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How Medical Ethics Differ in Asian Countries Compared to African Countries. Write an essay and elaborate...

How Medical Ethics Differ in Asian Countries Compared to African Countries. Write an essay and elaborate in detail up to max of 2000 words.

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Ans - medical ethics of asian countries : Southeast Asia is part of the continent where the major faiths arose; it is still a melting pot of different religious traditions and cultural beliefs, including animism and magic. Despite the rapid social change Southeast Asia has been undergoing, these religious and cultural beliefs remain vital, conditioning people's perceptions, values, attitudes, and behaviors in health and all other areas. An understanding of these beliefs is imperative for the implementation of projects in medicine and public health, and for the maintenance and improvement of public welfare.This article will first analyze the different types of traditional medicine in Southeast Asian countries, particularly Thailand, the Philippines, Malaysia, and Indonesia, their concepts of health and disease, methods of healing, their practitioners, and their ethics. Second, it will discuss some central biomedical issues in the practice of modern medicine, and the current efforts to teach the new medical ethics at medical schools in these countries. Finally, it will argue as a matter of great urgency the need to promote and strengthen bioethical education and research in Southeast Asia, in order to enable its medical community to cope with the new ethical and moral dilemmas, challenges to its traditional morality and religion.

Magic, Religion, and Naturalism - Medical systems in Southeast Asian countries may be classified into two types, traditional medicine and modern (scientific) medicine. Traditional medicine in turn can be very broadly grouped into three general types, depending on whether it is dominated by magic, religion, or naturalism. Beliefs concerning health, disease and its treatment, and preventive measures are in accord with the type of traditional medicine practiced. When magic is the focus, disease is believed to be caused by sorcery, and countersorcery and other spells are used as medical remedies. Similarly, when religion predominates, disease is attributed to supernatural forces, which must be appealed to or propitiated. When it is dominated by naturalism, disease is defined in terms of natural processes and the imbalance of elements or opposing forces in the body, and a judicious equilibrium is the basis of medical practice.

These traditional medical systems are often a blend of two or more types. Traditional Chinese medicine in Singapore, for example, is largely secular or naturalistic but includes magico-religious elements. Traditional Thai and Malay medicine is mainly magico-religious but is also permeated by elements of naturalistic medicine.

Healers, Shamans, and Mediums - Traditional medicine is integrated into a complex of beliefs and values comprising the worldview of Southeast Asian peoples. The magico-religious medicine of Southeast Asian countries is derived from magico-animistic beliefs that suffuse their cultures. In this cultural orientation, healers are shamans and mediums, and healing is effected through sorcery, exorcism, and spirit possession, assisted when necessary by herbal concoctions and massage.Spirit possession is believed to be a channel by which deities or spirits of a high order (e.g., spirits of monks or saints) use their divine power to heal the sick. Healing includes a diagnosis of illness and the performance of corresponding magical rites. These magical activities are usually conducted within the religious framework of the healer. Thai Buddhist shamans, for example, do not practice on wan phra, a Buddhist Sabbath observed at the four phases of the moon, and they make use of recitations from the Pali Buddhist texts. The Malay Muslim shamans add verses from the Qur'an to their healing, while the Taoist shamans in Singapore recite Tao incantations in their practice.

Herbalists, Folk Medicine Doctors, and Monks - The magico-religious medicine of Southeast Asia is tied to its culture, its naturalistic medicine is heir to the Indian ayurvedic medical system and traditional Chinese medicine. In these medical traditions disease is understood as a disturbance of inner equilibrium that can be corrected through the administration of herbal solutions. Thus this form of medicine is designated as naturalistic or herbal, and its practitioners are known as herbalists, ayurvedics, or folk medicine doctors. In Thailand many of these healers are Buddhist monks, who usually combine herbal treatment with religious rituals (e.g., the taking of religious vows and the sprinkling of lustral water) and meditation. Some of these monks have been credited with successful rehabilitation of drug addicts. The use of meditation differentiates traditional Thai medicine from the medicines of other Southeast Asian countries.

