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由死而觀生的中醫學, Hongzhong Qiu Jan 1999

由死而觀生的中醫學, Hongzhong Qiu

International Journal of Chinese & Comparative Philosophy of Medicine

The theoretical basis of traditional Chinese medicine lies in Confucianism and Daoism. Hence traditional Chinese medicine's perspectives on death have continuity with both the Confucian and the Daoist views on death. This essay analyzes many ancient Chinese medical texts and tries to articulate their views on death and dying.

Concerning the definition of death, traditional Chinese medicine offers two theories. One theory sees death as the loss of shen (spirit) or the separation of shen (spirit) from the body. Shen is located in our vital organs, not just in the brain. Another theory sees death as the dispersion of ...


放棄知情同意:一個尚未成熟的想法, Becky Cox White, Joel Zimbelman Jan 1999

放棄知情同意:一個尚未成熟的想法, Becky Cox White, Joel Zimbelman

International Journal of Chinese & Comparative Philosophy of Medicine

在晚近對知情同意的批判裏,Robert Veatch論證, 這種實踐之發展目標,在原則上是無法達成的。筆者則認為,Veatch以病人最佳利益之決定在理論不可能性為焦點,被誤用到醫療的實踐學科裏,而且,他誤以為病人/醫生的溝通,無法提供確保病人最佳利益的知識。筆者亦將推斷,Veatch倡議的那種以價值為基礎的專業配對,根據他自己的標準來看,是不可能落實的。最後,我們要重新檢視知情同意在哲學和實踐上的成立理由,並歸結核實踐應該保留下來。


遺傳聯繫、家族關係和社會紐帶:面對遺傳知識的權利和責任, Rosamond Rhodes Jan 1999

遺傳聯繫、家族關係和社會紐帶:面對遺傳知識的權利和責任, Rosamond Rhodes

International Journal of Chinese & Comparative Philosophy of Medicine

目前,涉及遺傳聯繫的一些意義重大的道德問題與遺傳知識有關。在這篇文章中, 我沒有著眼於通常提到的專業或公共機構對個人負責的問題,而是著手談論就遺傳知識而言,個人應相互負有的責任。我提出:個人在不提供社會的群體遺傳學知識、不增加他們家族的遺傳歷史知識、不發現關於他們自己和他們後代的遺傳信息的情況下,是否具有追求自己目標的道德權利。這些問題引導我們考察對遺傳不知的推定權利並探究各種各樣的社會紐帶。根據上述考慮我分析了幾個案例,從而導致了一些意想不到的結論,觸及了廣為人們接受的遺傳諮詢規則,也獲得了對典型問題的倫理學洞察力,並且進一步引發了未被答覆的面對遺傳知識個人所負何種責任的問題。


萬物之靈與死亡:我們的死亡法律定義在形而上學錯在哪裡?, John P. Lizza Jan 1999

萬物之靈與死亡:我們的死亡法律定義在形而上學錯在哪裡?, John P. Lizza

International Journal of Chinese & Comparative Philosophy of Medicine

本文對1981年醫學以及生物醫學和行為科學研究倫理問題總統委員會的建議提出異議,該委員會建議美國的所有司法機構應該採納統一死亡確定法案,該法採取全腦死亡定義,而不是高級腦死亡定義。我要論証委員會以哲學家們或一般人群對構成“萬物之靈”(personhood)的是甚麼沒有一致意見為理由,擯棄支持高級腦定義的“萬物之靈論據”是錯誤的。我主張,哲學家們同意認識功能的某些潛力是萬物之靈的必要條件,這一條件不存在於無腦畸形和持續性植物狀態(PVS),所以這類人應被認為死人。我進一步論証,一般人群之間缺乏一致意見在很大程度上是由於對PVS的醫學現實有誤解,以及受到對處於PVS的特殊個人的感情的影響。我也考查並反對曾用來支持委員會立場的兩個可能的論據:高級腦定義會威脅年遇老年人和嚴重致殘者,目前沒有充分的醫學技術來確定何時高級腦活動已經停止。


