Thailand: Refining Cultural Values
Ratanakul, Pinit, The Hastings Center Report
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 used to build more urban hospitals or rural health centers? Should Thailand's limited resources be devoted to training more doctors and nurses for hospital medicine or more paramedical personnel for rural health centers?
Whatever concrete decisions are made in the macro-allocation of health care resources, they should be guided by the Buddhist principle of justice. This involves nondiscriminatory treatment of all people, and requires that government provide aU with a fair share of health care resources in proportion to their health needs and medical conditions. Grave imbalances in the allocation of medical resources and the unnecessary persistence of inadequacies in basic services are not merely unjust, but also constitute violence to others and violate the Buddhist principle of "do no harm" that is the basis of traditional Thai morality. This question of distributive justice is one of the most urgent problems the present administration will have to address if it is not to repeat the mistakes of some Western nations where only the privileged few enjoy the best medical services.
To remedy the misallocation of limited resources to rural areas, the Buddhist principle of justice may be used as an action-guide. More provincial hospitals and rural health centers must be built and paramedics trained to staff them. Perhaps more subsidies are necessary as an incentive to attract doctors and nurses to serve in the rural areas. Through control of licenses it may be possible to avoid excessive concentrations of medical personnel in affluent parts of the country. And a higher allotment of resources must go to preventive public health measures such as health education, sanitation, provision of an adequate supply of clean water, maternal care clinics, and child development programs.
Only as the imbalance in the distribution of health services is corrected can we begin to think of introducing expensive, high-tech medicine into Thai society. Otherwise, will be setting up a ten-course banquet for a few while a multitude cannot even have a simple meal of rice.
The problem of AIDS also requires urgent attention in Thailand. …