Bioethics in India: Proceedings of the International Bioethics Workshop in Madras: Biomanagement of Biogeoresources, 16-19 Jan. 1997, University of Madras; Editors: Jayapaul Azariah, Hilda Azariah, & Darryl R.J. Macer, Copyright Eubios Ethics Institute 1997.
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30. Ethics in the Progress of Medical Science

A.K. Tharien.
Christian Fellowship Hospital, Oddanchatram, Tamil Nadu


1. Introduction

We are at the threshold of a new century. Old concepts are changing yielding place to new. Ethics delas with human behaviour, human relationships, death and dying for example. So many time-honoured ethical principles are being questioned or flouted. We have to consider what we are doing and where we are going. Medical science and technology have made spectacular strides in the recent past. Rapid progress of science and technology in isolation raises many ethical issues, such as the following:

i) Has not the patient the right to be delivered from incurable suffering?

ii) If a person has a right to life has he not also a right to take away his own life?

iii) Abortion though considered once to be a criminal act, is now considered as a benevolent and obligatory act.

iv) Is it wrong to find and eliminate a retarded fetus?

v) If the test tube baby is a breakthrough in medical technology why impose restrictions?

vi) Is it wrong to attempt to create super humans through genetic engineering?

vii) Is it unethical to buy or sell organs?

viii) Is our priority to spend our resources to prolong the life of a few rich, or to improve the quality of health of the masses.

2. Humanism versus Science and Technology

As Shimon Glick pointed out, there is a perceived professional failure in the caring - empathic dimension. Science is neutral regarding the human aspects of medicine. The success of scientific intervention in medicine had served to award science an increasing role in the physician-patient interaction. Scientific advances have relegated the human aspects of medicine to a secondary role. For instance a cardiologist would devote more time towards developing and perfecting manipulative skills for a procedure like angioplasty rather than spending time to develop communicative skills in dealing with patients' needs.

In the past, the Western educational system emphasised certain religious values such as personal concern and service to fellow humans. But the post-Freudian world emphasizes happiness and self fulfillment as the major personal goals. In today's materialistic and permissive environment, one may be seeking intellectual gratification, prestige or economic advantage rather than the patient's emotional needs. The unparalleled advance in technology have dazzled the medical profession and have almost relegated the human aspects of medicine to a secondary role, overshadowing compassion, empathy and care. It is essential to have a paradigm that links science and technology inextricably with humanism for the practice of medicine.

3. Code of Ethics

From the beginning of human existence there were certain codes of behaviour, however inadequate that formulated the pattern for personal and social behaviour connected with the healing ministry.

The earliest and the most popular standard was to accept the natural law and was to be directed by one's conscience. Wherever we go wrong there is still a small voice that always warns us. But individual conscience is something subjective, depending entirely on one's natural tendency, culture, circumstances and instincts.

The second stage was to allow the utilitarian criteria to arbitrate between right and wrong. As a means for bringing a greater good, it is seen sometimes as the end justifying the means, as it happended in Nazi Germany liquidating the old and handicapped. Then came situation ethics and permissive society, right and wrong decided by a particular situation, the norms set by existing social or cultural standards. Gandhi by his unequivocal stand for truth and nonviolence, emphasised that the means should be as good as the end. Philosophers like Immanuel Kant advocated the "Categorical Imperative", an objective of absolute standards set independent of the attitude of individuals that is the absolute unconditional command of moral law irrespective of every other factor and/or aimed at making people act responsibly. The individuals can disregard it only at their own peril. Kant insisted on acting in such a way that each person and the whole humanity itself is unique and never be used as a means.

4. Physician's Declaration of Oaths

Certain codes of ethics have been establishment from ancient times. The Hippocratic Oath dates back to BC 460 where the Greek Physician emphasised the moral ethical values and respect for the human person. Galen the Roman Physician (AD 201) commended moral assessment of the human soul and body. The UK Geneva Medical Council established in 1858, controlled the proper conduct of doctors and set standards for professional behaviour. The Geneva Declaration of 1948 emphasised the service of humanity, keeping up the dignity of the profession and preserving human life from time of conception until death. The Helsinki Declaration of 1964 cautioned that the aim of research should essentially be therapeutic for a patient, conforming to moral principles.

The Inuyama Declaration of 1990, in which I was also a participant, cautioned the risks in genetic engineering and embryo experiments intervention should be limited to conditions that cause significant disability and not employed merely to enhance or suppress cosmetic behavioral or cognitive characteristics unrelated to any recognised human disease.

