SEA/HSD/225 The issue of this document does not constitute formal publication. It should not be reviewed, abstracted or quoted without the agreement of the World Health Organization. Authors alone are responsible for views appearing under their names. CONTENTS Page ACKNOWLEDGEMENTS ........................................................................................................... vii INTRODUCTION............................................................................................................................ ix Country Reports ..................................................................................................................... ix MEDICAL ETHICS IN BANGLADESH.................................................................................... 1 Introduction............................................................................................................................... 1 History and socio-cultural setting ................................................................................... 2 Organizations and agencies............................................................................................... 3 Ethics in medical practice................................................................................................... 5 Medical ethics in research.................................................................................................. 6 Legal perspectives................................................................................................................... 6 Teaching of ethics................................................................................................................... 6 Health policy reform and other contemporary issues.......................................... 7 Looking towards the future................................................................................................ 8 Acknowledgment.................................................................................................................... 9 References.................................................................................................................................. 9 ETHICS PERSPECTIVES FROM INDIA.................................................................................10 History and socio-cultural setting .................................................................................10 Historical perspective .........................................................................................................11 Health infrastructure and health manpower development.............................12 The role of professional councils ..................................................................................15 Code of medical ethics ......................................................................................................15 Teaching of medical ethics ..............................................................................................16 Situation in medical colleges ..........................................................................................17 The Consortium Initiatives ...............................................................................................18 Page iii Health Ethics in South-East Asia Ethics in clinical practice and legal perspectives...................................................19 Poor vs. rich.............................................................................................................................19 Rural vs. urban .......................................................................................................................20 Bio-ethics and religion .......................................................................................................20 Status of women and ethical implications................................................................21 Medical termination of pregnancy...............................................................................21 Prenatal diagnosis of sex and female foeticide......................................................22 Donation of human organs for purposes of transplantation ...........................23 Consumer Protection Act..................................................................................................24 Neonatal and perinatal services and ethical issues..............................................25 Ethical issues and AIDS......................................................................................................27 Other issues emerging with regard to ethics and AIDS.....................................27 Suicide and euthanasia......................................................................................................27 Assisted reproductive technologies and ethics.......................................................28 Ethical issues and disabled persons .............................................................................29 Bio-ethical issues and mental retardation ................................................................29 Bioethical issues and mental health ............................................................................30 Ethics and research ..............................................................................................................31 Institutional ethical committee.......................................................................................32 Drug trials .................................................................................................................................33 Ethics and human genome studies ..............................................................................34 Other issues .............................................................................................................................34 Problems of applying teaching in practice ...............................................................35 Looking towards the future..............................................................................................35 Indian Literature on Ethics ...............................................................................................36 ETHICS IN MEDICAL EDUCATION AND MEDICAL PRACTICE: INDONESIA.............................................................................................................41 Introduction.............................................................................................................................41 Current situation ...................................................................................................................42 Ethics in medical education.............................................................................................42 Ethics in medical research................................................................................................46 Ethics in medical practice.................................................................................................46 The Consortium of Health Sciences............................................................................47 Page iv Health Ethics in South-East Asia A plea for improvements ..................................................................................................48 Recommendations ...............................................................................................................51 Acknowledgements..............................................................................................................52 References................................................................................................................................52 ISSUES OF ETHICS IN HEALTH CARE: A MYANMAR PERSPECTIVE.................53 Historical aspect ....................................................................................................................53 Organizations and agencies.............................................................................................53 Teaching....................................................................................................................................54 Clinical practice.....................................................................................................................55 Research....................................................................................................................................56 Problems associated with teaching and practice of medical ethics.............57 Health policy reform and other contemporary issues........................................57 Looking into the future ......................................................................................................58 MEDICAL ETHICS IN THE NEPALESE CONTEXT .........................................................59 Historical aspects ..................................................................................................................59 Organizations involved in regulating medical practice......................................60 Teaching of medical ethics ..............................................................................................66 Ethics in clinical practice...................................................................................................67 Research ethics ......................................................................................................................68 Problems associated with teaching and practice of medical ethics.............69