Director, YRG CARE, Chennai - 600 017
Doctor and patient relationship
Story of Mr. A, 33 years is an engineer in a large organization. He was admitted into a corporate hospital due to fever for one month duration. All investigations were normal. The junior resident doctor suggested a HIV test, which was overruled by the consultant. However, the junior doctor persevered, and drew the sample for a HIV test. To their shock and disbelief, the result came as "Positive". Since they had not taken the consent of the patient, nor counselled him, the report was withheld from the patient and sent to the Medical Officer of the employer-organization. The Medical Officer was excited, as this was the first HIV positive case that he knew, and widely announced the status of Mr. A to his colleagues. When Mr. A went back to the organization to join duty, he was prevented by the operator who informed him "YOU HAVE AIDS". Mr. A went back to his home and attempted suicide.
Ethics makes systematic study of our moral ideals and goals. It gives us some general practical knowledge, but we must still make personal decisions which apply this knowledge to our daily lives. The terms ethics and morals are often used interchangeably. Ethics refers to the systematic general science of right and latter, ethics would be an empty formal abstraction, because ethics is based upon a reflective analysis of moral experience.
Why do we need ethics, in addition to our working morality? The basic reason is that people reflect upon their action, compare them and seek their general principle. We then encounter certain difficulties, regarding a particular decision. For example
A HIV Positive woman who was pregnant revealed her status to the obstetrician who then refused to take her under her care. She experienced the same problem with the next two obstetricians. She therefore got herself admitted in a hospital without revealing her status. The obstetrician performed a C Section on her and during the course of surgery unfortunately suffered a needlestick injury. Should we blame the woman for not revealing her status? On the other hand, how else could she bring her precious child to this world?
Ethical reflection has seldom
been carried on in isolation from religious convictions. One reason
is that religion strongly affects the moral judgement of individuals
and communities. Christianity stressed the moral qualities of
love, mercy and self-sacrifice as being closely connected with
religious values. Judaism developed ethical monotheism, the belief
in a just God who is Father of all people and the goal of all
striving for goodness. The 10 commandments are the best-known
example of how religious beliefs shaped private and public morality.
The Koran emphasizes the ethical teachings for the Muslims to
follow certain laws for everyday life.
We have professional ethics which is the code that regulates action and sets standards for the members. It attempts to assure high standards of competence in a given field, strengthen the relationships among its members and promote the welfare of the whole community. It makes provision to deal with members who violate the professional ethics of the group. One of the best-known codes is the Hippocrates Oath in which the Greek Physician Hippocrates pledged the medical profession to the preservation of life and the service of humanity.
Another case, Mr. S, 57 years was admitted with multiple problems in a hospital where his own daughter was working as a medical officer. The hospital performed a HIV test on him. On finding him positive, the medical director of the hospital ordered the medical officer to discharge her father immediately, amidst pouring rain and though it was almost midnight. The HIPPOCRATES Oath was forgotten.
Advances in modern BIOTECHNOLOGY have not only revolutionised the picture of agriculture, animal breeding & medicine, conferring immense benefit on mankind, but have also raised ethical issues of profound significance both to the present and future generation. We generally tend to apply any new technique for immediate benefits it offers, without thinking of long range effects.
Another example, in the 1960s many married women with infertility were treated with Diethylstilbosterol which enabled them to become pregnant. A few years ago a number of young women presented themselves with menstrual complaints and an investigation were diagnosed as having early cervical cancer. Past history revealed that they were born of mothers treated with Diethylstilbosterol showing that DES could be a Carcinogen. We also have the example of thalidomide babies being born without limbs or with deformed limbs.
There are many, many such examples. Hence we should remember that with indiscriminate and irrational application of technologies, we run the risk of damaging the most prized possessions of man, namely his biological inheritance. No wonder many believe that man is the only animal capable of destroying himself and all that he has.
The community holds Doctors in awe and consider them as "Gods in white Coat". Doctors are expected to adhere strongly to the medical ethics. One such code of conduct is not to discriminate a patient based on the disease. How many medical institutions or medical personnel accept to handle and perform surgery if necessary for patients with HIV/AIDS?
Mr. S, 37 years had a road accident and was admitted with multiple fractures to a private hospital. Nine units of blood were transfused and his broken thigh bone was nailed. The total cost of treatment was more than Rs. 2 lakhs. He was asked to return after a few months for a follow up surgery for the removal of the nail. Unfortunately, when a mandatory HIV test was done on him on readmission, he was found positive. Comparing this result with the result of the test done on him prior to the first surgery, it was obvious that he was septicaemic and died after suffering for almost six months at home.
At the other end of the scale we have MO/hospitals using several artificial aids with which life is maintained for the terminally ill, for example advanced inoperable brain tumours. But to what purpose is the question raised by parents or close relatives, since they may need to sell all their belonging in some cases to pay the hospital bills. Even the help of the court has been sought to discontinue such support systems and let the patient die. But the medical scientist would argue that it is against his ethics and professional code to cause death. Today there are societies, that fight for the right of an individual to die with dignity, like, EXIT.
Another major ethical problems we face today is because of pressure to determine the sex of foetus, in order that a female foetus be aborted. This occurs in such frequency and numbers that question the ethics of the physicians.
There are other ethical
issues when we talk about artificial insemination especially when
using semen from a donor and not the legally wedded husband. More
modern techniques like embryo transfer storing human embryos in
frozen state, and surrogate mothers, pose ethical problems such
as the need to distinguish between legal father and mothers from
biological fathers and mothers. The sanctity of marriage and its
vows, the integrity of the family, the identity of the child are
all affected. Such practices call for close scrutiny at the ethical
as well as the legal level.
Let us remember that all science while it confers a lot of benefit, can also do much harm. We see that science has provided us with plenty to live with but nothing to live for: the latter, namely the purpose of life is contained in the culture, traditions and the ethics we have inherited. And therefore, scientific study and the use of science must be coupled with a perspective of spiritual and ethical values. Because what endures is the human spirit and not mere human life.
To Bioethics in India book contents
To Eubios Ethics Institute books
To Eubios Ethics Institute home page