5. Health and Healing

Healing is not merely like repairing or removing defects of a machine. It deals with a person. As such it goes beyond the techniques extending to relationships. These relationships should include, the family, the community, religion, environment and intact, the whole cosmos. So healing is defined as restoring a person to wholeness and to the purpose for which he is created.

In the healing process it is essential that the whole team is moulded together, which includes the physician, the nurse, the allied health professionals and the family. Responsibility is on each of them, to keep the integrity and bear and support each other. There is a tendency for commercialization of the medical profession. The healing ministry should be taken not as an occupation, not even as a profession but as a calling - a vocation.

6. Genetic Manipulation and Gene Therapy

In 1953 Watson and Crick in Cambridge unveiled the structure of DNA (DeoxyRibo Nucleic Acid) the material from which genes are made. Subsequent research showed that scientists have immense possibilities to manipulate the genes, by using recombinant DNA techniques. The purpose of genetic engineering is to introduce or delete or enhance a particular trait in the body. This is done by inserting foreign genes or by altering the existing genetic make up to the person. By genetic manipulation one can control the formation and development of a fetus, like the choice of sex, complexion, height, quality of brain and so on. In other words one can make a baby to order.

The first gene therapy experiment was successfully done on a four year old girl in 1990 in the USA. She had a defective gene that prevented her body from producing an enzyme ADA (Adenosine Deaminase) hampering her resistance to disease. The scientist used a deactivated virus as a kind of ferry boat to transport normal ADA genes into the child's white blood cells. These numerous genetically engineered cells would begin to produce the crucial enzyme. Science is now unlocking the most closely guarded secrets of human biology, yielding insights into the prevention, diagnosis, treatment and healing of some of the most devastating illness for which there was no remedy in the past. This breakthrough in medical science showed that, genetically engineered cells would be able to produce needed therapeutic drugs within the body.

Genes, direct body's growth and survival. Defective genes causes susceptibility to certain diseases like cystic fibrosis, cancer, diabetes, coronary diseases, mental retardation etc.

The other class of gene therapy is germ-line gene therapy. In this the gene is inserted into the germ-line (sperm or egg) or embryo and the offspring will have this inserted gene also, instead of a defective allele. It is possible now that treatment can be given to the fetus, if found defective by therapy or surgical procedure, within the uterus or outside the uterus.

7. Bioethics

Bioethics is a composite term derived from Greek words. Bio means life. Ethics has been described as the science of morals and rules of conduct, recognised in human life. The rules of conduct must be essentially social, religious and moral values. Our ethics must be more than rationalization. The new technique in genetic engineering and such other application of medical knowledge can relieve and prevent human suffering or protect and promote human life. Genetic engineering encompasses these techniques that manipulate genes especially those using recombinant DNA techniques. There will be some risks for individuals but it would benefit many.

One can replace natural procreation with extensive genetic selection of fetuses. We are not yet sure of the long term results. In biotechnology we are dealing with the complexity of life itself, by introducing newer gene sequences. What effect will this have on family life itself?

If we introduce different gene combinations into the environment, there could be irreversible consequences. New organisms may replace existing organisms in the ecosystem. A drug resistant pathogenic organism might emerge.

Another question is, in whose hands will the power be? Will the commercial interest dominate the scientist. USA alone is spending over two billion dollars annually backed by commercial interests. People whose tests reveal a defective gene could become victims of genetic discrimination. Man with his scientific curiosity, if given a free hand might even produce allophones between species like human and monkey hybrids and play God in creating new species. So it will be necessary to guard against potential abuses and avoid human vivisection.

8. In Vitro Fertilization

In vitro fertilization (IVF) is a process of fertilizing the egg cell, sucked out from the follicles of the ovary and mixing it with sperms in a test tube in the lab. This is a great break through in medical science and an alternative means of conception in many infertile women. About 10% of married couples are reported as infertile. In woman infertility may be due to defective ovulation or blocked fallopian tubes or unhealthy endometrium and in men absence of healthy sperms. The fertilized ovum (embryo) is transferred into the uterus in about 10 to 14 days. 25% of these are successful and gives no extra complication except increased number of multiple pregnancy. It is estimated that over 20,000 babies have been born since 1986.

Some argue that laboratory production of human beings is no longer human procreation, as it amounts to degradation of parenthood and deprives procreation of its human involvement and love. IVF might undermine values which biological parenthood give to marriage. But it is argued by scientists that IVF is a dramatic extension of the sort of interference found in delivery, by cesarean section or in hormonal induction of labour.

