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.

33. S.T.D. / AIDS: Social and Ethical Aspects

R.V. Ramana Rao
Dept. of Venereology, Guntur Medical College and General Hospital, Guntur - 522 001

The Sexually Transmitted Diseases (STD) including AIDS, the diseases, nobody wants to speak openly, but gossiping behind the screens are increasing not only in an epidemic but in a pandemic proportion throughout the world. The etiology is known, the clinical signs and symptoms are well defined, there are excellent diagnostic tools and effective methods of treatment is available (of course not AIDS) but the spread of these diseases could not be controlled because, the prevention of these diseases lie in the wider fields of behavioural science, psychology education and morality of the individuals. Various social aspects like urbanization, migration and immigration, economic reforms and others have been implicated in increasing the sexual promiscuity in the community.

The accelerated acceleration of science and technology has failed too in the control of these diseases. There is a lack of religious instruction. Gone is the security of mind, faith in future and ability to plan ahead. Younger generation wants experience in everything in life before it is too late, sex of course included.

If the individuals are to be prevented from STD and repeated re-infections it is necessary for a change in behaviour to occur. It is in this area that health/sex education can be of assistance. Our concern is for a civilized responsible approach to the subject of sex and STD, Education should be towards civilization and citizenship; to adulthood rather than to adultery.

34. Philosophy of sex - Sexoscopy and ethics

D.S. Sheriff
V.M.K.V. Medical College, Salem 636 308

Sexoscopy comprises the philosophy, principles, and knowledge that people have about their own personally experienced erotosexuality and that of other people, singly and collectively. It includes values, personal and shared and it encompasses culturally transmitted values systems. Its subdivisions are historical, regional, ethnic, religious, and developmental or life-span. The customs and traditions of a culture's sexoscopy are idiographically learned and grafted into their phylogenetic roots. The organ of conjunction is the human brain. But the principle on which sex revolves is the wheel of social taboo.

The sexual taboo is of great antiquity and widespread across the globe. It relates to the ancient concept of the bride as a chattel of the male lineage. It has led to a contemporary polarization of the madonna and the whore, the paterfamilias and the playboy, and of love above the belt and lust below the belt. Three subdivisions of the sexual taboo pertain to restrictions imposed on relationships according to the criteria of age-discrepancy, degree of familiarity or intimacy, and male/female discrepancy respectively. The age-avoidancy taboo restricts communication between people discordant for age. It greatly hinders sex education and is disastrous for research into child sexology. The intimacy-avoidancy taboo makes a person disclosing intimate erotosexual self-data vulnerable to blackmail or vengeance, and so hinders research. The allosex-avoidancy taboo imposes segregation of males and females and limits the amount of their shared erotosexual information and experience Its restrictions on research can be circumvented if male and female sexologists work conjointly. Longitudinal sexological research needs institutional support and funding, for without developmental foundations in fetal life and childhood, sexology should not wait for another lone Kinsey to defy the establishment, but should itself take on the founding, funding and political defense of the sexology of childhood.

35. Philosophy of Medicine - Dialogics and Medicine

D.S. Sheriff
V.M.K.V. Medical College, Salem - 636 308

Dialogics as a philosophical principle is, like the dialectics predominant at present in all industrialized countries, based on the duality of life and thought. It postulates, however, that two thoughts (which no one can think simultaneously), or two concepts (which are mutually exclusive, each with its own range) together make up a whole simultaneously (not sequentially), each being of equal value (with no claim to superiority). That is bipolar thought. The tension, or the contradiction, between the two poles, which in another form is part of dialectics, is no longer the invisible force behind an unending struggle or a temporary evil which will pass. Contradiction and tension are to be welcomed as a sign of vitality and wholeness, but there must be not the slightest claim to superiority from either side. This bipolar structure of thought should be familiar to physicians, who are aware, to use an analogy, of the importance of tension in the cell wall, or in a biological organism, it is a feature of life, which is maintained by concurrent, equal but polar processes and forces.

