Sunday, July 21, 2013
Issue of Medical Ethics in India
It was an invitation that I could not ignore as the subject was close to my heart and being organized by a premier medical institution in the capital of India. The issue was ‘medical ethics’ and the main speaker was a humanist philosopher from Utrecht University in Netherlands. As it was being organized for the students, who were future doctors emerging out from this premier institution, my friend suggested that there could be two other speakers who should express their opinion in the beginning for the benefits of the students. One was a former alumnus of the institution; a well-known doctor now settled in US but is contemplating to start working with communities in India and second was myself who was supposed to give some factual analysis of what happens here in India.
The other speaker finished in 5 minute time allotted to him and the host invited me to speak of my experiences so that our main speaker also has an idea. I started through bullet points and wanted to inform that I do not generalize but all these things have happened and we face it, though there are exceptions.
‘Friends, a few days back three sanitation workers died cleaning the sewage line in the Indira Gandhi National Centre for Art. The police took their bodies to Ram Manohar Lohia hospital and all the three were declared brought dead but their details were mentioned as unknown, unidentified etc. and their families got information next morning. There is no cooperation with families of the poor.
In Uttar-Pradesh and Bihar, most of the Primary Health Centers do not have proper facilities and sweepers and non-medical staff do even perform minor surgeries. You might have seen latest report of death of a child in Balia on the NDTV. I want to tell you why this happen. It reflects the class-caste bias among our medical fraternity. Since the upper caste-class in the villages or rural India prefer to private hospitals, it is the rural poor who go to these PHCs and hence we don’t want to touch them. It is this prejudices that we carry on further that result in unwanted deaths.
In Delhi, I am amazed to see the small temples outside the ICUs of many prestigious hospitals where people go and break coconut before entering the ICU. Is that ethical? Should we allow such thing inside the hospitals? Does it not violate the spirit of inquiry and scientific temperament?
My own experience at a hospital was that doctors don’t really appreciate when you want to donate organs and body after death.
The emergency wards of most of hospitals are horrible. I have gone through personal experiences when in a place like AIIMS, we had to wait since morning and finally the patient could only be admitted in the evening at 9 pm.
The doctors and nurses speak with their patient in most rustic way and forget that patient too deserve respect from the doctors and their staff. In the big hospitals, doctors do not inform the patients or their wards about the ailment and most shocking are the event when due to lack of money hospitals refused to give away the dead body.
Gynecologists normally discourage women for family planning if they have daughters.
Today, many of the psychiatrists in Delhi are promoting the ‘Gayatri Mantra’ to get rid of tension. What will they advise to Muslims, Christians or atheists to get rid of depression?
And finally, dear friends, the biggest ethics is to treat each patient without discriminating on the basis of their identity. You must have heard Praveen Togadia. Some people say, he was a doctor…’ (I am not allowed to complete my statement by a teacher who gets up and snatch microphone from my hand)
Suddenly, there is unease in the heart of some one. The participants are listening but the man at the end row gets up shouting,’ why have we been invited to ‘waste’ our time here? It is an ‘academic’ seminar and we cannot allow ‘anyone’ to speak here’. I am taken aback but keep my calm. The students and audience are stunned. The man comes and snatches the microphone from my hand. He does not allow me to speak. He just asks me to go. I don’t know how to react as every institution has a hierarchy. I give in and silently go and sit on my seat. I don’t retaliate as I feel the people who have invited me should have done or may have their problems. The ‘professor’ now takes charge. He starts condemning me and countering everything that I spoke. He justifies statues of gods and goddesses inside the hospitals suggested there was nothing wrong with Gayatri Mantra to give ‘strength’ to patient. Everybody is just shocked. Anyway, I decide not to walk out as I was not a designated speaker but only requested to speak. I want to listen to the guest from Netherlands and hence decide to not to make a fuss of it but as I don’t know the internal politics inside the institution which is very natural in all these big institutions.
Our friend from Netherlands speaks and explain beautiful what medical ethics is and the issue he focuses on is that we have to go beyond just being ‘doctor’ in technical sense. We have to respect scientific temperament and have humanist values. He spoke about prejudices of different kinds in our societies everywhere and how and why the doctors should keep away from it. We cannot be seen supporting alternative medical methods. We have to support all that which come through scientific inventions after years of hard work. Of-course, he raises the issues of prejudices against untouchables and disabled people. In many countries, there is a clear war against homo sexual and therefore he suggest that the doctors cannot go according to the prevailing notions of society but according to what science is and what medical research speak about.
After the lecture is over the students are silent but the organizers tried to have some questions answer session but not everyone is ready after all this. A girl stood up and asked how to deal with homo sexuality issue in India where society still treats it as taboo. And again this philosopher friend speak with same conviction that according to all report, there is nothing wrong about homo sexuality and it is the decision of two individuals to decide how should they live. We cannot criminalize homo sexuality and their country was the first one to allow the gay marriages too.
Feeling much uncomfortable again, this ‘professor’ again gets up to argue against that. ‘I have no problem with homo sexuality but it cannot be termed as normal behavior as there are no studies suggesting that. We live in a society which does not respect it. How can we justify gay marriages?’
The hall is silence and none want to respond to him. The silence has said so many things. The students in these institutions live under tremendous pressure and hence try not to offend their faculties. Secondly, these institutions still have people who are actually a shame to the name of teaching profession. It is also true that all kind of elements have entered into the medical profession who join it to earn money and in that humanity becomes the biggest victim of their deeds. The fact that we still feel sympathetic to the likes of Praveen Togadia and Maya Kodnani, shows that we still carry our caste and religious prejudices along with us and medical ethics don’t work for us. I am happy that most of the teachers that I spoke afterwards agreed with my view point though they disagreed direct ‘naming’ of an individual though I felt they should have stood up and objected but I also know that these institutions are always suffer from inter departmental politics and games are played to disturb the programme and hence I did not fall prey to their politics and kept quiet.
The profession of a doctor is noble one. They were considered as God. Their soft voice worked like balm on the patient. I never generalize the issue but the trend is visible. And when we were discussing things at the college, it means we are friends of society, after all, those who invited me to their institutions have been aware of my writings and my work for long. Even if they have not known my work, what were the things which violated the basic ethics? Did I speak anything which violate the basic decency but what I realize very fast was that once I uttered Togadia, the professor could actually visualize as what was coming next and being a sympathizer or a member of the organization, he could not allow such things to go but these fellows do not know that they can stop me from their institution but not from general public.
It is shameful that academic institutions where the freedom of expression and dissent should be honored are becoming highly intolerant to criticism. Each philosophy and ideology failed here because the caste and religious prejudices. The arrogance of being ‘powerful’ and ‘twice born’ still exist in our society. Medical profession has grown tremendously and money has become the major criteria yet with in this age of market and money, modernity has become the biggest victim. Medical ethics transcends nationality, caste, religious and all kind of boundaries and that is why doctors have been respected world over as their only respect is meant for humanity and trying to save a human life irrespective of his faith and political ideologies which actually look dim in India where our prejudices are superseding them. It is time the institutions start a cleanup operation so that our doctors are not just respected for their knowledge but also for their human values and medical ethics too. Our academic institutions can only do it once they shed their caste prejudices and allow wider diversity in these places of learning so that India as a whole grow and people here particularly those who are poor and not among ‘them’, do not suffer out of these prejudices.