In these experiments, there are a few surplus fertilized embryos which are kept frozen for future, use, for further experiments for researchers to study genetic and developmental abnormalities, intricacies of tissue and cell differentiation etc., or to be ultimately destroyed. Can we treat the fertilized ovum as a lump of jelly or piece of tissue which can be destroyed, like a tumor or toenail? Is it right to use human materials for experiments and if so how far? Then the question is raised do human embryos have any right at all? If they have rights, at what stage? Can such embryos be the material possession of the donors when they do not intend becoming the parents. The fundamental issue is whether or not respect should be shown to human embryo, in view of the potential for full humanness. If embryos are produced with the expressed purpose of providing scientific information, that information has already taken precedence, over the significance of human existence.

A London News Agency announced in July 1996 that there are 6,000 frozen embryos belonging to 1,500 donors. The British low demands that they be destroyed before five years. Pro life campaigners plead that the embryos should be allowed to develop into babies then, put up for adoption and avoid prenatal massacre.

In the West, ovum fertilized from sperm of unknown parents and children are born without identity of biological parents. (This is now changing, as donors have to record their identify.) A child conceived in a test tube can have as many as five parents: the egg donor, the sperm donor, the surrogate mother (who bears the child), and the couple who raise the child. The potential emotional and psychological ramifications of this could be deep and disturbing.

9. Prenatal Screening

Prenatal screening of embryo fetus, amniotic fluid etc., has now become a routine in most of the industrialized countries to discover any defects. Sampling of the amniotic fluid from the uterus by a needle after 12 weeks of gestation is one of the easiest procedures. Sex can also be decided. In India sex determination lead to extensive feminicide by abortion. This has devastating effects on our social structure and consequently legislation has come against sex diagnoses.

10. Organ Transplantation

Organ transplantation is indeed a breakthrough in medical history, like the discovery of anesthesia and antibiotics. Ancient Indian and Chinese medical literature includes some description of organ transplantation.

The technical basis of organ transplantation was initiated by the French Surgeon Alexis Carrel, experimenting in animals. The Hungarian surgeon Ullman in Vienna also made some trials in 1902. Sir Peter Medaver discovered that the main cause of rejection of transplanted organ, was due to the development of antibodies in the host. He found, in 1951, that cortisone could suppress the rejection process. Subsequently more powerful immuno-suppressive drugs were discovered like azathioprine and later in 1978 drugs like cyclosporine were found to be more effective. Yet another problem was the need for matching of identical tissue types. Identical tissue types are seen in identical twins or close relatives like parents or siblings.

Early procurement of organs specially when single organs are to be procured from the dead is that it be removed as early as possible for viability. So there was tendency to harvest the organs even before the extinction of life.

Law once regarded death as extinction of life as manifested by the absence of heart beat and respiration. The medical community was faced with the dilemma of not being able to harvest organs from patients who seemed to have lost all brain function but continued to be kept alive by life support systems which artificially maintained respiration and circulation.

A Harvard medical school committee made a historical proposal in 1968 recommending the criteria of death based on brain activity. They defined rain death on the following criteria, 1. Total unresponsiveness to external stimuli; 2. Lack of spontaneous movements or respiratory effort; 3. No elicitable reflexes. Also flat EEG (electro encephalogram) and flat ECG (electro cardiogram) tracings are confirmatory, but not required. Now most countries including India in 1994 have redefined death as cessation of brain stem activity. So organs can now be legally removed after brain death.

In 1947 human kidney was transplanted by Lord Steiner and Hume in Boston. In 1963 liver was transplanted by Dr. Stgarzien, USA In 1967 heart was transplanted by Dr. Christian Bernard in S. Africa. This was followed by many other organs including lung, pancreas, intestines, one marrow, etc. with immune suppressive drugs. Survival rate now is close to 80%. blood transfusion, bone marrow transplants, embryo transplants, though do not come under the title of organ transplant, but these have close relationship with organ transplants and involved ethical issues.

Consent has to be obtained before transplantation. There are two ways of obtaining consent for removal of organs from the dead individuals.

1. Presumed consent, in the absence of objection from the deceased when he or she was alive, or from family members.

2. Informed consent, based on the express consent of the deceased or family members. As the demand for organ is greater than the availability there is the dilemma of who should get the priority. Is it the most sick ones or relatively healthier ones whose chances of survival and benefit are better. In 1994, 3000 patients in USA died while waiting for an organ. There is also the influence of money, race and religion creeping into the distribution system.