死亡的標準:自我決定和公共政策, Hans-Martin Sass Jan 1999

死亡的標準:自我決定和公共政策, Hans-Martin Sass

International Journal of Chinese & Comparative Philosophy of Medicine

“全腦死亡”標準,在死後器官捐獻和對符合這些嚴格標準的病人終止治療方面,得到了西方文化的支持。但是,它們對亞洲文化和照顧持續性植物狀態的倫理學來說,沒有多少價值。本丈把“包括腦幹的整個腦”的標準作為一種默認的觀點,以此為基礎,本文為綜合性的統一確定死亡法規引入一個公式,但允許有行為能力的成年人通過事先指令在死亡過程中選擇其他確定死亡的標準。


導言:病人自主與醫療行善, Yali Cong, Ruiping Fan Jan 1999

導言:病人自主與醫療行善, Yali Cong, Ruiping Fan

International Journal of Chinese & Comparative Philosophy of Medicine

在臨牀實踐中所說的病人自主是指病人有知情同意的權利。由於醫療本身存在風險、患者的權利意識日益增強、醫生的職務行為有時會威脅到其自身利益,使得患者的決定和醫生的決定時有不一致的情況發生。雖然醫療上的善就是為了患者的利益,但它的實現需要醫生的努力、患者的知情同意等中介條件,於是在臨牀上會出現矛盾。其根本原因應在於知情同意和醫療行善的主體的不一致, 前者是患者,後者是醫生,而二者畢竟不可能在所有的情況下都保持共同的利益,所以在知情同意和醫療行善原則分別指導下的行為會發生矛盾。由於此二原則並無內在的聯緊,亦無絕對的主次之分,更由於醫療行善是個多層次的道德範疇,而知情同意是個相對單一的道德和法律要求,因此二者之間難以完全吻合便構成了臨牀的醫學倫理學難題。


對死者和垂死者的尊重, Anthony Preus Jan 1999

對死者和垂死者的尊重, Anthony Preus

International Journal of Chinese & Comparative Philosophy of Medicine

本文反對永久無意識的人不可能受到傷害,因而得不到道德上的敬重這個論題,並論証:即使是死者也能被傷害和得到道德上的尊敬,所以那些有疑問的或者沒有完全死亡的人更應受到某種道德上的敬重。


儒道死亡思想之比較, Fenglin Jin Jan 1999

儒道死亡思想之比較, Fenglin Jin

International Journal of Chinese & Comparative Philosophy of Medicine

This essay is a comparative and in-depth analysis of the Classical Confucian (Confucius, Mencius) and Classical Daoist (Lao Zi, Zhuang Zi) views on death. Four aspects of these two philosophies of death (attitude toward death, philosophical articulation of the essence of death, valuation of death, and transcending death) are analyzed and critically contrasted.

First, regarding the general attitude toward death, Confucianism is more rational whereas Daoism is more mystical. Confucianism deems that the problem of human life is more important than the problem of human death, and hence speaks little of death. Daoism, however, is strongly against the human tendency ...


隱私與自主:從Warren And Brandeis到Roe And Cruzan, Thomas Halper Jan 1999

隱私與自主:從Warren And Brandeis到Roe And Cruzan, Thomas Halper

International Journal of Chinese & Comparative Philosophy of Medicine

Warren and Brandeis 有關侵犯隱私權之訴訟,有一個主要是社會性目標:獲得法院的同情,強化文明的規範。多年以後,在Griswold v. Connecticut(1965)的案例裏,最高法院宣示以個人為焦點的一項隱私的憲法權利。在這個及往後有關墮胎及「死之權利」的判例裏,即顯然看出,Warren and Brandeis 那種維多利亞式的「不受打擾的權利」(the right to be let alone)已變形為自主的權利,其多種變形使得加以預測甚至是描述,都成為棘手的事。然而,隱私乃是自主的一項不充分的代理(an unsatisfactory proxy for autonomy),也許正因為如此,其作為這些領域中的根據之重要性,已然縮減。


個人自由與責任:以市場為基礎的保健改革之倫理基礎, Robert Emmet Moffit Jan 1999

個人自由與責任:以市場為基礎的保健改革之倫理基礎, Robert Emmet Moffit

International Journal of Chinese & Comparative Philosophy of Medicine

當前的保健系統並不以功能恰當的市場來運作。保健成本被隱激起來,且往往被轉移,而消費者和供給者都受到保護,不受其決策在經濟上的影響,使得成成本大幅上升。柯林頓的計劃不思針對當前以雇主為基礎的保險系統,以及其形成的不平等來對症下藥,反而把不平等擴大,還添加以大量的政府管制。到底選擇以消費者為基礎的系統,抑或是政府控制的系統?這是大眾最終的選擇。以保健改革為基礎的市場,強化了個人的自由與責任,而追求這樣的市場,可滿足兩條倫理原則。其一,美國消費者可察覺到保健服務真正的成本,而市場力量亦因而引起供給者控制成本的動機。其次,公義的需求亦能滿足,理由是,不但醫療服務供給者得到應得者,公共政策製訂者亦能更有效地使最需要的人得到援助。


