MEDICAL ETHICS

It has been the misfortune that recently we have witnessed a very undesirable trend wherein the non-medical public no longer hold the medical profession in high esteem as earlier, DR V N JINDAL x-rays the reasons for this erosion of confidence in the medical profession.

ETHICS IS the science of moral values. The rules of conduct based on moral values which are enunciated by a recognized association are collectively called a Code of Ethics. Medical ethics may, therefore be described as the moral principles which should guide members of the medical profession in their dealings with each other and with their patients. As the principal purpose of the medical practitioner is to render service to suffering humanity, he invites the confidence of those whom he heals and advises. To deserve the full measure of his patient’s confidence he should strive to conduct himself in a disciplined manner.

A survey in 1970 in U.S.A. and another survey in 1990 in India showed that the general public of both the countries held judges to be the most honest and the most respectable among all professionals. Doctors came second in their estimation in both the surveys. All other professionals were ranked lower than judges and doctors. However, it has been the misfortune that quite recently; we have witnessed a very undesirable trend wherein the non-medical public no longer hold the medical profession in very high esteem as earlier. This is basically due to erosion in medical ethics today. Transparency International has recently held the medical profession to be highly corrupt in India. Issues relating to medical ethics today are very many. To discuss the issue of medical ethics, first let’s see what the main aims of a doctor are. A medical man ought to keep in mind four cardinal aims.

PRESERVE LIFE

TO PRESERVE life is one of the most important aims of the doctor. In certain circumstances, however, a doctor is faced with a situation demanding a quick decision as to whether he should sacrifice one life for another. For example, in order to save the life of a mother, it might become necessary to sacrifice the life of her unborn child. By all standards of ethics he will be right in sacrificing the life of the child for the sake of the mother. But a difficult question arises when an attempt to preserve the life would require the doctor to prolong the agony and pain of an incurable invalid. Must he adopt all means possible to continue to preserve life, even though the result would be the continuance of suffering to an incurable invalid? The world over the debate is going on, but no consensus has been reached as yet. This is a very difficult problem to settle as many issues of medical ethics revolve around this.

LESSEN SUFFERING

THE SECOND aim is to cure the illness. When a cure is not possible, the object should be to lessen the suffering. A doctor must also aim at bringing comfort to a patient. A doctor by his sympathetic attitude and care can bring solace to a patient as the patient usually has full faith in him. A doctor deals with human beings. His attitude, his way of handling a patient, his understanding of and his approach to human suffering, all these have a bearing on his ability to inspire confidence in the patient. He should, therefore, mind his language and temper. He is expected to be a gentleman. How many of us in this profession possess this quality?

DISEASE PREVENTION

THE THIRD AIM of a doctor is prevention of disease. Prevention is always better than cure. Today doctors are in a much better situation than their predecessors in preventing diseases. Progress in pharmaceutical and immunology has made it possible for a doctor to prescribe proper medicines and vaccines for the prevention of various kinds of sicknesses.

DISSEMINATE FINDINGS

THE FOURTH aim of the practitioner is to help in the advancement of medical knowledge. If he has discovered something, however small, he should disseminate his knowledge. The easiest way for him is to publish his observations and knowledge in medical journals. If he feels that a particular drug or procedure causes harm to his patients, it is his duty to inform the same to his fellow colleagues. At the same time, every doctor should improve and expand his own knowledge. He should keep abreast of the latest developments in the medical science by reading medical journals.

EXPECTING MIRACLES!

COMING BACK to the topic of ethics, we have to remember that there have been unethical practices in every group, in every profession, in every country and in every century from topmost to the lowest level. There is also no denying the fact that the recent fall in ethical standards is a universal phenomenon and affects all professions. However, the medical profession has been a victim of allegations of unethical practices since time immemorial. This is because the profession deals with human life and whosoever does not get the desired results, blames the profession without realizing that doctors cannot guarantee cure in all cases. A famous Roman writer, Pliny, in the first century A.D. was very critical of the medical profession because of unethical practices followed by doctors at that time. He said, “There is also no law against incompetency; no striking example is made. They learn by our bodily jeopardy and make experiments until the death of the patient, and the doctor is the only person not punished for murder”.

On the other hand Charak Samhita, more than 3000 years ago, enunciated the ethical code for medical men as follows: “Day and night, however thou mayest be engaged, thou shalt endeavor for the relief of the patients with all thy heart and soul. Thou shalt not desert or injure thy patient even for the sake of thy life or living. Thou shalt not commit adultery even in thought. Thou shalt not covet other’s possessions. Thou should be modest in thy attire or possessions. Thou should speak words that are pure, gentle and righteous, pleasing, worthy, true wholesome, moderate. Thy behaviour must be in consideration of the time and place and heedful of past experience…….. While entering a patient’s house thou shall be accompanied by a man who is known to the patient and who has his permission to enter, and thou shall be well clad, self possessed and conduct thyself with dignity. Having entered, thy speech, mind intellect and senses shall be entirely devoted to no other thought than that of being helpful to the patient and of things concerning him only. The peculiar customs of the patient’s house shall not be made public. Even knowing that the patient’s span of life is coming to a close, it shall not be mentioned by thou there, where if so done, it could cause shock to the patient and to the others……” Charaka emphasized that medical practice should be humanitarian ‘A medical teacher should be like a mango tree that gives all its fruits to others and retains none for itself’.

When charges of unethical behaviour are made against the medical profession, one’s response is to deny vehemently that nothing bad is happening at all and to shut our eyes completely to ground realities. Another response is to condemn vigorously, without any objective analysis of the situation, and shout from the roof tops that the guilty should be punished very severely, as we presume we are all lily white saints and only the few who are ‘found out’ are jet black sinners. Probably the best response should be to investigate why certain situations and incidents arise in the present rapidly changing scientific, social, economic and cultural environment and try our best individually and collectively to eradicate the evil.

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