Another factor is the ambition of some surgeons to become the first, the fastest and the furthest in the race. This creates the problems of the fastest and the furthest in the race. This creates the problems of ethics and values.

Recently in India, commercialization of organs has been a blot on the ethical foundation of the medical profession. There was then no comprehensive law controlling organ transplantation. There was an organized network involving hospitals, doctors, touts and agents doing unethical trading in human organs through the "Organ racket".

Some nursing homes acted as frontal outfits. Rich buyers from India and abroad have been buying kidneys and other organs from poor slum dwellers and rural folks without proper information and consent of the concerned persons. The choice before the poverty stricken people is whether to sell one kidney and live or to keep both kidneys and die of starvation. Unfortunately some of the donors did not survive to receive the monetary remuneration promised. The law that the donor should be a relative or spouse was also circumvented through certain dubious means such as "Kidney marriage" by rich Gulf country men, marrying a girl before the operation and divorcing her soon after surgery. Another method was transboundary smuggling of organs by live carriers where trade can take place in a foreign country where laws are not sot strict. There were other criminal ways of stealing kidneys on the pretext of performing other operations like appendectomy or kidney stones.

Human organs like kidney, liver, heart or fragments of body like skin, semen, egg, genes, embryo and even fetuses are sold over the counter as a commercial enterprise. Andrew Kimbrell's book "The Human Body Shop" reveals the following:

* Unregulated fetal tissue brokers in the US reap close to a million dollars a year in fetal organ sales.

* Researchers have successfully transplanted fetal organs into laboratory animals creating humanized mice.

* Babies are ought and sold through surrogate mother contracts

* Frozen embryos are often in legal limbo as the courts decide whether they are people or property

* Numerous patents on human genes have been awarded

To attempt to overcome the uncontrollable trade in organs the Indian Parliament passed a ill in 1994, in keeping with the WHO guiding principles, prohibiting commercial dealings. There are restrictions for removal and retrieval of human organs and also regulations of hospitals involved to ensure transparency by all concerned. Law prohibits removal and transplantation of organs for any purpose other than therapeutic. Surgery can only be done after explaining the effect and risks both to the donor as well as the recipient. For violation of rules the act prescribes a minimum imprisonment of two years extendable to seven years and a fine of Rs.10,000/- to Rs.20,000/- for the middle man.

Organ transplantation is a very expensive process. It is not only the cost to patient but the cost of the special facilities preparatory to the procedures, like dialysis surgery fees to the donor, expensive immuno-suppressive drugs etc. . The question, arises can these facilities be made available for the care of the poor, who have very little access to the health care and even the basic health care is denied to most of them. The life of the poor patient is as valuable as that of a wealthy person.

Spare part surgery is making steady progress. Artificial and mechanical devised are replacing organs, such as joints, eye lenses, heart, lungs etc. A philosophical question arises. Should the human persons, the ultimate perfection of a divine creation, be replaced by screws, nuts, gadgets, electronic microchips, super conductors, computers etc. will be remain a human person or will be become a machine clothed with human appearance or a robot in human form.

Hindu, Muslims and Christians generally support organ donation as this is an act of giving. Judaism prohibits deriving benefits from mutilating or delaying the burial of a corpse but this prohibition can be overridden to save a life for organ transplants. In Japan there is such debate about using brain dead donors, and still no law.

To overcome the scarcity of organs attempts have been made to use organs from other species like Chimpanzee kidneys, baboon heart, liver and kidney. There is also a risk of transmission of unknown infection from animals to humans triggering human epidemics. Organs from transgenic pigs after altering the immune potential are being tried to avoid rejection.

Organ transplantation has raised many ethical, moral, religious and legal issues. Biotechnology has made great advances. As in other technological endeavours, absence of accountability and a regulating system have virtually reduced the human body to a lucrative, commercial enterprise. The medical profession must set ethical guidelines. Organ transplantation is a very expensive procedure. Besides the cost of surgery the transplant patient has to spend an enormous amount for immune suppressive drugs throughout their life. Sheila Sherlock in the book, Disease of Liver warns, before a liver transplant is considered the patients and the family must be told of the physical consequences.

The question is also raised whether it is justifiable to spend enormous amounts of money and energy to prolonging the life span of a few, when in developing countries like India thousands are denied even the basic primary needs which cost very little. also it is a cruel act to extend longevity of life without improving the quality of life.