對原則主義的批判, K. Danner Clouser, Bernard Gert Jan 1999

對原則主義的批判, K. Danner Clouser, Bernard Gert

International Journal of Chinese & Comparative Philosophy of Medicine

在本文作者的用法,『原則主義』(principlism) 是指這樣的做法, 即以「原則」 取代道德理論、特殊的道德規則和理想,來處理源自醫務中的道德問題。作者的論點是,這些「原則」並未發揮原則主義主張的那種功能,而其使用在實踐和理論上都是誤導的。實際上,「原則」並非行為的指導,毋寧說,它們只是名目,指涉處理道德問題時,一組有的待考量,但關係卻慮淺的事項。每一「原則」之間,未有系統性關係,且往往相互衡突。而這樣的衡突是無法解決的,蓋因未有統一化的道德理論,據之而推導出所有原則。為了作一比較,作者勾勒出使用一個統一化道德理論的優點。


醫療行善:中國醫學道德傳統的詮釋, Daqing Zhang Jan 1999

醫療行善:中國醫學道德傳統的詮釋, Daqing Zhang

International Journal of Chinese & Comparative Philosophy of Medicine

China has a long standing of a dominant medical ethical tradition. This tradition can be characterized a medial beneficence. The physician, within this tradition, is morally required to pursue the best interest of the patient rather than the best interest of himself. The practice of this tradition is characteristic of the Chinese culture of family determination on medical issues and is also closely related to the basic virtues approved in the Chinese community.

This tradition is rooted in three primary Chinese religions. First, Confucianism sets the basis of Chinese medical beneficence. Confucianism emphasizes humanity (ren) as the fundamental principle of ...


病人自主決定與醫療行善, Hong Cui Jan 1999

病人自主決定與醫療行善, Hong Cui

International Journal of Chinese & Comparative Philosophy of Medicine

It is important to respect for patients' rights. The patient should be informed of medical interference and the physician must obtain the patient's consent to perform serious treatment. This is a sense of patients' self-determination in contemporary medical practice. This paper argues that, granted its importance, patients' self-determination should not be given unique emphasis independent of physicians' medical beneficence.

The paper considers this issue from both Chinese physicians' and patients' perspectives. First, from the physician's perspective, the role of the physician as a professional ought not to be overlooked. Should the physician play a role no more than ...


導言:確定死亡之醫學及哲學問題, Ping-Cheung Lo Jan 1999

導言:確定死亡之醫學及哲學問題, Ping-Cheung Lo

International Journal of Chinese & Comparative Philosophy of Medicine

This essays begins by noting the brief history of "updating" death since the Harvard Medical School Report in 1968. The deficiencies of this report are noted and the background of the President's Commission's Report on "Defining Death" are briefly explained. The author then discusses and endorses the three-fold distinction in the determination of death as suggested by other scholars, viz., the definition of, the criterion of, and the tests for death. While the test for death is basically a medical issue, and that the definition of death is basically a philosophical issue, the criterion of death is both ...


導言, Ren-Zong Qiu Jan 1999

導言, Ren-Zong Qiu

International Journal of Chinese & Comparative Philosophy of Medicine

我們用“遺傳學與倫理學”為題作為最後一期來告別20世紀和舊的千年,迎接新的21 世紀和新的千年。20世紀的最大科學技術成就之一是我們深入人類細胞核的秘密,圍繞發現DNA 的雙螺旋結構和人類基因組計劃建立了新的遺傳學和人類基因工程。在新的21 世紀,可以預期隋著人類基因組DNA的測序和繪圖的完成,人類基因結構、功能和表達的調控的進一步暸解,醫學將發生新的革命。一方面,人類的疾病將得到進一步的控制,其中許多將得到治療,人類的健康將得到進一步的維護和促進,預期壽命將大為延長,生命質量將不會因壽命延長而日益降低;但另一方面人類的生老病死的自然安排將更加被人工安排所排擠,由此提出的社會、倫理和法律問題將更加尖銳,不同道德共同體和不同文化在這些問題上的碰撞將更加激烈。生命倫理學在這些領域上的學術爭論和政策分析將給21世紀的人類帶來更多的“光”和“泉”(培根)。


