Role of Ministry of Health in Malaysia Essays

Role of Ministry of Health in Malaysia Essays Role of Ministry of Health in Malaysia Essay Role of Ministry of Health in Malaysia Essay The Ministry of Health’s role is basically to lay the policy and the direction of health services in the country and to show the commitment of the Government, and the powers-to-be, that health is of utmost importance in nation building. And the role of the ministry is to enforce regulations and be the regulator. Imagine if there is no Ministry of Health, anybody can make the claim that their product is the best for health; anybody can set up a hospital. Nobody to regulate the quality of the workforce involved the quality of healthcare, and the quality of equipment. So the Ministry of Health has a big role as a regulator and policy maker. The Ministry of Health, being the lead agency in health provides leadership on matters relating to health and also sets the direction for health care development in the country. During the Ninth Malaysia Plan period (2006 – 2010), efforts will be undertaken to consolidate health care services, enhance human resource development and optimize resource utilization. The Strategic Plan for Health is a summary of the Country Health Plan, which was developed for the Ninth Malaysia Plan (NMP). It is intended to be a quick reference for all programs, institutions and state departments under the Ministry of Health to ensure that all activities and resources are directed towards similar goals. Achieving the Ministry’s mission and goals will require sustained commitment. The plan will not only serve as a guide within the Ministry of Health, but will also provide a framework for other stakeholders to work together towards improving our health care system. Without doubt, Malaysia has one of the best health systems in the region. The recently released Country Health Plan: 9th Malaysia Plan 2006-2010 has detailed out the health plan for Malaysia. Much effort had been put into its development. It involved months of deliberations and serious thoughts. Multiple parties, both from within and outside the Ministry of Health, had come aboard to contribute to its contents. Many a supporting document had been scrutinized. The Strategic Plan presents the Country Health Plan at a glance. It is intended to be a guiding light, for all programs, institutions and state departments under the Ministry of Health, to ensure that no activity and resources go astray; that they are aligned along the same intended path. The health status of Malaysians has improved significantly since the nation achieved its independence in 1957. Despite such success, there remain issues and challenges that need to be addressed. These matters in question range from the evolvement of disease patterns to the administration of health services. As the custodian for health in the country, it is imperative that the Ministry of Health addresses these concerns in the interest of boosting the system which in turn will ensure the health of the people. The Ministry of Health shall give emphasis to the changing patterns of communicable as well as non-communicable diseases, including mental health. At the same time, it will persevere to provide universal coverage of healthcare services at affordable costs. Provision of quality of services and optimization of health resources, in the forms of human, financial, infrastructure and technological will be given priority, both in the public and private sectors. The Ministry of Health will also not overlook the marginalized population such as the underprivileged and elderly as well as those living in the remote parts of the country. At present, the Ministry of Health’s initiatives at reforming healthcare are in progress to support these efforts. Its feat at enriching the health status of Malaysia depends greatly on the promotion of wellbeing to individuals and communities. It shall rely on the awareness, conduct and use of research evidence to continually improve its performance to meet local and global demands. The areas of health care quality, tourism and informatics shall be strengthened to provide the Ministry of Health with the competitive edge on the international platform. The Ministry of Health’s vision for health is to make Malaysia as a nation of healthy individuals, families and communities, through a health system that is equitable, affordable, efficient, technologically appropriate, environmentally adaptable and consumer-friendly, with emphasis on quality, innovation, health promotion and respect for human dignity and which promotes individuals responsibility and community participation towards an enhanced quality of life. The Ministry of Health has a mission to build partnerships for health, to motivate and facilitate the people to fully attain their health potential, appreciate health as a valuable asset, and to take positive actions to further improve and sustain their health status. The Ministry of Health’s vision for the future and the strategic objectives are based on its corporate values that incorporate professionalism, teamwork and caring. The Ministry of Health has some strategic goals which are to prevent and reduce the burden of disease, enhance the healthcare delivery system, optimize resources, improve research and development, manage crisis and disasters effectively, and to strengthen