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Asia-Pacific Perspectives on Medical Ethics Asia-Pacific Perspectives on the Medical Ethics

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Asia-Pacific Perspectives on Medical Ethics Asia-Pacific Perspectives on the Medical Ethics Asia-Pacific Perspectives on Medical Ethics Asia-Pacific Perspectives on the Medical Ethics. Bangkok: UNESCO Bangkok, 2008. vi + 115 pp. 1. Medical Ethics. 2. Reseach Ethics 3. Human Rights 4. Bioethics. 5. Asia and the Pacific. ISBN 978-92-9223-219-1 (Electronic version) © UNESCO 2008 Published by the UNESCO Asia and Pacific Regional Bureau for Education 920 Sukhumvit Rd., Prakanong Bangkok 10110, Thailand Chief Editor: Daniel Calderbank Editor: Darryl R.J. Macer Cover design: Alessandra Blasi Design/Layout: Celia H. Thorheim Printed in Thailand The designations employed and the presentation of material throughout the publication do not imply the expression of any opinion whatsoever on the part of UNESCO concerning the legal status of any country, territory, city or area or of its authorities, or concerning its frontiers or boundaries. SHS/08/EP/002-1 CONTENTS CONTENTS iii ACRONYMS iv PREFACE v Controversy over Medical Futility 1 Bioethical Issues in Nursing 4 Impulse of Ethical Research in Life Science and Health Systems: Foundation for development in sub-Saharan Africa 6 Capacity Building of Research Ethics in China 10 Current State of Research Ethics in Developing Countries: Where Do We Stand? 17 Informed Consent in Health Research: Current State of Knowledge among Physicians in Bangladesh 22 Utilization of Traditional Knowledge and Support of Access to Health 26 Avoiding Biopiracy? Protecting Traditional Marshallese Medicinal Knowledge and Plants 30 Market-driven Biomedical Research: A Major Challenge to “Everyday Bioethics” 38 Social Discrimination and Health Disparity Across Generations: Are We Sufficiently Informed? 47 Islamic Codes in Medical Ethics 59 Gender Foeticide: Exploring Beyond Medical Ethics 63 Human Rights and Gender Equality 68 Organ Donation: The Bioethical and Sikh Perspective 77 Biomedicine - legal and ethical issues 81 Discussion 97 Samantha M.C. Pang (Hong Kong) and Michiko Yahiro (Japan): How do Chinese and Japanese patients characterise the good nurse? 98 Paungphen Choonhapran (Thailand): Bioethics issues in intensive care nursing 98 iii Alireza Bagheri (Iran): Controversy over Medical Futility 99 M.K. Tadjudin (Indonesia): Ethical Issues in the Face of Scarce Resources 101 Xiaomei Zhai (China): Research Ethics in China: History, Status Quo and Issues 102 M. Al Mamun (Bangladesh): Informed Consent in Health research: Current State of Knowledge Among Physicians in Bangladeshi Perspectives 103 M Saidur Rahman (Bangladesh): Informed Consent in Health Research: Current State of Knowledge among Physicians in Bangladeshi Perspective 104 on Medical Ethics Perspectives Asia-Pacific Mihaela Serbulea (Romania): Utilization of Traditional Knowledge and Support of Access to Health 105 Irene Taafaki (Marshall Islands): Avoiding Biopiracy: Protecting Traditional Medicinal Knowledge in the Marshall Islands 106 Chan Chee Khoon (Malaysia): Market-Driven Biomedical research: a Major Challenge to Everyday Bioethics 107 Mohammad Hasan Ghadiani (Iran): Islamic Codes in Medical Ethics 107 Jasdev Rai (UK): Gender Feticide: Exploring Beyond Medical Ethics 109 Ken Daniels (New Zealand): Governance of Donor Insemination (DI) 109 Leonardo de Castro (the Philippines): Informed Consent: An Essential Requirement for Essential Health Research 110 Le Dinh Luong (Viet Nam): Some Issues in the Implementation of International Bioethics Declarations in Viet Nam Practice 112 About the contributors 114 ACRONYMS AIDS: Aquired Immune Deficiency Syndrome ARV: Anti-Retroviral Medicines CHRB: Convention on Human Rights and Biomedicine CIOMS: Council for International Organizations of Medical Sciences COMEST: World Commission on the Ethics of Science and Technology ELSI: Ethical, Legal and Social Impact HES: Human Embryotic Stem HIV: Human Immunodeficiency Virus HUGO: Human Genome Organization Ethics Commitee IBC: UNESCO International Bioethics Committee ICN: International Council of Nurses IDHDG: Internal Declaration on Human Genetic Data IVF: In Vito Fertilization IRB: Institutional Review Board NGOs: Non-Governmental Organizations NHMRC: National Health and Mecial Research Council (Australia) OECD: Organization for Economic Cooperation and Development PGD: Pre-Implantation Genetic Diagnosis REC: Research Ethics Committee RMI: Republic of Marshall Islands RUSHSAP: Regional Unit for Social and Human Sciences in Asia and the Pacific SARS: Severe Acute Respiratory Syndrome UNAIDS: Joint United Nations Programme in HIV/AIDS UNDP: United Nations Depelopment Programme UNESCO : United Nations Educational, Scientific and Cultural Organization US-FDA: US-Food and Drug Administration iv WHO: World Health Organization