Ethics 1. Is it ethical or not?

Not a day passes without us being given vivid details of this or the other rape case. Today the media is covering the rape of a young hearing impaired girl by a doctor in West Bengal. This caught my attention, because the perpetrator was a doctor. By any criteria, this would be one of the better educated groups in our society and traditionally, doctors were placed next to God. But, of late the profession has certainly fallen a long way into a chasm, mostly because of its own doings. As in this case!!

There is an oft exchanged view within the profession, that Godliness is too much of a burden to carry and the doctor is a part of society and hence would reflect the changing values of society. This, I would agree,  is an argument that cannot be wholly discarded. However, by the very nature of the profession, a doctor has to assume a role that, if not ‘Godly’, is one that has a substantially greater responsibility to society than most others. However, the medical student comes from that very society. Does the training process prepare him for these ‘responsiblities?’

On the completion of training, all graduating doctors take the  the “Hippocratic oath”.  Part of this oath says “Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient.

WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret.”

Thus, the graduating doctor takes an oath to practice ethical medicine. However, what is ethics? The word ethics  as per the Cambridge dictionary is ‘a system of accepted beliefs which control behavior, especially such a system based on morals’ or ‘the study of what is morally right and what is not’. It is usually used in the plural and the usage would be  ‘He said he was bound by a scientist’s code of ethics.’ or ‘Publication of the article was a breach of ethics.’. Ethics as a discipline is ‘the philosophical study of moral values and rules’.

As a medical student, I don’t remember the subject of Ethics as any part of the teaching/training or even the mention of the word at all! So, did I understand the implications of theHippocratic Oath when I took it? Was there any discussions regarding its application to real life scenario? Not that I can remember! However, life was less complicated then and in the initial years of clinical work, under the supervision of seniors, one picked up the essentials, more by imbibation and observation than by any directed guidance and teaching. And, one trusted common sense and good will to guide you through issues that may arose in your practice form time to time.

Unfortunately, things have not changed at all at the one end  while at the other end, nothing is the same. Medical training is more or less stuck in a time warp, and ethics is still not part of any discourse through the 5 and half years of training. The role models are few and supervised acquisition of skills becoming rare as the teacher-student ratios widen and commitment of teachers to teaching declines. On the other hand, the practice of medicine has been transformed and the values of society have changed. The young doctor has to face  the changing demands and perceptions of the patient as well as those of the employer. Other collaborating entities like the pharma sector and laboratories, have a greater role in the overall scheme of things and can put their own agendas on the table and further complicate the scenario.  The young physician has to steer through this maze, ill equipped in terms of knowledge and attitude. So, instead of posing “Is this ethical or not?” at various time points in the day, there is little awareness that there is an ethical issue involved.

Even if there was an awareness, extreme cases like rape will not stop as these are done by people with sick monds.  But if there was the inner voice to ask the question “Is it ethical or not?”, doctors may perform fewer unneeded angiographies and cesarian sections, write fewer prescriptions for various multivitamin combinations, order fewer re-testing from”my recommended laboratory” etc. How to bring about the awareness? Everyone has to play their role. Medical training needs to re-look at itself and change. Patients must question and demand answers from their doctors, pushing them to think. And doctors, must realize that few individuals hold the the kind of social responsibility that they do, the life of the people who trust them with their health, sickness and sometimes life!!

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