the health information management system. Ministry of Health has some strategies. First, they want improve governance, and adoption of appropriate technology and service practices to empower individuals, families and communities towards attaining lifelong wellness. Second, they will develop skills and competencies to further reduce mortality and morbidity rates in furtherance of strengthening the quality of healthcare delivery. Third, they aim to establish effective business strategies to enhance organizational performance and the consumption of resources. Then, they will increase the use of evidence through research to support all levels of decision making. Other than that, Ministry of Health will elevate the level of preparedness in managing disasters and health-related crises effectively. And lastly, they will upgrade the standards of information and communication technology as well as health informatics to maintain sound health information management. The Ministry of Health is a vast organization comprising of different Programs and Divisions, with varying functions and responsibilities. These components have in turn formulated strategies to uphold the above strategies of the Ministry of Health. Reproductive medicine is a branch of medicine that deals with prevention, diagnosis and management of reproductive problems; goals include improving or maintaining reproductive health and allowing people to have children at a time of their choosing. It is founded on knowledge of reproductive anatomy, physiology, and endocrinology, and incorporates relevant aspects of molecular biology, biochemistry and pathology. In the assessment of patients imaging techniques, laboratory methods and surgery may be needed. Treatment methods include counseling, pharmacology, surgery, and other methods. Reproductive medicine addresses issues of sexual education, puberty, family planning, birth control, infertility, reproductive system disease (including sexually transmitted diseases) and sexual dysfunction. In women, reproductive medicine also covers menstruation, ovulation, pregnancy and menopause, as well as gynecologic disorders that affect fertility. The field cooperates with and overlaps to some degree with gynecology, obstetrics, urology, genitourinary medicine, medical endocrinology, pediatric endocrinology, genetics, and psychiatry. Reproductive rights are rights relating to reproduction and reproductive health. The World Health Organisation defines reproductive rights as follows: Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence. Reproductive rights is an umbrella terms that may include some or all of the following rights: the right to legal or safe abortion, the right to control ones reproductive functions, the right to access quality reproductive healthcare, and the right to education and access in order to make reproductive choices free from coercion, discrimination, and violence. Reproductive rights may also be understood to include education about contraception and sexually transmitted infections, and freedom from coerced sterilization and contraception, protection from gender-based practices such as female genital cutting, or FGC, and male genital mutilation, or MGM. Reproductive rights were first discussed as a subset of human rights at the United Nations 1968 International Conference on Human Rights. The sixteenth article of the Proclamation of Teheran states, Parents have a basic human right to determine freely and responsibly the number and the spacing of their children. In 1945, the UN Charter included the obligation to promote universal respect for, and observance of, human rights and fundamental freedoms for all without discrimination as to race, sex, language, or religion. However, the Charter did not define these rights. Three years later, the UN adopted the Universal Declaration of Human Rights (UDHR), the first international legal document to delineate human rights. The UDHR does not mention reproductive rights, which were first recognised as a subset of human rights in the 1968 Proclamation of Teheran which review the progress made in the twenty years since the adoption of the Universal Declaration of Human Rights and to formulate a programme for the future. The Proclamation of Teheran states: Parents have a basic right to decide freely and responsibly on the number and spacing of their children and a right to adequate education and information in this respect. This right was adopted by the UN General Assembly in the 1974 Declaration on Social Progress and Development which states The family as a basic unit of society and the natural environment for the growth and well-being of all its members, particularly children and youth, should be assisted and protected so that it may fully assume its responsibilities within the community. Parents have the exclusive right to determine freely and responsibly the number and spacing of their children. The 1975 UN International Womens Year Conference echoed the Proclamation of Teheran. The United Nations Population Fund (UNPF) and the World Health Organization (WHO) advocate for reproductive rights with a primary emphasis on womens rights. In this respect the UN and WHO focus on a range of issues, including access to family planning services, sex education, menopause, and the reduction of obstetric fistula, to the relationship between reproductive