February 2013 issue

Medical ethics – Where does the buck stop?

Wikipedia describes medical ethics as a system “of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.”

In 1955 two philosophers Thomas L. Beauchamp and James F. Childress put forward the principles of medical ethics. They identified four principles, which have become the cornerstone of medical ethics. 1. Do the best for the patient (beneficence) 2. Do no harm (non malfesance) 3. Autonomy  4. Justice.

However, with growing commercialisation and greed of medical professionals, medical ethics is a term to be referred to only in textbooks. As patients are treated as customers or guinea pigs, there is growing mistrust between doctors and patients. Regulators like Medical Council of India (MCI) and other bodies too are shrouded in controversies. So who will bell the cat?

The February 2013 issue of OIOP is on this frequently debated topic - Medical Ethics. Eminent doctors and other professionals candidly speak on the rot that has set into the system and stress upon the need for medical professionals to uphold the principles of medical ethics. We hope that the issues debated help in bringing awareness and the regulating bodies, the government and the doctors work together to rebuild the lost trust in the medical profession.

In ‘The grey areas’, Dr. G. D. Ravindran, Professor of Medicine and Medical Ethics, Head of Dept of Medicine and Medical Ethics, St. John’s Medical College, Bangalore, writes that there are no black and white solutions to ethical problems in medicine. It is a grey area through which a doctor has to wade through. Decisions made should have a solid basis on the principles of medical ethics, as he suggests how some of the road blocks can be removed and an ethical medical profession can be a reality.

In ‘Whither trust in doctor-patient relationship?’, Dr. Vijayaprasad Gopichand, community health physician, currently pursuing PhD in Public Health Ethics from the School of Public Health, SRM University, Tamil Nadu, says that good doctor-patient relationships are extremely rewarding and enriching for both the doctor and the patient. The bond can be built by communication and showing compassion towards the patient, he adds.

In ‘Ethics and law in conflict’, Dr. Lalit Kapoor, a General and GI surgeon and founder, Medico-Legal Cell, Association of Medical Consultants, Mumbai, writes that the Medical Code of Ethics is out of sync with times and the Medical Council Act is a flawed piece of legislation which needs re-crafting. He calls for a greater autonomy for the medical councils and hopes that they are kept free from political interference. Dr. Kapoor has also authored a book Better Safe than Sorry–Medico-Legal Dos and Don’ts.

In ‘The unholy trade’, Dr. Samiran Nundy and Dr. Vibha Varma, say that organ transplantation is a life saving and life enhancing procedure but is accompanied by a host of problems which involve cost, doing harm to a living donor, curbing the organ trade and deciding on an equitable and just way to distribute organs. We are still far from finding solutions to these problems.

Dr. Samiran Nundy heads the Surgical Gastroenterology and Liver Transplantation Department at Sir Ganga Ram Hospital in New Delhi and is also the Dean of the Ganga Ram Institute for Postgraduate Medical Education and Research and Editor-in-Chief of the website DrRaxa.com.

Dr. Vibha Varma is a Consultant in the department of Surgical Gastroenterology and Liver Transplantation Department at Sir Ganga Ram Hospital.

In ‘Partners in crime’, Sunita V S Bandewar, currently an independent researcher in global health and bioethics, writes that by being party to sex-selective practices, medical professionals have been contributing to strengthening cultural norms and practices that are gender discriminatory as it works against girls.

In ‘Clinical trials - shrouded in controversies’, Dr. Reba Kanungo, Dean-Research and Head of Clinical Microbiology at Pondicherry Institute of Medical Sciences, observes that clinical trials in India are raising questions on ethics. Expansion of knowledge through medical research must not lose track of the basic principles of ethics when it involves human participants, she adds. Dr. Kanungo is also the President of The Indian Association of Medical Microbiologists.

In ‘Who is a ‘next friend’, Neha Madhiwalla, coordinator of the Centre for Studies in Ethics and Rights, Mumbai, questions how an institution can be a ‘next friend’ in euthanasia cases, as she feels only a human being can produce such an altruistic response, not an institution. Madhiwalla is also the managing trustee of Chehak Trust, an organisation involved in developing community based models for education, life-skills and disability rehabilitation.