Dialogics thus rejects the intolerance of confrontation as embodied in dialectics. Furthermore, it must be distinguished from `monologics', the attempt which, since the Middle Ages, has been made time and again, in medicine too, to reduce to one single point of view or principle, and thereby to dominate, all living matter and all knowledge. It must also be distinguished from the indifference of coexistence (in which the two sides tolerate each other but do not cooperate as a whole greater than its parts) and from the half heartedness of compromise (in which the two opponents surrender rather than defend their positions).

In contrast to the complementary principles of yin and yang in Oriental philosophy, dialogics stresses the contradiction and tension inherent in the `bipole'. It considers harmonization to be just as much an illusion as subsequent synthesis. We must rather learn in future to feel, think and work, both as individuals and as social beings, with dialogical tension, with contradiction which must be affirmed.

36. Family Physician and the Patient

One of the principles of family medicine is continuous, comprehensive, and personal care for the patient over time. It teaches us to learn to distinguish between disease and illness. disease is a biological process that can be explained by scientific and objective terms. Illness on the other hand is human event involving the interaction of a person with a disease. The care of illness becomes the great concern of a family physician.

37. Medical Humanism

B.M. Hegde
Kasturba Medical College, P.O. Box 52, Mangalore 575 001, South India

We talk about medical ethics and medical science, but often forget about the most important aspect of medicine, medical humanism. You may be wondering what is medical humanism. It is about medicine and man, not the sex nor the species, but about the human beings who as patients talk to us and question us about their personal medical problems. It is not about humanity and the general problems that arise from advances in medical science. Daily I am reminded that in our profession we are forgetting the individual while thinking of mankind.

We are back to square one. What happens to each of us can never e predicted with confidence despite all the advances that new investigations and treatment may ring. As D.H. Lawrence wrote:

Our ingress into this world was naked and bare

Our progress in this world is trouble and care

Our egress from this world will be nobody knows where.

May I add when and how and if we do well here, we will do well there! Medical science has labeled the various exits through which we go out to meet our maker with awe inspiring names, our end is the same as our ancestors who used labels such as God's anger, a curse or what have you. Human life span has not changed. With the fall in perinatal mortality, better hygiene, better nutrition and some degree of success in the control of communicable diseases, the life expectancy at birth has gone up markedly in the West, and to a significant, but lesser, degree in the developing world. This has resulted in more elderly people living in the society, with all the problems in provision of medical and social care for them. Life is the only condition with one hundred per cent mortality. It is a queue for people to go to meet their maker but, as in any other queue, people sometimes jump it.

When the end comes, the bereaved family needs the succour of the presence of God. Does God exist? How I wish I knew! However, I agree with Voltaire, when he said `If God did not exist, it would be necessary to invent him?' The concept of God must have saved more people in this world from suicide than all the support provided y medicine. Medical humanism is a new concept, where the kingpin is the person and not humankind.

41. Psychoteratogens: Right to retard?

T.S. Vijayakumar & Jayapaul Azariah
Department of Zoology, University of Madras, Guindy campus, Chennai 600 025

Abortion or termination of pregnancy has been practiced for long, but has come to be debated only when steps were taken to legalize the procedure and minimize the risks of abuse and misuse. No doubt that the rights of a person to end the life of another, however small it may be, is questionable and is yet under controversy. What then is the status of deforming, physically or mentally? Because, that is exactly what happens to fetuses, on exposure to teratogens and psycho teratogens. The etiology of many non-hereditary disabilities, mental and functional, can be traced to the preventable habits of the parents, especially the mother during pregnancy. Prenatal and post-natal exposure to psycho teratogens, mentally/functionally handicap the offspring who otherwise would have been normal. Pollard in her article in EJAIB (1996) has reviewed the consequences of three preventable habits of parents and rightfully voices her concern over the un-concerned attitude of parents, which almost borders callous indifference, whether it is willful negligence or ignorance is anybody's guess.

This article adds further information in an attempt to underscore the importance of this issue. On the ethical front, the parents will have to restrain and refrain themselves if at all to avoid these occurrences. But while advocating this solution, are the ethicists interfering or curbing the rights of the adult to live the way they wish? An ethical judgment is left to the public jury, to decide whose right is might: That of the fetus or the mother?

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