health and economic status. The reproductive rights of women are advanced in the context of the right to freedom from discrimination and the social and economic status of women. The group Development Alternatives with Women for a New Era (DAWN) explained the link in the following statement: â€Å"Control over reproduction is a basic need and a basic right for all women. Linked as it is to womens health and social status, as well as the powerful social structures of religion, state control and administrative inertia, and private profit, it is from the perspective of poor women that this right can best be understood and affirmed. Women know that childbearing is a social, not a purely personal, henomenon; nor do we deny that world population trends are likely to exert considerable pressure on resources and institutions by the end of this century. But our bodies have become a pawn in the struggles among states, religions, male heads of households, and private corporations. Programs that do not take the interests of women into account are unlikely to succeed † Attempts have been made to analyse the socioeconomic conditions that affect the realisation of a womans reproductive rights. The term reproductive justice has been used to describe these broader social and economic issues. Proponents of reproductive justice argue that while the right to legalized abortion and contraception applies to everyone, these choices are only meaningful to those with resources, and that there is a growing gap between access and affordability. Mens reproductive rights have been claimed by various organizations, both for issues of reproductive health, and other rights related to sexual reproduction. Three international issues in mens reproductive health are sexually transmitted disease STDs, cancer and exposure to toxins. Recently mens reproductive right with regards to paternity have become subject of debate in the U. S. The term Male abortion was coined by Melanie McCulley, a South Carolina attorney, in a 1998 article. The theory begins with the premise that when a woman becomes pregnant she has the option of abortion, adoption, or parenthood; it argues, in the context of legally recognized gender equality, that in the earliest stages of pregnancy the putative (alleged) father should have the right to relinquish all future parental rights and financial responsibility, leaving the informed mother with the same three options. In 2006, the National Center for Men brought a case in the US, Dubay v. Wells (dubbed by some Roe v. Wade for men), that argued that in the event of an unplanned pregnancy, when an unmarried woman informs a man that she is pregnant by him, he should have an opportunity to give up all paternity rights and responsibilities. Masculists argue that this would allow the woman time to make an informed decision and give men the same reproductive rights as women. In its dismissal of the case, the U. S. Court of Appeals (Sixth Circuit) stated that the Fourteenth Amendment does not deny to [the] State the power to treat different classes of persons in different ways. Reproductive rights are understood to include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence. In this respect compulsory or forced sterilization and abortion is understood as a violation of reproductive rights, particularly when they occur in the context of eugenics programs. The Eugenics movement in North America and Europe at the beginning of the 20th Century led to the widespread forced sterilization of vulnerable populations, including the mentally or physically disabled. In the case of mentally or physically disabled women proponents of compulsory sterilisation may argue that it is in the womens best interest. Forced sterilization and forced abortion has been recognise as crime against humanity if the action is part of a widespread or systematic practice by the Rome Statute Explanatory Memorandum, which defines the jurisdiction of the International Criminal Court. In recent years, reproductive issues constitute a major part of bioethical studies and discussions in most study centers of the world. No other ethical subject matter may elicit more heated controversy at all levels of society. This is not surprising, as reproduction constitutes the most private and intimate aspect of the life of individuals and consequently the most sensitive and fundamental concern of our society. In the past, abortion and sterilization were the foremost reproductive ethical issues which generated controversy and debate throughout the world. At present, topics of Assisted Reproduction and Prenatal Diagnosis have emerged as important reproductive ethical issues in the developed world. The philosophy of Assisted Reproduction or Assisted Procreation is often erroneously referred to as Artificial Reproduction. From a scientific viewpoint, there is nothing Artificial about this technology. Assisted Reproduction technology relies completely on the principles of normal anatomy, physiology, biochemistry, pharmacology, endocrinology and genetics of human reproduction. Since the birth of the worlds first test-tube baby, Louise Browne, in Manchester, United Kingdom in March 1978, there have been considerable developments in new technologies relating to the theme of Assisted Reproduction. We have In-Vitro Fertilisation (IVF), Gamete Intra-Fallopian Transfer (GIFT), Pronuclear