Medical Ethics in Traditional Medicine : The preoccupation of traditional medicine with magic, religion, and herbal concoctions is due to its holistic approach to health and healthcare. The practitioners work on their patients at both the physical level and the psychological/spiritual level. While herbal concoctions are mainly used to cure patients' physical illness, magico-religious rites have a therapeutic effect on their minds. The rites reassure patients of divine blessing and protection, and strengthen their self-confidence.

This traditional method of healing may be especially suitable today for Southeast Asians, who, living in societies with increased urbanization and industrialization, need physical, psychological, and spiritual care to enable them to cope with such change and the strains and stresses of modern life. Modern Western medicine with its advanced knowledge and technology has more effective means of healing, but it divides the patient into organ systems and treats only those parts of the person that are afflicted by a specific disease, rather than the whole person. Southeast Asians, who do not divide the person in such a way but need treatment with scientific medicine, will often seek traditional medicine as a supplement to scientific medicine. For example, a patient with a brain tumor might request magico-religious rites from a Buddhist shaman in order to ensure the success of an operation to be performed by a neurosurgeon. It was reported in the Thai press that the patient who uses this approach experiences such an operation with great calm and recovers more quickly.

Medical ethics in Southeast Asian traditional medicine is not codified but is inherent in the values and practices of its practitioners. Some of these healers are Buddhist monks whose ethic of conduct approximates the Buddhist ideal of showing compassion and loving kindness.

HumanExperimentation : Another important ethical issue in Southeast Asia concerns human experimentation. Since the adoption of modern medicine in the nineteenth century, medical schools in Southeast Asian countries have become more research oriented and are increasingly moving into the area of human experimentation. In violation of international agreements, Western researchers who have been restricted in the kind of human experiments they may do in their own countries are turning to Southeast Asia to conduct their research where there is less public awareness of the issue and less government regulation. These researchers are usually assisted by Southeast Asian colleagues, who engage in all kinds of human experimentation no longer permitted in the West, including forms of psychosurgery and genetic experiments. Drug testing and tests of new contraceptives have been carried out in Southeast Asian countries on a massive scale. Nearly all of these experiments use poor people as subjects, without their informed consent. Abuse of poor patients and the violation of their human rights in public hospitals often occur.

The governments and the medical communities in Thailand and the Philippines have taken some measures to prevent the exploitation of the poor by researchers.

The creation of national ethics committees and institutional review committees in Thailand and the Philippines is another Southeast Asian response to the issue of human experimentation. These institutional committees are concerned primarily with the evaluation of the scientific value of research proposals; the national ethics committees are expected to deal with the ethical aspects of experiment proposals and their protocols. Both the proper role and the composition of national ethics committees are still being debated. At present such committees are far from being instruments for effective control of experimentation in Southeast Asian countries.

Medical ethics of African countries : Medical ethics has existed since the time of Hippocrates. However, formal training in bioethics did not become established until a few decades ago. Bioethics has gained a strong foothold in health sciences in the developed world, especially in Europe and North America. The situation is quite different in many developing countries. The scope of bioethics has continued to expand in response to changes in societal dynamics, medical technology and health care practices. Perhaps more because of its antecedents than for want of content, most of the discourse and writings in the early days of bioethics centred on issues of patient-physician relationship, respect for person, best interest of the patient, and justice in health care delivery. Today, traditional bioethics discussions and literature are changing as new ethical concerns evolve around dilemmas posed by new technology on the subjects of end of life issues, organ donation, human reproduction and human genomics. Moreover, the bioethics agenda has expanded to include the subjects of resource allocation, organizational ethics and public health ethics, among others.

its present form is rooted in and largely dominated by western culture. The tempo and content of bioethics discourse are largely influenced by the technological creations of the developed world. However, ethics is not exclusively the domain of the west. Core ethical values are essentially the same for all human communities leaving aside each community's customs, culture and preferences . According to Potter, bioethics is "the application of ethics to all of life" . In the globalization of bioethics, different cultural, ethnic and religious perspectives are given a voice. Though bioethics has come of age in the developed and some developing countries, it is still largely "foreign" to most African countries. It is time Africa joined the bioethics bandwagon. Its relevance and applications to science and research are vital and should not be overlooked. The call of this paper therefore, is for bioethics to be integrated as a required component of medical education curriculum in Africa.

