Bioethics on the Pacific Rim: Thailand

41 T h a i l a n d : R e f i n i n g C u l t u r a l Va l u e s P i n i t R a t a n a k u l In 1990, the Hastings Center Report published a series of three short essays entitled, “Bioethics on the Pacific Rim”. In the Inaugural Edition of Asian Bioethics Review, we began looking back at these articles and asking how the issues and concerns raised then apply now. We will have a series of three articles commissioned from leading bioethicists in each country exploring the developments, dilemmas and changing faces of healthcare and bioethics in the 21st century. We continue our “Retrospectives” in Thailand. Bioethics on the Pacific Rim: Thailand Resource allocation, euthanasia, pro-creation, AIDS-these familiar issues of Western bioethics seem to know no geographical boundaries, as the following collection of articles by authors in the People’s Republic of China, Thailand, and the Philippines illustrate. Yet, the cultural embeddedness of practices and values presents a rich diversity of interpretations and resolutions. Population policies are of vital concern in China and the Philippines, but are perceived and addressed very differently given divergent underlying cultural and religious values; the character of bioethics reflection in Thailand, meanwhile, is ineluctably marked by that country’s historical legacy of Buddhism. The intersection of cultural norms and the increasing international scope of bioethics present intriguing prospects for descriptive, comparative, and normative inquiry. Courtney S Campbell Hastings Center Report, 20 (2), March–April 1990, pp. 24–28 R E T R O S P E C T I V E Asian Bioethics Review March 2009 Volume 1, Issue 1 41 A s i a n B i o e t h i c s R e v i e w M a r c h 2 0 0 9 Vo l u m e 1 , I s s u e 1 42 Thailand: Refining Cultural Values P I N I T R ATA N A K U L Today Thailand is frequently referred to as one of the newly industrialized countries (NICs). The present ambition of Thai policy-makers is to move the country toward realizing its economic and social potential. The concern for rapid development affects many aspects of Thai society, including the health sector. High technology medicine is increasingly supplanting traditional methods of treatment, reflecting the displacement of traditional models, with their holistic concept of health and health care, by Western models with their emphasis on technology, research, and specialized training. Health Care Allocation A multitude of ethical problems exists beneath the surface of benefits brought about by the introduction of Western medical models into Thailand. The most important concerns the macro-allocation of health care services, and centers on grave inadequacies in needed services. While the nation is striving to become a NIC, 80 percent of its population still lives in rural areas. Nearly all rural residents are poor and have a short average lifespan with rates of chronic illnesses many times higher than those of wealthier people living in urban areas. Yet 60 percent of Thai government personnel and 62 percent of doctors and 58 percent of nurses are concentrated in the metropolitan sector with large hospitals equipped with the most expensive technologies. As in the case of many Western countries, government after government has tended to devote more funds and medical resources to the urban sector for diseases that affect relatively few, such as cancer and heart disease, while the majority suffer and die for lack of basic health care and services. Correcting this grave imbalance will involve finding solutions to ethical questions such as: Should money, time, effort, and personnel — always in limited supply — be R E T R O S P E C T I V E B I O E T H I C S O N T H E P A C I F I C R I M 42–46 Asian Bioethics Review March 2009 Volume 1, Issue 1 43 T h a i l a n d : R e f i n i n g C u l t u r a...