Sperm Transfer (PROST), Zygote Intra-Fallopian Transfer (ZIFT) and Direct Intra-Peritonial Insemination (DIPI), all denoted by appropriate acronyms. The rapid development of these Assisted Reproduction procedures within the short span of a decade, has been made possible by numerous technological advances relating to sperm collection and preservation, ova maturation, collection and preservation, in-vitro fertilization procedures, embryo storage, embryo transfer, embryo donation, surrogate motherhood, and more important, to the reproductive endocrinological advances related to all these procedures. It must also be appreciated that for successful implementation of the research and clinical service aspects of the various facets of the new Assisted Reproduction technologies, there must be high quality ethical surveillance to safeguard the legal, religious and social norms prevailing within our society. Pioneer programmes especially those in developed countries already face the issues and problems created by rapid technological advancements outpacing existing medical laws. Doctors and scientists are now urgently seeking professional guidelines or new laws to ensure that rapid advances in research on human embryos do not progress into areas that may be considered repugnant by the community. Legal answers have yet to be formulated for many pertinent ethical questions. The controversial question of what should become of the remaining fertilized eggs (embryos) was debated in Vienna, Austria by the First International Congress of In-Vitro Fertilization in 1983. In view of the need for legal guidelines to regulate the development of in-vitro fertilization programmes, the United States Congress held several hearings on the various implications of artificial human reproduction. In Australia, France and the Netherlands, special committees have been set up to study all aspects of invitro fertilization. In the United Kingdom, the British Government acknowledged the report of the 16-member Warnock Commission of doctors, scientists, lawyers and lay persons which studied and made specific recommendations on this issue. To-date, there are no specific laws or regulations governing artificial insemination and in-vitro fertilization in Malaysia, except for the Medical Act of 1971 on the rules and regulations of medical practice. However, the Indecent Advertisements Act 1953 (revised 1981) could have legal bearings on the publicity and activities of these procedures. Even though a Human Tissues Act of 1974 exists in Malaysia, there is no provision under this Act to effectively control the handling of embryos or human tissues under the invitro fertilization programme. The issues of in-vitro fertilization and embryo transfer (ET) involve more a question of medical and religious ethics. And these matters are usually dealt with by national medical and religious councils. In Malaysia, the various medical and religious councils and the Ministry of Health have to-date, not laid out any standard code of ethics, guidelines or legislation relating to such matters. Considering the benefits that Assisted Human Reproduction can confer on a significant proportion of subfertile couples, estimated at between 10 to 15 percent of married couples in Malaysia, the National Population and Family Development Board (NPFDB) of the Prime Ministers Department has taken the lead to undertake research into this new area of family development. And to formulate guidelines on such procedures and propose subsequently, to monitor the development and expansion of such centres and services in Malaysia. Various religious councils have given their full support in the preparation of Guidelines for the Assisted Human Reproduction Programme. Such modern technologies are welcomed in enabling married couples to fulfill their procreative responsibilities. The support is specifically given for procedures that involve legally married couples in stable union. That is, the biological and social parents of the child would also be the natural parents and that the child would be given all loving care. Reproduction as for the treatment of subfertility, which can enable some subfertile women to conceive and have their children within marriage. A publically assisted programme would carry this philosophy further by bringing down the cost of treatment and ensuring deserving but otherwise nonprivileged couples to have access to such medical innovations (optional). An IVF procedure costs between RM4000 RM6000 in a private centre in Malaysia whereas a public sector sponsored programme for example that at the NPFDB costs only half as much. Capital outlay for clinical and laboratory personnel, operation theatre and reproductive endocrinology set-ups are already available at Government institutions. Medical practitioners, scientists and other allied personnel are urged to cooperate and help formulate the national guide in order to promote family health and welfare in our country. Mental health is a term used to describe either a level of cognitive or emotional wellbeing or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individuals ability to enjoy life and procure a balance between life activities and efforts to achieve psychological resilience. The World Health Organization states that there is no one official definition of mental health. Cultural differences, subjective