基因資訊--文化與後現代倫理觀, Shiu-Ching Wu Jan 1999

基因資訊--文化與後現代倫理觀, Shiu-Ching Wu

International Journal of Chinese & Comparative Philosophy of Medicine

If machine engine is the emblem of the industrial age, computer for the advanced industrialization, it would be safer to say that genetic information revealed through decoding genome can be an emblem of the ongoing postmodern age. Leaving safety and availability issues aside, the rapid development of genetic technology, including artificial reproduction, genetic therapy, genetic engineering and cloning, opens many choices never thought before. Likewise, it also radically challenge our traditional way of handling with giving birth, enhancing health, curing disease and improving farming productivity. Many questions arise, such as, would it be moral to reproduce by way of 'unnatural ...


“扮演上帝”與生殖系干預, Ted Peters Jan 1999

“扮演上帝”與生殖系干預, Ted Peters

International Journal of Chinese & Comparative Philosophy of Medicine

對於新聞記者來說如此熟悉的短語“扮演上帝”在關於生殖系的遺傳干預的爭論中顯現出重要的意義。雖然在“扮演上帝”這個短語中蘊含著人類自鳴得意所帶來的危險,但在這裏特別注意基督教的那種按神的形象創造的人的概念。人類被賜予了“被創造的創造夥伴”的稱號。有鑒於此,在考查和反駁禁止生殖系干預的倫理時,以一種開放的態度來讓這一世代對我們後代擔負創造性的責任。


人類遺傳學家的社會責任, Huan-Ming Yang Jan 1999

人類遺傳學家的社會責任, Huan-Ming Yang

International Journal of Chinese & Comparative Philosophy of Medicine

The advances of the world-wide Human Genome Project and other research in this field have led to the explosion of knowledge about our genes which are so widely and deeply involved in our lives. The knowledge and related technologies have already made a great impact on the whole society.

Science is only good when it is applied to the society in a proper way. Science has proved itself a double-edged sword. The sword is in the hands of the scientists who should be closely observed by the public. As human geneticists, we should be the best to know that genes ...


中國文化視野中遺傳知識的應用, Xin-He Hu Jan 1999

中國文化視野中遺傳知識的應用, Xin-He Hu

International Journal of Chinese & Comparative Philosophy of Medicine

The solutions or resolutions of ethical issues in genetic screening and testing as well as in other fields are shaped by a framework of ethical principles. Now the three (or four) basic ethical principles, i.e. beneficence (or plus nonmaleficence), autonomy and justice which were developed in a medical context of Judeo-Christian culture have been widely accepted in the world as well as in some countries with non-Judeo-Christian culture. So it can be said that these principles form a common framework in the international community, and more or less became universal principles in the world. However, when applying these principles ...


在遺傳醫學中能否區別增強與預防?, Eric T. Juengst Jan 1999

在遺傳醫學中能否區別增強與預防?, Eric T. Juengst

International Journal of Chinese & Comparative Philosophy of Medicine

對使用人類基因轉移技術治療健康問題與使用該技術增強或改善正常人遺傳特性加以區分已成為討論基因治療倫理學的標準。一些人對這一區分的規範力提出質疑,認為這忽視了如何在醫學上合法使用人類基因轉移技術預防疾病。例如,用基因工程增強免疫功能,改進DNA修復功能或增添細胞受體獲得和處理膽固醇的功能。一些批評者認為。如果疾病預防是醫學的正當目標,使用基因轉移技術增強人類健康維護能力將有助於實現這一目標。然而,“治療/增強”的區分法不能對合法的基因治療進行界定。我論證在基因治療的預防與增強(以及在基因治療醫學方面的正確使用與基因治療非醫學方面的使用)之間能夠劃一條線,但只有你願意接受以下兩種老式的主張:1)一些健康問題最好被理解為體現在生物系統中的各種過程或部分的實體,至少具備了像受抑制的功能一樣的本體論客觀性與理論意義。2)合法的預防性基因保健應該限於努力保護人的不受更強有力的病理實體的侵襲,而不是改變他們的身體以逃避社會的不公正。


