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Bioethics in Multi-cultural and Multi-religious Malaysia

Bioethics in Multi-cultural and Multi-religious Malaysia

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Published by hskhaira
Brief look at the ethical issues faced by a multi-cultural and multi-religious society like Malaysia which is a secular state with Islam as its official religion.
Brief look at the ethical issues faced by a multi-cultural and multi-religious society like Malaysia which is a secular state with Islam as its official religion.

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Categories:Types, Research, Law
Published by: hskhaira on Sep 09, 2008
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05/09/2014

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Bioethics in Multi-cultural and Multi-religious Malaysia
In Malaysia while there are guidelines for medical ethics there seems to be no clearphilosophy for bioethics. Medical ethics are narrower in their application and are morerelated to moral issues associated with the practice of medicine. Bioethics on the otherhand covers a much wider field and is concerned with the ethical questions that arise inthe relationships among life sciences, biotechnology, medicine, politics, law, philosophy,and theology. Bioethics would therefore involve the study of ethics, morality and law.Basically bioethics is the study of ethical issues in the context of medical developments.One of the fundamental questions that concern us in the study of bioethics is – ‘whatought we to do?’ Stewart & Blocker
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state that ethics is simply another term for ‘moralphilosophy’. It is that area of philosophy which investigates the principles governinghuman actions in terms of their ‘goodness, badness, rightness, and wrongness’. Theyfurther state that ethics is an extremely important branch of philosophy because it directsour attention not only to human morality but to values in general. They also raise thefollowing questions:
Are there standards that ought to govern all human behaviour?
If so, how can one know what they are?
Even if the ethical standard is known, why should it be followed especially, whenit does not seem to be in one’s self-interest?
In general, what makes something ‘good’ or ‘bad’?
Is there any common property, for example, that not only makes a chocolate cakegood but also has the same impact on a lawnmower?
Is ‘goodness’ just a feeling people have of liking or wanting something?
Ultimately, what is it that makes an action ‘right’ or ‘wrong’?
Are ‘rightness’ and ‘wrongness’ just arbitrary social conventions?A multi-cultural and multi-religious country such as Malaysia can have its own peculiarissues in attempting to formulate the ethics that can universally cover all research in thebiomedical field. Given Malaysia’s multi-cultural and multi-religious population themedical ethics adopted in Malaysia as stated in the Malaysian
Code of Medical Ethics
espouse a more multi-dimensional approach.
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The Malaysian
Code of Medical Ethics
recognises that:
Malaysia is a multi-racial, multi-religious and culturally diverse nation with ‘belief in God’ beingthe first tenet of the country guiding principles (Rukunegara). There are many core values runningthrough the ethical beliefs of the various communities in Malaysia, which are worthy of emulation.
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… Physicians may experience conflict between different ethical principles, betweenethical and legal or regulatory requirements, or between their own ethical convictions and thedemands of patients, proxy decision makers, other health professionals, employers or otherinvolved parties.
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Malaysian writers on medical ethics have urged that not only must there be knowledge of medical codes but also of the philosophical and historical derivations of these codes.
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The study of Malaysian medical ethics or bioethics is not without complications. As
 
2some Malaysian writers point out, quoting Radhakrishnan
6
,it is important to bear in mindthat:
Ethical truths are not very easy to justify, as although the opposite of a correct statement is a falsestatement, the opposite of a profound ethical truth may be another profound ethical truth.Moreover, the law and ethics are not always in harmony with each other. In fact, in manysituations, they would seem conflicting, although both horns of the dilemma are attached to thesame bull.
There may be more than just two horns to the same bull as a recent debate on whetherMalaysia is a secular or Muslim state will not help in the easy formulation of anyuniquely Malaysian philosophy of bioethics. If Malaysia is indeed a Muslim state it maywell dictate a single dimensional approach that will require the bioethics to be based onthe principles of Islam. In an article
7
on Islamic medical ethics Omar Hasan Kasule hasargued that:
Secularized European law denied moral considerations associated with ‘religion’ and thereforefailed to solve issues in modern medicine requiring moral considerations. This led to the birth of the discipline of medical ethics that is neither law enforceable by government nor moralityenforceable by conscience. On the other hand, Islamic Law is comprehensive and encompassesmoral principles directly applicable to medicine.
He in fact goes on to claim that the secularised approach of the European philosophersthat disregarded religion was inferior and created a dilemma for them but that the:
Muslims did not face (such) a similar dilemma because Islamic Law, unlike European secular law,is based on a complete system of morality and can therefore handle all moral problems that arisein medicine from a legal perspective. It also is very flexible being adaptable to many new andnovel situations. Strictly speaking, Muslims do not need to talk of ethics as a separate disciplinebecause it is already included in their Law. It was unfortunate that Muslims with the richintellectual heritage of 
usul al fiqh
followed the Europeans into the lizard hole by copying andusing inferior European ethical theories, principles, and rules.
The question that arises is whether Western law is as secularised as claimed by OmarHasan Kasule and really a ‘lizard holecreated by ‘inferior European ethical theories,principles and rulesand theological principles totally disregarded? Some Westernwriters such as Cahill
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have in fact argued and concluded that:
(T)he idea that theology has disappeared from public bioethics is a fallacy that distracts attentionfrom the competing and equally elaborate symbolic narratives of science, the market and liberalindividualism. (T)heological accounts of meaning and transcendence were never reallyevacuated from the spheres of human health, and of institutional allocation of the goals necessaryto health and well-being.
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The same writer in her paper has maintained that three or four decades ago, theologianslike Paul Ramsay, James Gustafson, Richard McCormick and Karen Lebacqz served onthe
Protection of Human Subjects of Biomedical and Behavioral Research
(1974) and the
President’s Commission for the Study of Ethical Problems in Medicine and Biomedicaland Behavioral Research
(1979).
She goes on to give by way of example the role
 
3played by Gustafson
who does not disregard universally religious values when hedefined the contributions of theologyto medical ethics by lifting three themes:
God intends the well-being of creation.
God preserves and orders the creation, as well as creates new possibilities.
Humans are finite and sinful agents who have great power to determine whetherthe well-being of the creation is sustained or not
.
Beauchamp & Childress
have identified four broad principles of biomedical ethics that,while being secular, do not contravene any religious or cultural values. The fourprinciples are:
Autonomy.
That a patient must give ‘informed consent’ to any medical treatmentthat is proposed.
Beneficence.
This principle reflects the traditional emphasis in medicine on doinggood for the patient.
Non-malefience.
Here no harm should be caused and it in effect reflects theHippocratic maxim
primum non nocere
– ‘first of all, do no harm’.
Justice
. This principle assures that all harm and benefit is distributed fairly.There are indeed many philosophical and theological approaches that may be adopted. If as a starting point one adopts the approach of Stewart & Blocker, the ethical theories canbe broadly divided into four theories that are in turn a result of two basic approaches tothe subject of ethics. The teleological approach emphasises the consequences of anaction. For every action that is taken the question to be asked is – ‘What would theconsequences of that action be?’ The deontological approach on the other handemphasises the ethics of a duty and depends on the question – ‘What are the obligationsin relation to the action?The relationships Stewart & Blocker have ascertained are setout in the diagram below:

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