Asia-Pacific Perspectives on Medical Ethics Perspectives Asia-Pacific PREFACE The pursuit of health is a natural drive for survival found in all living organisms. The development of medicine and ethical norms to guide the conduct of the medical profession has been seen in every society over the course of history. UNESCO has made ethics of science and technology one of its five priority areas and the International Bioethics Committee of UNESCO was established in 1993 to deliberate on issues raised by the pursuit of advanced medical research. This volume offers perspectives from people in a range of countries across Asia and the Pacific on medical ethics, many of whom are actively involved as members of the UNESCO Asia-Pacific School of Ethics. UNESCO’s programmes in bioethics aims to strengthen the ethical link between scientific advancement and the cultural, legal, philosophical and religious context in which it occurs. UNESCO’s strategy in bioethics has been to act as a standard-setter on emerging ethical issues, to disseminate information and knowledge and to help Member States build their human and institutional capacities. The standards include the Universal Declaration on the Human Genome and Human Rights, adopted by UNESCO’s General Conference in 1997 and subsequently endorsed by the United Nations General Assembly in 1998. This was followed by the International Declaration on Human Genetic Data, adopted in 2003; and the Universal Declaration on Bioethics and Human Rights, adopted by UNESCO’s 33rd General Conference in 2005. This collection of papers is third in a series of books from RUSHSAP, UNESCO Bangkok offering perspectives on ethics in Asia and Pacific, with each focusing on a specific theme. These papers were originally presented during conferences on ethics in science and technology which UNESCO’s Regional Unit for Social and Human Sciences (RUSHSAP) has been convening since 2005. Since intercultural communication and information sharing are essential components of these deliberations on the ethics of science and technology, the books also provide theme-related discourse from the conferences. The First UNESCO Bangkok Bioethics Roundtable was held 11-15 September, 2005, as the first event in Bangkok to celebrate UNESCO’s 60th anniversary. The UNESCO Bangkok office is the largest UNESCO branch office in the Asia-Pacific Region, encompassing 46 member countries. RUSHSAP is designated v as the regional office for coordinating implementation of the UNESCO programmes in the social and human sciences sector in Asia-Pacific region, which includes the programmes on ethics of science with the Division of Ethics of Science and Technology in Paris. The Sector’s Programme on the Ethics of Science and Technology1, being one of UNESCO’s five priority areas, is designed to ensure that the world remains secure for everyone by placing the ongoing revolutionary scientific and technological progress within a context of ethical reflection rooted in the on Medical Ethics Perspectives Asia-Pacific cultural, legal, philosophical, and religious heritage of the various human communities. This programme covers two primary areas of ethical reflection: bioethics (addressing concerns stemming from advances in life sciences), and ethics of science and technology (addressing other areas of applied ethics in relation to scientific and social developments). The Bioethics Programme is part of UNESCO’s Division of the Ethics of Science and Technology in the Social and Human Sciences Sector. It acts as the Secretariat of two advisory bodies: the International Bioethics Committee (IBC), composed of 36 independent experts, and the Intergovernmental Bioethics Committee, composed of representatives of 36 Member States. These Committees cooperate to produce advice, recommendations, and proposals that each submits to the Director-General for consideration by UNESCO’s governing bodies. The IBC is a body of 36 independent experts that follows progress in the life sciences and its applications in order to ensure respect for human dignity and freedom. It was created in 1993. The IBC provides a global forum for in-depth bioethical reflection by exposing the issues at stake. It does not pass judgment on one position or another. Instead, it is up to each country, particularly lawmakers, to reflect societal choices within the framework of national legislation, and to decide between the different positions. The 1 http://www.unesco.org/ethics tasks of the IBC include: (1) To promote reflection on the ethical and legal issues raised by research in the life sciences and their applications, and to encourage the exchange of ideas and information, particularly through education; (2) To encourage action to heighten awareness among the general public, specialized groups, and public and private decision-makers involved in bioethics; (3) To co-operate with the international
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