科學與政治:遺傳學歷史上的辛酸教訓, Ren-Zong Qiu Jan 1999

科學與政治:遺傳學歷史上的辛酸教訓, Ren-Zong Qiu

International Journal of Chinese & Comparative Philosophy of Medicine

What happened in Nazi Germany or Nazi Genetics and eugenics left us a grave lesson we should never forget. We must keep in our mind that everybody is ethically and legally equal regardless of race, healthy or ill, smart or retarded, and enjoy equal rights including life, Health, marriage and reproduction. Calling retarded "inferior" is a discriminatory action. Science, medicine and genetics aim at "better life for all", should not do harm to anybody who comes to seek help. Technologically possible does not amount to ethically obligatory. Technological imperative is untenable and harmful. State intervention in to private affairs such ...


對兒童進行遺傳檢測, Ellen Wright Clayton Jan 1999

對兒童進行遺傳檢測, Ellen Wright Clayton

International Journal of Chinese & Comparative Philosophy of Medicine

在這篇文章中,作者主要論述了在給兒童作遺傳檢測問題上,父母與醫生誰更有決定榷。她認為,父母應該更有理由判定遺傳檢測對於他們的孩子是否有好處。而且他們在作選擇時,可以適當考慮其利益(除了孩子利益之外)。然而,醫生認為,遺傳檢測會對孩子為生極危險時,他們可以拒絕執行父母對於該孩子進行檢測的要求。對於一系列案例的討論將說明在此問題上如何平衡父母與醫生對此問題的控制。對父母要求檢測攜帶者的狀況和對遲發疾病的遺傳傾向,通常有理由加以拒絕。作者通過討論為甚麼隨著孩子年齡的增長而逐漸遵從他們的意見是適當的這一問題而對她的分析做出了總結。


導言, Zhizheng Du Jan 1999

導言, Zhizheng Du

International Journal of Chinese & Comparative Philosophy of Medicine

當今,衛生保健體制的問題,已經成為包括發達國家,發展中國家等不同類型國家朝野上下共同關心的社會問題。醫療新技術的廣泛應用,老年人口的激增,慢性病及非感染性疾病等無窮無盡的救治,使得醫療保健費用飛漲,政府, 企業和個人都不堪重負。醫療費用的飛漲,不僅危及醫療保健的覆蓋面,而且威脅着許多醫療機構的生存,因而不約而同地呼籲保健體制的改革。

問題是同一的,但開出的藥方卻大相徑庭。保健體制改革的目標是什麼?醫療保健服務體制改革的基礎和價值是什麼?保健服務是否應當充分運用市場?政府應否干預?在保健體制改革中如何尊重個人的自由?本期發表中美學者的幾篇文章,向讀者提供了這一討論的概貌。


衛生保健體制改革:理性與現實的選擇, Zhizheng Du Jan 1999

衛生保健體制改革:理性與現實的選擇, Zhizheng Du

International Journal of Chinese & Comparative Philosophy of Medicine

Health care costs soar and become unbearable everywhere in the world. This is not only a problem faced by developed Western countries. It is also a difficult issue for the third world countries such as China. China's health care system needs reform. On the one hand, a great number of people have not been covered by any basic health insurance. On the other hand, however, critical care medicine in high-technology hospitals in urban areas consumes tremendous public health care resources for a very small group of patients. This essay argues that China should appropriately establish multiple goals for its ...


公平的照護:奧瑞岡、保健限額分配,以及知情的民主考量, Leonard M. Fleck Jan 1999

公平的照護:奧瑞岡、保健限額分配,以及知情的民主考量, Leonard M. Fleck

International Journal of Chinese & Comparative Philosophy of Medicine

本文要論證,國家的健康改革努力,理應參照奧瑞岡(Oregon)十一項關鍵的教訓。特別是,我們要理解到,保健限額分配(health care rationing)是無可避免的,限額分配過程一定要公開透明,而公平限額分配的草案,亦必須通過一個理性而民主的量(rational democratic deliberation)過程有自我強加的(self-imposed)。本文第一部分點出,限額分配 乃是我們當前保健系統的一個特徵,但大都是隱而不現的限額分配,應當算是不公乎的。本文第二部分要論證,保健限額分配的需要是不可避的。作為一個限額分配模式,奧瑞岡是有瑕疵的,但在全國性的保健改革上(第三部分分析並維護這樣的改革),確能被我們吸取值得學習的道德教訓。這些教訓最有意義之處,是表明了為一個社群開展一個公平的限額分配草案上,理性而民主的考量是重要的。在第四部分,筆者勾勒出這種進路在哲學上的成立理由,並回應丹尼爾某些重要的批評。