The question is also being asked; is there meaning and purpose in life? What is the value of human life? Are there any scientific parameter which determines the quality of life

Ethics is essentially one of relationship - relationship with one another in the community, nature and the Creator. It cannot be totally contained within the narrow constraints of scientific reasoning but go beyond and reach the realm of spirituality. True spirituality is in discovering, identifying and experiencing depth in discovering the Divine in human.

11. Abortion

Abortion was a much debated subject in the recent UN population conference at Cairo. It is a highly emotional subject. It touched the mysteries of human sexuality and reproduction. Pro-life advocates like the Muslim fundamentalists and Roman Catholics, emphasised the sanctity of life and the right of the unborn child who needs protection from society through his life. Until the Medical Termination of Pregnancy Act was passed by Indian Parliament in 1971 abortion was a violation of law. Now it can be done on demand.

The pro-abortion lobbies at the UN forum in Cairo emphasised the reproductive rights of women and pleaded for legalizing abortion. Their concern arose from the high incidence of deaths due to unsafe abortions, which is greater in countries where abortion is not legal. A study of legal status of abortion in 190 countries reveals the following facts:

Reasons for Abortion Number of countries

To save the life of mother 173

For physical health of mother 119

To protect mental health of mother 95

Pregnancy caused by rape or incest 81

Causes of fetal impairment 78

For economic and social reasons 65

On simple request 41

No permission needed 17

It was reported in Cairo that paradoxically abortion is minimum in countries like Netherlands where laws of abortions are very liberal, 5 per 1,000 births and in Latin American countries like Brazil where abortion is legally restricted, the abortion rate is 40 to 60 per 1,000 births.

Pro-abortionists plea to legalize abortion for certain humanitarian grounds like, the stigma of pregnancy out of wedlock (unmarried girl, adultery, incest, rape), or if the fetus is diagnosed as physically or mentally defective, or if pregnancy is a serious threat to the mothers survival, or extreme financial and social stress. Most people rightly agree that abortion should not be resorted to, as an easy method of family planning.

12. Euthanasia

Medical science and technology have made great strides in recent years. The medical profession has today more power over life and death than they would have chosen to have. Doctors have power to prolong life where life seems to have lost its meaning and have power to terminate life without suffering. There are several points of view on euthanasia: legal, social and compassionate.

The debate on euthanasia has again become a live issue in India as the Supreme Court of India in 1994 passed a verdict that attempted suicide is not a crime. According to the India Penal code, which was mainly adopted from British Penal Code, attempted suicide was a crime, punishable with years of imprisonment. With the recent medical knowledge gained by researchers and the opinions expressed by eminent psychiatrists all over the world, the judges in their verdict were sympathetic to those who attempted suicide. The Supreme Court of India is the highest court, authorized to interpret the Constitution of India for legal matters. They gave the verdict that attempting suicide is a mental derangement and hence not to be considered as a crime. This signifies social approval of suicide and euthanasia which is assisted suicide.

Euthanasia is the deliberate bringing about a gentle and easy death, making the last days of the patient as comfortable as possible. This is to ensure a calm and peaceful death, within the context of relieving incurable suffering in terminal illness or disability. Euthanasia is voluntary, when requested by the sufferer, involuntary or compulsory if it is against the will of the patient; and passive when death is hastened by deliberate withdrawal of it effective therapy or nourishment.

While I was working in England, I was resuscitating an elderly lady who was admitted in the hospital emergency ward with severe demonstrable cerebral damage. My chief of surgery an Englishman and devout Christian told me gently, "I don't want to interfere with your procedures, but if it were my mother I would not do all that you are doing and would allow her to die peacefully." This is often our dilemma. Should one prolong the act of dying in a case of irreversible death or when life is effectively over. One of the achievements of modern medical technology is the use of artificial life support systems like artificial feeding, dialysis, controlled respiration, pump circulation, etc. In some cases it can be so dehumanizing, painful, hazardous or costly that other considerations out weigh the aim to conserve life. Euthanasia supporters weigh the aim to conserve life. Euthanasia supporters raise the question, how long to sustain life? A patient might say "I do not want a vegetative existence by drips, drugs and dialysis. I want to die with dignity. I have a right to lay down my life just as I have a right to live."

In the well known Dr Arthur trial, where Dr. Arthur in UK had prescribed an overdose of codeine to a baby, born with Down syndrome with the object of hastening his death, Dr. Arthur was charged with murder. Many eminent witnesses were called to the trial. Most of them justified the procedure. Finally the court acquitted Dr. Arthur as his motive was compassion. There is an argument that if a fetus is found to be abnormal and severely handicapped it should be sought out and eliminated before birth, as such children are socially valueless. Do not the physically handicapped and mentally retarded have as much right to life like others and deserve to get the needed care?

