The doctrine of informed consent has the effect of allowing the mentally competent adult patient to exercise individual choice in any proposed medical treatment. The ethical principles primarily inherent in this doctrine would be the principles of autonomy and beneficence. However, it is argued in this essay that the concept and meaning of autonomy might be vastly different between western and eastern communities. Consequently the doctrine of informed consent will lead to a different meaning in these different societies. The essay also raises the implication of transplanting legal doctrines into societies which might not be fully prepared to implement the ideal contained in the doctrine of informed consent.
The author reviews the legal theory and practice of the requirements for informed consent. He uses a discussion of relevant cases and judgements from courts in the UK, USA, Australia and Malaysia to illustrate apparently conflicting attitudes exemplified by these cases. From this he aims to form some consensus in their application to everyday practice.
The announcement of Dolly's birth took the world by storm, mainly because what was thought impossible has become possible. Optimism that new approaches in agriculture and medicine abound, as much as fear and imagination leading to Frankenstein-like scenarios. Scientifically, cloning refers to replicating an animal with the same nuclear genetic material; whilst it may refer to embryos as the source material, the current storm refers to differentiated ("somatic") cells. Cloning technology is useful in the following areas: agriculture, to produce animals of superior or specific qualities; endangered animals, to increase genetic diversity through widening the gene pool; understanding fundamental questions in developmental embryology, through the use of laboratory animals; and in human therapy, to produce cells and possibly tissues for repair and regeneration. In the first 2 instances, it is reproductive cloning. In the last instance, it is therapeutic cloning, as no individuals are "produced". Human reproductive cloning is not allowed by all governments that have deliberated on it, and therapeutic cloning is allowed by some under certain circumstances. As therapeutic cloning has great potential in cures of many diseases, it should be allowed but with safeguards to prevent abuse and reproductive cloning in the human.
Globally, abortion mortality accounts for approximately 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high maternal mortality and morbidity from abortion tend to occur together. Unplanned and unwanted pregnancies constitute a serious public health responsibility. While fertility has declined by half in developing countries, the motivation to control and space births has risen faster than the rate of contraceptive use. Preventing maternal mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives. A range of positive steps has been taken to reduce deaths and morbidity from abortion in a growing number of countries over the past 15 years. Making abortion legal is an essential prerequisite in making it safe. In this respect, changing the law does matter and assertions to the contrary are ill conceived and unsupported in practice. Although, in many countries, trends towards safer abortion have often occurred prior to or in the absence of changes in the law, legal changes need to take place if safety is to be sustained for all women. Religious laws may also require attention when legal change is being contemplated. There are three main ways of approaching this problem: liberalizing the existing law within the penal or criminal code; partially or fully legalizing abortion through a positive law or a court ruling; and decriminalising abortion by taking it out of the law. Women's health groups and other advocates, parliamentarians and health professionals, can work together to support the right of women not to die from unsafe abortions and to ensure they receive treatment for complications. Committed doctors can make a difference by providing treatment for abortion complications, interpreting the law in a liberal way and providing safe services where these are legal as well as training providers in the safest techniques to reduce mortality and morbidity. Although law, policy and women's rights are central to this issue, making abortions safe is above all a public health responsibility of governments. Moreover, reducing maternal mortality by making abortions safe is also an important part of the international commitment made in Cairo in 1994 at the ICPD and reaffirmed at the Cairo meeting in 1999.
This report describes the ethical and legal aspects of assisted reproduction technology (ART) that have been instituted in Asian countries. The data were collected by a questionnaire circulated to ART units in Asia. These are Taiwan, Singapore, Korea, Indonesia, Thailand, Japan, Iran, India, Jordan, Malaysia, China, Israel, Hong Kong, Pakistan, Lebanon, Saudi Arabia, and Persian Gulf countries. According to the survey, there are approximately 260 ART centers in Asia (half of which are in Japan). On a global basis each ART centre in Asia serves an average population of 13 million people. On the other hand, in those Asian countries where the standards of living are relatively high, the availability of ART services, including the more sophisticated and costly ART procedures like micromanipulation, is similar to that in the Western world. In most of the Asian countries practising ART, however, no state registry exists. Taiwan is the only country that has specific legislation, and in six other countries some kind of ministerial regulations are practised. We conclude that ART is now practised in 20 countries in Asia. The prevailing rules and cultural heritage in many of these Asian countries has a major influence on the implementation of ART in Asia. However, in view of the complicated and sensitive issues involved, and as no supervision on ART clinics exists in most of the Asian countries, we advocate that some kind of quality control should be urgently instituted in all centres practising ART. In this way, it is hoped that the highest standards be attained for all parties concerned.
Matched MeSH terms: Fertilization in Vitro/legislation & jurisprudence*
The decision to terminate a pregnancy is not one that is taken lightly. The need for an abortion reflects limited sexual autonomy, ineffective or lack of access to contraceptive options, or a health indication. Abortion is protected under human rights law. That notwithstanding, access to abortions continues to be contested in many parts of the world, with vested interests from politically and religiously conservative states, patriarchal societies, and cultural mores, not just within local contexts but also within a broader geopolitical context. Criminalization of a women's choice not to carry a pregnancy is a significant driver of unsafe procedures, and even where abortions are provided legally, the policies remain constrained by the practice or by a lack of coherence. This review outlines the trends in abortion policy in low- and middle-income countries and highlights priority areas to ensure that women are safe and able to exercise their reproductive rights.