公義為綱、融資為目:香港醫療制度改革的社會公義問題, Ho-Mun Chan Jan 1999

公義為綱、融資為目:香港醫療制度改革的社會公義問題, Ho-Mun Chan

International Journal of Chinese & Comparative Philosophy of Medicine

This paper discusses the financial arrangement of the healthcare system and the issues of justice arising from healthcare reform in Hong Kong. The current Hong Kong public healthcare system is quite efficient. The population of Hong Kong has higher life expectancy and lower infant and maternity mortality rates than that of many developed countries, such as the United States. However, the public expenditure in healthcare in Hong Kong only amounts to 2.18% of GDP. This is much lower than most of the developed countries although the per capita income of Hong Kong has surpassed that many industrialized nations, including ...


美國該創造一個保健系統嗎?, Laurence Mccullough Jan 1999

美國該創造一個保健系統嗎?, Laurence Mccullough

International Journal of Chinese & Comparative Philosophy of Medicine

有一種正統說法已然形成,它聲稱美國保健系統有危機,需要加以改革。本文挑戰這種正統說法,其方法是指出美國並沒有保健系統。我們有一個保健的非系統(a non-system of health care),正如同實質上我們所有基本的社會制度那樣。挑戰當前的正統說法,使一直都受忽略的兩個倫理議題浮出檯面:創造一個保健系統會(1)使家長主義再次檯頭並(2)威脅到道德多元論。


救援與責任:學會在限制中生活, Haavi Morreim Jan 1999

救援與責任:學會在限制中生活, Haavi Morreim

International Journal of Chinese & Comparative Philosophy of Medicine

醫療保健權利的普遍化仍然是個夢想,尚未成為現實。部分原因在於求援規則(rule of rescue),促使我們救援身處困境的人,因而令我們忽視保健政策的限制,只要政策很可能損及特定的個人。由於救援規則動搖了我們對保健權利的限制,因而可能防礙了我們對成本之控制。但成本控制卻又是擴大保健取得之關鍵。因此,我們至今的做法,不是接受無限制的保健支出,而是拒絕將保健權利普遍化。這種情形日益惡化,因為病人和醫生得到保護,不受到保健成本在經濟上的影響,甚至都認為保健乃是免費的、是一項無限制的權利。為了扭轉這種花大錢的權利心態,並對求援有合理的限制,成們必須讓病人體會到其保健決策的某些後果,從而為其保健成本承擔更大的責任。有好些方法可以用來達成這項目標,而無須對所需要的保健設下經濟的障礙,或對病患形同懲罰。


中國醫院經營面臨的主要問題及對策, Hao Wang Jan 1999

中國醫院經營面臨的主要問題及對策, Hao Wang

International Journal of Chinese & Comparative Philosophy of Medicine

At the threshold of a new millennium, China's hospitals face a series of problems in their management. This essay attempts to analyze these problems and explore appropriate solutions to them.

First, the contemporary Chinese pattern of medical education is not suitable to the rapid growth of medical knowledge. Ever increasing new theories, methods, and technologies in diagnosis, therapeutics, and prognosis promote the quality of medical care tremendously. However, most health care professionals in China's hospitals are unable to follow up-to-date developments of medical information. Very few medical scientist s or physicians in China's medical care field are ...


中國農村貧困地區衛生保健問題及對策, Wujing Luo Jan 1999

中國農村貧困地區衛生保健問題及對策, Wujing Luo

International Journal of Chinese & Comparative Philosophy of Medicine

Approximately sixty million Chinese people live in China's poverty-stricken rural areas (annual income per capita is lower than 400 Chinese yuan, or US $50). Most people in these areas do not have any level of health insurance. About 72.6% of the individuals who need to visit physicians are not unable to do so because of financial difficulties. The death rate of newborns is as high as 10%. Many households are caught up in a vicious circle: they contract disease because of poverty, and they become poor because of disease.

It is vitally important to establish a basic level ...