The concept of death in the light of new knowledge, is changing. It may be obtained by redefining life. Descriptions of life are organized at many different levels of complexity like molecular, cellular, organ, system, corporal, mental, spiritual etc. Human life may be described as the ability, actual or potential to respond to others, or to be self-aware. This is based on cerebral function. Silverman and others in 1969 have established this by extensive studies and confirming it by encephalogram findings. Once cerebral death is confirmed there is no chance for survival though heart and lung functions continue. so it would be quite unnecessary to continue supportive measures after cerebral death.

According to the Christian concept, almighty God has created man in his image. He is the giver and sustainer of life. He alone has the right to withdraw life. Life is not a right but a gift of God belonging to God and at all times in His hand. So we have no right to take away deliberately take away a human life, even one's own. Other religions generally agree with the same concept.

Euthanasia requests may come out of depression and confusion or out of a feeling of worthlessness, or due to persuasion of interested parties with ulterior motives. Respect for the personality of the patient and concern for the family should lead us to use our resources as best as we can to promote life. The essence of our approach to a dying patient is to give ourselves in loving care to meet his needs. A patient is not merely a biological unit but a person before God with social and family connections.

Suffering can some times be redemptive and purposeful. It is God's opportunity (as health is an opportunity) foe a creative outcome or a witness or an amendment of life.

Let me share with you the experience of two of my friends who faced the issue of caring for children with disability. One was a hospital Chaplain. When a child with disability was born to him, he asked God why this happened to him, but he could not get an immediate answer. He loved that child but the child could not adequately respond to his love in the normal way. This helped the Pastor to realize how God loves us in spite of us not being responsive to His love. The other was a colleague of mine and a highly qualified Pediatrician. When a child with disability was born to him and his doctor wife. they did their very best to sustain her life. The child became critically ill immediately after birth needing exchange blood transfusion. Though their colleagues questioned the wisdom of taking such an extreme step for such a child, they choose to have the exchange transfusions. The child recovered and subsequently brought a new purpose to their life before she finally died at four months of age. Through his the parents realized that God had a purpose in bringing her to their home. This experience was an act of God to make them aware of the need of caring for many neglected children with disability in our society. So they resigned from their busy clinical work to start a centre for children with mental handicaps and special needs. An apparent traumatic experience became the rallying point for a new mission for compassion.

"Suffering is evil and we should take every step to mitigate or relieve it." In the extreme, Hitler had a utilitarian philosophy of life. Any person who had a utilitarian value he preserved, and others he eliminated. But we respect the unique value of human life. Scriptures say man is made in the image of God. This gives human life, a unique dignity and value. Life should be cherished, supported and cared.

Some practical suggestions include:

* Doctors should serve and care for their patients in love.

* Deliberate attempt to end or shorten life, whether by omission or commission is unethical, is my personal view, and should be restrained.

* Our society's leaders should proclaim the way to righteousness and truth, against taking innocent lives, and provide compassionate care.

* Education of medical personnel and people with moral and spiritual values should be done, which may lead to solid legislation.

* Bring in the principle of love as the motive and main-spring.

13. Conclusion

Views and ideas and even concept of ethics are fast changing in the context of the rapid progress of science and technology. Ethics are not merely laws for enforcement by the state, but self regulatory principles to be practiced voluntarily together with a sense of honour and social responsibility. We need serious ethical evaluation to check the domination of market forces over human values. Corrupt trade practice have seeped into the system. The guiding principle of optimum benefit to all needy patients seems to have lost in the melee of activities. The benefit of scientific and technological development has gone beyond the reach of the common patient mainly due to reasons defying ethics. Care should be taken not to prescribe costly drugs when less expensive but equally effective substitutes are available. One should confine to the minimum essential investigations, resisting the temptation of monetary benefits.

A doctor serves his patients with love and from true ethical principle. There must be sound education in moral and ethical principle. There must be sound education in moral and ethical principle. There must be sound education in moral and ethical values through educational institution and communication media. We should create a public opinion on moral values so that appropriate legislation can come up in Parliament. Only ethics based on spiritual values and love can lead our society to lasting happiness, harmony and peace.

References
Medical Ethics in India - India Peace Centre
AdHoc Committee of Harward Medical School
Three Ethical Revolution - F.D. Moore
EJAIB


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