assessments, and competing professional theories all affect how mental health is defined. Mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture. The recognition and understanding of mental disorders has changed over time and across cultures. Definitions, assessments, and classifications of mental disorders can vary, but guideline criterion listed in the ICD, DSM and other manuals are widely accepted by mental health professionals. Categories of diagnoses in these schemes may include dissociative disorders, mood disorders, anxiety disorders, psychotic disorders, eating disorders, developmental disorders, personality disorders, and many other categories. In many cases there is no single accepted or consistent cause of mental disorders, although they are often explained in terms of a diathesis-stress model and biopsychosocial model. Mental disorders have been found to be common, with over a third of people in most countries reporting sufficient criteria at some point in their life. Mental health services may be based in hospitals or in the community. Mental health professionals diagnose individuals using different methodologies, often relying on case history and interview. Psychotherapy and psychiatric medication are two major treatment options, as well as supportive interventions. Treatment may be involuntary where legislation allows. Several movements campaign for changes to mental health services and attitudes, including the Consumer/Survivor Movement. There are widespread problems with stigma and discrimination. Three quarters of countries around the world have mental health legislation. Compulsory admission to mental health facilities (also known as Involuntary commitment or sectioning), is a controversial topic. From some points of view it can impinge on personal liberty and the right to choose, and carry the risk of abuse for political, social and other reasons; from other points of view, it can potentially prevent harm to self and others, and assist some people in attaining their right to healthcare when unable to decide in their own interests. All human-rights oriented mental health laws require proof of the presence of a mental disorder as defined by internationally accepted standards, but the type and severity of disorder that counts can vary in different jurisdictions. The two most often utilized grounds for involuntary admission are said to be serious likelihood of immediate or imminent danger to self or others, and the need for treatment. Applications for someone to be involuntarily admitted may usually come from a mental health practitioner, a family member, a close relative, or a guardian. Human-rights-oriented laws usually stipulate that independent medical practitioners or other accredited mental health practitioners must examine the patient separately and that there should be regular, time-bound review by an independent review body. An individual must be shown to lack the capacity to give or withhold informed consent (i. e. to understand treatment information and its implications). Proxy consent (also known as substituted decision-making) may be given to a personal representative, a family member or a legally appointed guardian, or patients may have been able to enact an advance directive as to how they wish to be treated. The right to supported decision-making may also be included in legislation. Involuntary treatment laws are increasingly extended to those living in the community, for example outpatient commitment laws (known by different names) are used in New Zealand, Australia, United Kingdom and most of the United States. The World Health Organization reports that in many instances national mental health legislation takes away the rights of persons with mental disorders rather than protecting rights, and is often outdated. In 1991, the United Nations adopted the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, which established minimum human rights standards of practice in the mental health field. In 2006 the UN formally agreed the Convention on the Rights of Persons with Disabilities to protect and enhance the rights and opportunities of disabled people, including those with psychosocial disabilities. The term insanity, sometimes used colloquially as a synonym for mental illness, is often used technically as a legal term. In Malaysia, the Malaysian Medical Council has produced a guideline on Assisted Reproduction. The Malaysian Medical Council, with the objective of ensuring that registered medical practitioners are fully aware of the codes of professional medical practice, issues directives and guidelines from time to time. The purpose of these codes, guidelines and directives is to safeguard the patient and members of the public, to ensure propriety in professional practice and to prevent abuse of professional privileges. The Guidelines are designed to complement, and should be read in conjunction with, the Medical Act and Regulations, Code of Professional Conduct of the Malaysian Medical Council and other Guidelines issued by the Council or any related organisation, as well as any statute or statutory provisions in force and all related statutory instruments or orders made. Assisted reproductive technology (ART) includes a range of methods used to treat human sub-fertility, including in vitro fertilization (IVF), embryo transfer (ET), gamete intra-fallopian