Research ethics -In the bioethics literature, bioethical discourse and arguments have been most prominent and intense concerning research involving human participants. One major achievement in this regard is the creation of an oversight body that sees to the proper design and conduct of research that conforms to generally acceptable and established ethical guidelines. There resides in this body the duty of ensuring that research sponsors and investigators abide by established conventions for carrying out clinical research. They also perform the role of assuring the safety of research participants and ensuring that participants (and/or society) benefit from the outcome of research. The relevance of this body to modern day health care and research is partly exemplified in the absence of any major scandals in the form and magnitude of those already recorded in history. The establishment of research ethics boards has not solved all the ethical problems of biomedical research though. There is still a lot to do to re-structure, re-empower and re-position the board to match the complexities of the present-day technology-driven medical research and practice.

Current efforts in Africa

Various bodies within and outside Africa have pioneered the movement towards ensuring that medical research in Africa conforms to international ethical guidelines. This is the aspect of bioethics that is most visible in Africa and has been anchored partly by the Pan African Bioethics Initiative (PABIN), a pan-African organization that was established in 2001 to foster the development of bioethics in Africa with a particular focus on research ethics (5). This idea has arisen in recognition of the genuine need to develop capacity for reviewing the ethics of research in Africa. It is also a condition required by external sponsors of collaborative research in Africa. Ethics workshops and conferences have been held in different parts of Africa, including Tanzania [6], Zambia [7], South Africa [8], Ethiopia [9], Cameroon [10] and Nigeria [11,12]. Moreover, some institutions and research centres have established research ethics review committees and some members of these committees have attended training workshops on research ethics.

While the present efforts and achievements are commendable, much still needs to be done for the effects to filter through to the grassroots, which is the main arena of research activities and where the burdens of research are most felt. I say this for the following reasons. First, the present efforts are still limited in extent and effect. Hitherto, most of the conferences have taken place in two or three geographical zones of the continent and have been limited to a few days of activities. Of course, the interests and motives of the sponsoring agencies together with the presence on the ground of those who are available to organize the conference locally determine where, when, for how long and the number of participants in the workshop. There is thus restriction on the number of researchers who can attend the conferences from all over Africa and on the amount of knowledge that can be imbibed in those few days. The consequence is that the same few people attend the conferences most of the time. These attendees from a few centres might not be able to change unethical research practices in their countries. Attempts by these few to train their colleagues locally are often constrained by lack of funds.

Second, absence of national directories of research activities in most African countries makes the magnitude of biomedical and social sciences research in Africa to be underestimated. For example in Nigeria, five categories of research and researchers are easily identifiable. Individual or institution-supported research is done by students, clinicians (including resident doctors) and other scientists. This category constitutes a significant proportion of research in tertiary academic and health institutions. Industry-sponsored research is undertaken by researchers for pharmaceutical companies to promote new or old drugs. Such research protocol may be indigenously developed or be a part of multicentre trials. In most instances, these companies do not go through the institutions where the researchers are based, but deal directly with individual researchers, who may or may not subject the research protocol to an ethics board review. Collaborative research with colleagues from the developed countries is often externally funded. It includes hospital and community-based trials and mostly involves experimenting with drugs or vaccines. Of particular ethical concern in collaborative research is the fact that external sponsors may differ in their motives for conducting research and there may be limited applicability of research benefits to the country or local community [13]. Moreover, the clinician/researcher and/or institutions are themselves vulnerable to funding pressures. Another category of research is that which occurs through indigenous government-funded agencies. An example of such an agency is the National Institute for Medical Research, which has been carrying out research in Nigeria for more than thirty years on parasitic, infective and non-infective diseases. Non-Governmental Organizations (NGOs) are also involved to variable extents in both clinic and community-based research.

Third, a majority of Africa's research participants are highly vulnerable given their low level of formal education and the political, social and economic milieu in which they live. The fourth reason is that Africa is a pluralistic society with diverse peoples and cultures. While general guidelines may apply in most cases, in some the peculiarities of each ethnic and cultural group will significantly affect what research is done and how it is done in those communities. Lastly, not every research centre has established an ethics review process. Where already established, most of the ethics review committees are grossly underfunded and unequipped for their duties.

