is despite the reportedly low incidence of sports fishing in Thailand. The general support for genetic engineering products is very high, and it represents a lack of discrimination about pleasure uses of genetic engineering, like India.

6. Genetic diseases and AIDS

There was majority support for selective abortion of fetuses with congenital abnormalities (Q1g, 79% for, 12% against), despite rejection of abortion in general (Q1f, 17% for, 66% against), and the reportedly strong Buddhist views against selective abortion (Ratanakul, 1994). There was very high support for prenatal genetic screening in Thailand (Q16 - general, 88% yes, 3% no; Q17 - personal, 77% yes, 13% no). Students were somewhat less willing for the general case, but more willing for personal use. Their reasoning was similar to most of the samples, with almost none mentioning a "right to life" of the fetus. The translation of Q16 was as a governmental project rather than government-funded Medicare.

In the questions regarding privacy of genetic disease or HIV (Q21, 23), which asked who deserves to know that information, the proportion saying "yes" was reasonably high in all cases, especially for the employer. The Thai question included only a carrier of a genetic disease, deleting "or has a genetic disease", to make the translation better. The relative order of preferences, spouse, family, insurer, employer was the same as in other samples, and as in other samples, HIV status was considered more important to reveal.

More than half said that they knew someone with a genetic disease (Q19), and about 40% said they knew someone with a mental disease (Q24). The major genetic diseases cited were diabetes, Down's syndrome and thalassemia, with quite a few of the mental diseases being neurosis or anxiety problems. The question on mental disease deleted "or has had", which could have lowered the response a little. In most Asian countries mental disease is more shameful than genetic, which may also be reflected in the reduced familiarity with mental disease compared to genetic disease.

They were quite sympathetic and understanding of people with genetic diseases and mental diseases (Q20, 25). However, the highest proportion of people in any country (public 5%, students 8%) expressed rejection of people with neurosis. They were sympathetic and positive towards people with AIDS (the question did not include "HIV-infected") (Q22). Several people said they knew someone with AIDS, and the high prevalence of AIDS in Thailand may have contributed to the low number of negative comments.

7. Gene therapy

There was reasonably strong support for gene therapy, with 55% willing to undergo it themselves, and 83% willing for their children to undergo gene therapy to cure a usually fatal disease (Q26, 27). However, Thailand was the sample with the highest degree of unwillingness to undergo gene therapy personally, with 35% unwilling for themselves. A high proportion (15%) gave reasons of playing God for rejection of it. Otherwise the comments were generally similar to other samples.

However, there were relatively many who gave reasons supporting germ-line gene therapy, with 9% saying it would "improve genes" for their family for themselves to undergo it (Q26), and 10% in the case of children (Q27). Support was strong for enhancement uses (Q28efg) as well as for therapeutic uses, in fact the strongest among all the samples. The word "inheriting" was replaced with "getting", which was a matter of translation, and given the number of comments supporting improvement of genes, may not have any significant effect on response. 86% agreed with using gene therapy to make people more ethical, if we could ever perform such gene therapy. 74% 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


This sample had a good degree of concern towards the sick, and a very positive view towards therapy and technology, especially biotechnology and genetics. Their view of technology appeared to be so positive that they accepted some enhancement, beyond therapy.

Thai people appeared quite supportive of selective abortion, which is consistent with the statistical results of Ratanakul (1992) among the general population, but in contrast to some reported attitudes from a survey among non-science students (Ratanakul, 1994). Although the respondents in this survey showed some concern about abortion and animal rights, consistent with some Buddhist influence, they were pragmatic in many respects when it came to choices in medical genetics. They were among the most religious of the samples in the survey, following the Philippines sample. They also had a positive view towards the environment, and many had contributed some time and change in lifestyle.

9. Acknowledgements

We thank Dr Oranart Suntornwat for her help with translation of some of the comments on nature and life, given as examples. We also thank Mr Shiro Akiyama for assistance with data input.

10. References

Ratanakul, P. (1992) " A preliminary report on the handicapped and heredity in Thailand", pp. 199-202 in Human Genome Research and Society, N. Fujiki & D.R.J. Macer, eds., Eubios Ethics Institute. Ratanakul, P. (1994) "A survey of Thai Buddhist attitudes towards science and genetics", pp. 199-202 in Intractable Neurological Disorders, Human Genome Research and Society, N. Fujiki & D.R.J. Macer, eds., Eubios Ethics Institute.
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