transfer (GIFT), and all manipulative procedures involving gametes and embryos as well as treatment modalities to induce ovulation or spermatogenesis when used in conjunction with the above methods. The technology has been developed out of concern for individuals and couples who are unable to have children when they desire them. The very broad range of such desires inevitably raises numerous ethical dilemmas. Reproductive cloning is not allowed and commercial trading in gametes, semen or embryos is prohibited under this Guideline. Explanations of the various treatment modalities used in ART and the ethical viewpoints regarding each modality are also addressed in this Guideline. Assisted reproductive technology (ART): includes a range of methods used to circumvent human sub-fertility, including in vitro fertilization (IVF), embryo transfer (ET), gamete intra-fallopian transfer (GIFT), all manipulative procedures involving gametes and embryos and treatment modalities to induce ovulation or spermatogenesis when used in conjunction with the above methods. The reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health†. These concepts include concern for individuals and couples who are unable to have children when they desire them. However, the above statement has also led to some controversial issue. For examples, a 60 year old woman may request to have assisted reproduction in order to achieve a pregnancy. A lesbia n couple may want to have a child. Although these rights may be viewed differently in different societies and communities, it is important for the medical community to consider these issues in the context of individual rights, societal concerns, the norms of the community and the legal framework of the country. Impaired fertility or sub-fertility may be due to a relative or absolute inability to conceive, or to repeated pregnancy wastage. It affects both men and women in approximately equal proportions, causing considerable personal suffering and disruption of family life. The best strategy of dealing with sub-fertility is its prevention. Although some cases of impaired fertility can be corrected by simple measures, others require complicated diagnostic procedures and treatment. An empathetic approach to individuals and couples who have subfertility problems is required. This includes an appreciation of cultural and social customs, the individual’s perception of sexuality, an understanding of the reproductive function and awareness of the aetiology and prevalence of sub-fertility in the community. Indeed sub-fertility is now accepted as a condition of poor health and there are tremendous social and mental effects on a couple that suffer from sub-fertility. The development of medically assisted conception to help couples with sub-fertility has brought new social, legal and ethical issues related to the management of sub-fertility. Medical practitioners should be fully cognizant of these issues whenever they are in a position to refer patients for treatment or whenever they themselves establish a centre for such activities. These issues involve respect for the dignity and integrity of the human being, protection of human genetic material so that it is not misused or used inappropriately without the donors consent and the need for quality of care. In drawing these recommendations, the following principles have been used as a guide which include first; the respect that is due to human life at all stages in its developments, second; the rights of people who are or may be sub-fertile and the proper consideration of their request for treatment, third; concern for the welfare of children, which cannot always be adequately protected by concern for the interests of adults involved, fourth; recognition of the benefits, both to individuals and to society which can from the responsible pursuit of medical and scientific knowledge, fifth; the sanctity of marriage and the importance of marriage prior to having children is a widely held belief by society in Malaysia, and lastly; the difficulty of forcing potential patients to prove their marital status and maintaining constant checks on the same must be realized as a practical difficulty for medical practitioners. Be that as it may, in this country, assisted reproduction techniques must onl y be offered to married couples. For the principles for quality of care, the practitioner should have an effective system for monitoring and assessing laboratory and clinical practice to ensure that both the procedures and outcomes are analysed and can be shown to be satisfactory on independent assessment. All persons undergoing ART should be adequately tested for transmittable diseases before procedures are performed on them. Detailed records must be maintained and be easily retrievable. The practitioner must maintain accurate record keeping and labeling in respect of gametes and embryos, and he should ensure that proper standards are maintained in storage and handling of gametes and embryos. There should be an effective monitoring system to ensure high standards of security wherever gametes and embryos are handled and stored. Records should enable authorized staff to trace what happens to an individual embryo, oocyte or sperm sample from the date of collection. Centres are responsible for ensuring that standards of quality and security of genetic material are