1. A good opportunity exists in Malaya for any national leprosy control. Institutional care is of the best that is available and it is felt that it has reached the saturation stage. Field work has not been established.
2. Thus leprosy has remained more of a medical problem than health.
3. Owing to the absence of any health education on leprosy, there exists an extensive gulf between the patient and the public thus creating problems of rehabilitation. The main rehabilitation performed by the government is on the employment of a few discharged patients in leprosy institutions. Though the objective of the Malayan Leprosy Relief Association is to rehabilitate, time is needed, and it may be years before the discharged patients can expect any benefits.
4. The apathy of medical officers towards serving in the Leprosaria is evidenced by the fact that since the establishment of the Leprosaria, barring 2-3 local officers, all have been outsiders on contract or otherwise. The World Health Organisation has offered a fellowship for six months and there has been no applicant from the medical officers in the Federation .
In 1994, the Government of India enacted the Transplantation of Human Organs Act (THOA) to prevent commercial dealings in human organs. However, a greater number of scandals involving medical practitioners and others in the kidney trade has surfaced periodically in every state in India. The present regulatory system has failed mainly due to the misuse of Section 9(3) of the THOA, which approves the consent given by a live unrelated donor for the removal of organs for the reason of affection or attachment towards the recipient or for any other special reason. Currently in India, approximately 3500-4000 kidney transplants and 150-200 liver transplants are performed annually. However, the availability of organs from brain-dead persons is very low. As a result, live related or unrelated donors form the main source of organ transplantation. Therefore, physicians and policy-makers should re-examine the value of introducing regulated incentive-based organ donation to increase the supply of organs for transplantation and to end unlawful financial transaction.
Matched MeSH terms: Commerce/legislation & jurisprudence*; Tissue and Organ Procurement/legislation & jurisprudence*; Organ Transplantation/legislation & jurisprudence*
Malaysia disposes of 28,500 tonnes of municipal solid waste directly into landfills daily. This fact alone necessitates sustainable landfills to avoid adverse impacts on the population and the environment. The aim of the present study was to elucidate the issues and challenges faced by waste managers in moving towards sustainable landfilling in Malaysia. Various factors influence the management of a landfill. Among them is the human factor, which includes attitude and public participation. Although Malaysia's economy is developing rapidly, public concern and awareness are not evolving in parallel and therefore participation towards sustainable waste management through the 'reduce, reuse and recycle' approach (3Rs) is severely lacking. Consequently, landfill space is exhausted earlier than scheduled and this is no longer sustainable in terms of security of disposal. Challenges also arise from the lack of funding and the increase in the price of land. Thus, most waste managers normally aim for 'just enough' to comply with the regulations. Investment for the establishment of landfills generally is minimized since landfilling operations are considered uneconomical after closure. Institutional factors also hamper the practice of sustainable landfilling in the country where 3Rs is not mandatory and waste separation is totally absent. Although there are huge obstacles to be dealt with in moving towards sustainable landfilling in Malaysia, recent developments in waste management policy and regulations have indicated that positive changes are possible in the near future. Consequently, with the issues solved and challenges tackled, landfills in Malaysia can then be managed effectively in a more sustainable manner.
In 1981 the World Health Assembly (WHA) adopted the International Code of Marketing of Breastmilk Substitutes out of concern that inappropriate marketing of breastmilk substitutes was contributing to the alarming decline in breastfeeding worldwide and the increase in child malnutrition and mortality, particularly in developing countries.
Matched MeSH terms: Marketing of Health Services/legislation & jurisprudence*; Nutrition Policy/legislation & jurisprudence*; Infant Formula/legislation & jurisprudence*
To review how tobacco transnational companies conducted their business in the hostile environment of Singapore, attempting to counter some of the government's tobacco control measures; to compare the Malaysian and the Singaporean governments' stance on tobacco control and the direct bearing of this on the way the tobacco companies conduct their business.
OBJECTIVE: To describe tobacco industry efforts in Malaysia to thwart government efforts to regulate tobacco promotion and health warnings.
METHODS: Systematic keyword and opportunistic website searches of formerly private tobacco industry internal documents made available through the Master Settlement Agreement and secondary websites; relevant information from news articles and financial reports.
RESULTS: Commencing in the 1970s, the industry began to systematically thwart government tobacco control. Guidelines were successfully promoted in the place of legislation for over two decades. Even when the government succeeded in implementing regulations such as health warnings and advertising bans they were compromised and acted effectively to retard further progress for years to come.
CONCLUSION: Counter-measures to delay or thwart government efforts to regulate tobacco were initiated by the industry. Though not unique to Malaysia, the main difference lies in the degree to which strategies were used to successfully counter stringent tobacco control measures between 1970 and 1995.