In the second of a set of three articles concerned with "bioethics on the Pacific Rim," Ratanakul, director of a research center for Southeast Asian cultures in Thailand, provides an overview of bioethical issues in his country. He focuses on four issues: health care allocation, AIDS, determination of death, and euthanasia. The introduction of Western medicine into Thailand has brought with it a multitude of ethical problems created in part by tension between Western and Buddhist values. For this reason, Ratanakul concludes that "bioethical enquiry in Thailand must not only examine ethical dilemmas that arise in the actual practice of medicine and research in the life sciences, but must also deal with the refinement and clarification of applicable Thai cultural and moral values."With the advance of industrialization in Thailand, the country's health care sector faces a host of ethical problems that have arisen from the clash between Western medical models and Thai culture. The most prominent of these problems centers on the question of just distribution of health care. While 80% of the population still lives in rural areas, 62% of the doctors practice in the large, modern hospital located in urban centers. While the majority of the population lacks basic health care, the government devotes most of its resources to diseases that affect few people, such as cancer and heart diseases. This distribution imbalance runs counter to traditional Thai morality, based on the Buddhist principle of justice -- "do not harm." Following this principle would require an increase in the number of provincial hospitals and rural health clinics, and perhaps greater incentives for doctors who practice in rural areas. Besides the issue of imbalance, the spread of AIDS has also raised ethical concerns. Initially, the government refused to disclose statistics on the disease, hoping to avoid panic, but public pressure changed the secretive manner of addressing AIDS. The increase in attention has raised the question of voluntary HIV-testing. Because Thai culture does not emphasize respect for individual rights, most people fear reprisals from testing positive. The government needs to pass regulations protecting the interests of these people. Another cultural clash centers around the definition of death. Western standards (whether the traditional hear-lung or the new brain-oriented criteria) run counter to the traditional Buddhist conception of a lifespan. In a related issue, Thai Buddhist attitudes towards killing, understood to be acts of hatred, have led to conclusion that euthanasia is immoral, even when a doctor performs a "mercy- killing," or when the life involved is that of an impaired newborn. In order to sustain the life of an impaired newborn, scarce resources are used up. In Thailand's health care sector, ethical dilemmas are not confined to the actual practice of medicine, but include the country's cultural values.