maintained, wherever the material happens to be on the premises. This includes material being transferred from the laboratory for treatment or preparation for treatment. If gametes or embryos are transferred from one site to another, adequate arrangements should also be made to protect their quality and security. Controversies on the use of stored embryos have raised legal disputes, particularly when the couple involved have since separated, divorced or one member has deceased or with disagreement by the next of kin. It is therefore important that information on such matters should be included when taking informed documented consent at the time of initial in-vitro fertilization. The patients generally have the right to give or withhold consent to examination and treatment. No ART treatment should be given to any couple without their written consent to that particular treatment which must be clearly explained to them, including success rates and complications. In the course of the discussion, the following aspects must also be brought up, considered and, where appropriate, consent obtained. Consent must be obtained from couples for the use of genetic material for treatment as well as possibly for research; the latter, however, is still not permitted in Malaysia. The decision and consent whether couples who have had successful assisted reproduction would like either disposal or further storage of genetic material should also be obtained. While couples have the right to determine the period of storage of the genetic material, they must be made aware of the period of maximum statutory period of . ve (5) years, which may be extended to ten (10) years if approved by the relevant authority, at the present this being the Ministry of Health. The couple must also agree that in the event of them getting separated, divorced or one of them becoming deceased, one or the other (next of kin in the case of the deceased) cannot use the stored gametes. The gametes will then be destroyed. Gametes or embryos which have been exposed to a material risk of contamination, which might cause harm to recipients or to any resulting children, should not be used for treatment. The practitioner and the treated couple should agree upon the number of embryos transferred, informed consent documents completed and the information recorded in the clinical record. Multiple gestation is an unintended result of assisted reproduction techniques. Multiple gestation leads to an increased risk of complications in both the fetuses and mother. It would be unethical for the individual practitioner not to generate his or her own data regarding patient characteristics, outcomes and number of embryos transferred in order to minimize these complications. In blastocyst transfer procedure, the embryos are allowed to grow beyond the typical 2-3 days of culture and are allowed to develop to the blastocyst stage before they are transferred to the womb. A higher pregnancy rate is thought to result. There are no ethical objections to this practice as it uses the natural progression of embryo growth. Assisted hatching is a procedure to help in zona pellucida thinning and thus in implantation. This procedure does not alter the progression of embryo growth and therefore there are no ethical objections to this procedure. Eggs, embryos and sperms are donated to treat human sub-fertility in others with the help of assisted reproductive procedures, provided the unethical and prohibited factors, as listed in Section 15, are adhered to. The religious and cultural sensitivities of the patient and the medical practitioner involved in ART procedures should be taken into consideration before embarking on these procedures. There should be no selection of the sex of embryos for social or personal reasons. Sex selection is, however, allowed if a particular sex predisposes to a serious genetic condition e. g. haemophilia, Duchenne muscular dystrophy, fragile X syndrome, etc. Excessive multi-fetal gestation should be minimized by careful induction of ovulation and restriction of numbers of embryo transferred. If despite these measures, more than 3 fetuses are gestated, fetal reduction may be considered if the prospect of fetal viability is compromised or if the health or life of the mother is threatened. Patients should be counselled extensively and informed consent obtained if the procedure is to be performed. A couple undergoing ART should be asked for instruction concerning the storage and disposal of embryos, as discussed under Consent. The termination of the development of a human embryo and the disposal of the remaining materials are sensitive and delicate issues. The practitioner should take full account of this. Specific instruction concerning storage and disposal of embryos must be asked of the couple and informed consent duly obtained. When an embryo is no longer to be kept for treatment, the practitioner should decide how it is to be allowed to perish, and what is to happen to the perished material. The procedure should be sensitively devised and described, and should be communicated to the people for whom the embryo was being stored. Controversies on the use of stored gametes have raised legal disputes, particularly when the couple involved have since separated, divorced or one member has deceased (with disagreement by the next of kin). In such instances, the