Clinical ethics - This is the branch of bioethics that addresses ethical conflicts that arise in daily clinical practice in health care institutions, through the establishment of hospital ethics committees and ethics consultation services. Fletcher and Siegler define ethics consultation "as a service provided by an individual consultant, team or committee to address the ethical issues involved in a specific clinical case. Its central purpose is to improve the process and outcomes of patents' care by helping to identify, analyze, and resolve ethical problems". An ethics consultation service also responds to conflicts that arise from technological improvements in medical care and the increasing pressure to meet a perceived standard of care [15]. Clinical ethics is also concerned with organizational ethics and networks and the implications of health care policy at the bedside. Although there are contrasting views about the presence of ethics consultants at the bedside, hospital ethics committees are now available in most hospitals in North America and Europe, providing services to patients, families, staff and the entire hospital organization.

the services of hospital ethics committees or consultants in African hospitals or at the bedside? That may not be the point presently. However, clinical ethics is neither about committees and consultations, nor about technology and end-of-life issues alone. Common sense and intuition are insufficient to address all ethical issues that arise in patients' care. The well-intentioned clinical decisions and judgments of yesterday may turn out to be unsound in the searchlight of today's ethical scrutiny. Although core moral virtues have generally guided medical practice in Africa as elsewhere, there is the increasing need to apply both cognitive and behavioural ethical values to everyday decision making at the bedside by the physician as well as other health-care professionals [16]. Perhaps ethical concerns have unwittingly been unrecognized, downplayed or overlooked by health care professionals. The management of chronic diseases like HIV/AIDS and cancer, the incidences of which are on the increase, has attendant ethical implications about care, cost and consequences on patients' personality, values and families. Besides, Africa will someday cross the technological divide that will make resolution of ensuing ethical issues urgent, which health care providers will no longer be able to ignore. The societies are becoming more enlightened and it may be sooner than anticipated when physicians and other health care workers begin to grapple with some ethical challenges for which they are ill-prepared.

It is not here suggested that next on the agenda of health care in Africa is to devote attention and resources to training bioethics consultants for the bedside. Most people in Africa still do not have access to qualified health personnel and reasonable health care. The point is that deliberate efforts should be made to train present and future health care providers to be aware of the core moral virtues required of them in their duties to patients; and be sensitive to the ethical values of their patients, their families and the society.

Ethics education - In the developed world education in ethics is no longer a "hidden curriculum" [17] that is passively passed to medical students during their training. It has become an "open" subject that is actively taught, not only in medical schools, but also in institutions that train other categories of health care workers. It has also become a required module in the training of resident doctors in most countries where bioethics is well grounded. Ethics education is aimed at teaching the cognitive and behavioural aspects of ethics for the purpose of improving the quality of care in terms of both the process and outcome of care. It enhances the student's ability to integrate the technical and moral components of the decision making process in clinical practice [16]. It also prepares the recipients to meet with ethical challenges of clinical practice and biomedical research. The pedagogic formats used include didactic teaching, clinical case studies, small-group discussion of ethical issues, and ethics rounds or grand rounds. A survey of medical graduates in the United States who had received ethics teaching while at medical school revealed that they were better suited to confront ethical issues in their practice and favoured continuation and expansion of ethics teaching in medical schools. Other reports from both developed and developing countries that evaluated medical ethics programmes among medical students attest to the positive impact it has on their appreciation of ethical issues in clinical practice and the way they resolve them.The rest of the world by introducing ethics education into the curricula of all medical schools where it is not presently taught. This is where the future of bioethics and health care delivery and research in Africa lies. Apart from some countries in the southern and eastern part of Africa and a handful of universities in other parts of Africa, there is no formal ethics education in most of Africa's medical schools. Ethics education to medical students is a necessary and required commitment to accomplishing an all-round training of the doctor whose decisions are both technical and moral. Much attention has wholly focused on the technical aspect of medical education, leaving the student to develop his or her moral attitudes passively through observation and intuition. Formal ethics teaching aims at equipping students with a common framework on which to reconcile patients' medical needs with their values, perceptions, situations and beliefs and may be a process towards achieving the hitherto elusive regulation of medical practice in most of these developing countries.


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