Know India Better: This issue we take our readers to the serene Meghalaya through the feature ‘In the Abode of Clouds’. Meghalaya, literally means ‘The abode of clouds’ and it does appear to be so when you see the glorious mountains bathe in the morning fog. Katie Dubey had an amazing experience exploring the exuberant state, wading through sparkling lakes, staring at alluring waterfalls, crawling through Mawsmai caves, feeling the richness of vast forests, being one with the tribal populace, admiring the beauty of the churches and wandering the streets of the busy capital town of Shillong. Katie is the author of three coffee-table books and writes for various newspapers and magazines on nature and environment.

In ‘Face to Face’, Dr. Amar Jesani speaks to Rajlakshmi Pillai about declining ethics in medical profession but hopes that with growing awareness in society regarding laws and ethics, medical professionals will make efforts to put their house in order.

 Dr. Jesani is an independent consultant, researcher and teacher in bioethics and public health. He has been researching on human rights, medical ethics and public health since three decades. He is one of the founders of the Forum for Medical Ethics Society and its journal, IJME (Indian Journal of Medical Ethics); and is presently its editor. He is also a Trustee of Anusandhan Trust, which runs CEHAT (Centre for Enquiry Into Health and Allied Themes) and CSER (The Centre for Studies in Ethics and Rights) in Mumbai and SATHI (Support for Advocacy and Training to Health Initiatives) in Pune.

General section:

In ‘India needs to stand up to China’, P. M. Kamath, currently, Director, VPM’s Centre for International Studies (Regd), Mumbai and Adjunct Professor, Department of Geopolitics and International Relations, Manipal University, opines that China in reality has gone from assertiveness to aggressiveness in its policy toward India. India, he says should regain her strength by standing up to China and assert its legitimate role in international relations. This will also win back her South Asian friends. Kamath is former Professor of Politics, University of Bombay and his book on India-China Relations for Asian Century (Gyan, 2011) deals with some issues raised in this article.

In ‘Where does your city’s garbage go?’, Disha Shetty, pursuing a post graduate diploma in Broadcast Journalism from the Asian College of Journalism, Chennai, brings you a slice of life from Kodungaiyur garbage dump yard, a part of Metropolitan Chennai. She meets children who are school dropouts and live on the waste. Her article highlights the conflict between the residents and the local municipal corporation in metros that arises due to the close proximity of dumping grounds near residential colonies which pose a health hazard to the people.

OIOP February 2013 highlights the significance of the National Science Day celebrated on February 28, each year. Arvind Gupta, a scientist and winner of the inaugural National Award for Science Popularization amongst Children in1988. emphasises the need to inculcate scientific temper in society, initiating activity based learning in schools and promoting a cost-effective science activities programme in villages and municipal schools of India. This, he says would be a lasting tribute to the vision of Sir C. V. Raman – whose work we celebrate as the National Science Day. Gupta works in IUCCA’s Children’s Science Center in Pune and shares his passion for books and toys through his popular website http://arvindguptatoys.com.

In ‘Youth Voice’ Sakshi Nanavati, who works as a Senior Executive at the Royal Bank of Scotland (Mumbai) writes on how a common culture and tradition binds Indians. Stating that an independent nation is a gift to us from ancestors, she calls upon the youth to nourish this independence to build a country that stands on the ideology of One India, One People. Sakshi is a gold medalist in MA Economics (May 2011) from SNDT University. She is a visiting faculty at ITM Institute of Management and since seven years, she has been a part of Rotaract, an international voluntary youth organisation and the youth wing of the Rotary. 

In ‘Great Indians’ we feature:

Chempakaraman Pillai, The spirited and daring fighter (1891-1934);

 

Lt General Ranjit Singh Dayal PVSM, MVC, The hero of Haji Pir (1928-2012) and

Captain Keishing Clifford Vincent Nongrum MVC, The daredevil Captain (1974-1999).

And also read our regular columns and other features. To book a copy, email to oiopfoundation@gmai.com / oiop@vsnl.net or call Nagesh Bangera, OIOP Subscription-in-charge at 022- 2353 44 00.

We look forward to your feedback.