stored gametes cannot be used independently by either one of the parties involved. It is therefore important that information on such matters should be included when taking consent at the time of initial invitro fertilization, as indicated above. In a surrogate arrangement a women agrees to becomes pregnant and bear a child for another person/persons and to surrender it at birth. The above practice is not acceptable to most of the major religions in this country. Such a surrogate pregnancy can also potentially lead to many legal dilemmas for the persons involved. Cryo-preservation can be used to store sperm. The sperm can be thawed and used for arti. cial insemination or in-vitro fertilisation. The sperm can be stored for future use especially in patients about to undergo chemotherapy. Sperm can also be retrieved from the epididymis or testes in those with blockage of the vas deferens. Proper procedures must be in place for the identfication of sperm specimens. The use of donor semen should be guided primarily by medical needs and the religious sensitivities of the couple and the medical practitioner involved. Pre-implantation genetic diagnosis (pgd) is a procedure involves genetic testing and selection of embryos produced by in-vitro fertilization (IVF). Once an embryo is created using IVF techniques, a cell is removed from the embryo after about three days and tested for specfic genetic abnormalities. Usually healthy embryos will be transferred to the mother’s womb and embryos with the abnormality will be destroyed. At present PGD is used mainly for the diagnosis of many diseases and to determine the sex of the embryo to avoid the transmission of severe sex-linked disease. Some have attempted to select embryos free of genetic disease but of the same tissue type as an existing ill child in order to harvest their umbilical cord blood for transplantation to the affected sibling. As there is no worldwide agreement as to when human life begins or when it acquires moral signi. cance, there is no agreement on the moral status of an embryo2. Nor is there any agreement as to whether discarding an embryo with a genetic disorder, prior to implantation, is the equivalent of an abortion. At present, it is best that PGD be used for only severe and life threatening genetic diseases. It would be unethical to analyse and select the inherited characteristics of embryos (e. g. intelligence, height, hair and eye colour); any social or psychological characteristics or any other condition which is not associated with disability or a serious medical condition. There are some prohibited and unacceptable practices which includes no research or experimentation shall be performed using any human oocyte and/or sperms without the explicit consent of the donors and approval of the appropriate authority. At the present time, such research or experimentation is not permitted in Malaysia. The following practices are ethically unacceptable and are prohibited under this Guideline which are first; developing embryos for purpose others than for their use in an approved ART programme. Second, culturing of an embryo in vitro for more than 14 (fourteen) days. Human oocyte fertilized with human sperms should not be cultured in-vitro for more than 14 days (excluding any period of storage at low temperature). Under no circumstances shall research be carried out on or using human embryos which are more than 14 days old from the date of conception or the appearance of the primitive streak, whichever is the earlier, except with the explicit approval of the authorizing authority, which is at present the Ministry of Health. Third, experimentation with the intent to produce two or more genetically identical individuals, including development of human embryonal stem cell lines with the aim of producing clones of individuals. Fourth, under no circumstances should embryo splitting with the intention of increasing the number of embryos for transfer be allowed. Fifth, using fetal gametes for fertilisation. Sixth, mixing of human and animal gametes to produce hybrid embryos. There shall be no attempt at trans-species fertilization. Seventh, mixing of gametes or embryos of difference parental origin so as to confuse the biological parentage of the conceptus. Eighth, placing an embryo in a body cavity other than the human female reproductive tract. Under no circumstances should a human embryo be placed in the uterus of another species for gestation. Ninth, under no circumstances should the nucleus of a cell of an embryo be replaced with a nucleus of a cell of another person, another embryo or a subsequent development of an embryo. Tenth, under no circumstances should the genetic structure of any cell be altered while it forms part of an embryo. Other than that, embryo flushing, commercial trading in gametes, semen or embryos, pre-implantation diagnosis to create â€Å"designer babies† (those with specfic physical, social or specfic gender characteristics and not for the reason of avoiding serious medical illnesses), the use in ART treatment programmes of gametes or embryos harvested from cadavers and the use of ART in unmarried couples are also prohibited. There is no mention regarding the policies of reproductive medicine among mental health patient. We believe that the application of policy is similar regardless of mental patient or normal patient.