Indian journal of medical ethics最新文献

Numerous challenges have crippled the Afghan healthcare system. The nearly half-a-century-long war - that continues to this day - has had profound effects on all aspects of Afghans' lives, medical education being no exception. However, Afghans have partially revived their healthcare and medical education systems recently, and updated medical curricula and teaching methods, with international support [1]. The quality of medical education has, however, been a growing concern in the country [2]. We outline the Ministry of Higher Education (MoHE) perspective on Afghan medical education policy, envisioning the rapid scaling-up of medical education facilities, describe the evolving challenges faced in the current economic and political collapse, and put forward some recommendations.

The conventional sharing of information and education between doctor and patient is no longer what it used to be prior to Dr. Google's entry into the mix with voluminous data, not only transforming but often threatening the patient-doctor relationship. While patients no longer seek basic information from their physicians since they've already consulted Dr. Google, the wise physician accepts that patients are now more aware, more involved in their own care, and more empowered with information. The good old doctor who knew everything is now more a myth that exists largely in folklore. While doctors may be well versed in a variety of fields, they have often narrowed down their areas of specialisation, while they continue to apply what they learn from their daily encounters with patients, establishing a stronger relationship over time. The challenge arises when a patient, having consulted Dr. Google, starts to question their doctor with the little knowledge gained from the internet. Biased opinions based on prior knowledge, have lately placed the doctor-patient relationship in jeopardy.

This is in response to Dr. Harish Gupta's letter [1] commenting on my editorial titled "Police investigation and unethical 'scientific interrogation'" [2] in the January-March 2023 issue of the Indian Journal of Medical Ethics. I had written in light of the resurgence in the use of narcoanalysis (truth serums) ─ especially in the Shraddha Walkar murder case, against the accused, Aaftab [2]. I appreciate the author's engagement with the editorial and his acknowledgement of the challenges within the Indian criminal justice system, including the large numbers of undertrials jailed for years together, and the many documented instances of police torture during investigation that go unpunished. The case of police torture from Tamil Nadu in which even an IPS officer was directly involved in the brutal torture is just one recent reminder of how prevalent custodial torture is [3]. Hence, the main point of disagreement appears to be regarding the use of narcoanalysis in investigations. I do agree with Dr Gupta that narcoanalysis is not just used for confessions but is also claimed to yield leads and information during investigation. However, the question remains whether the use of narcoanalysis is either ethical or effective, which is the focus in my editorial. Here I quote Dr. Gupta.

Researchers often neglect adolescents' willingness to participate in research. The granting of permission by parents is sometimes not in accordance with the unwillingness of adolescents. Relational ethics is the right approach to overcome inconsistencies between legal and ethical agreements in granting parental permission and adolescent's assent. This is because relational ethics is based on building relationships among many parties. The focus of this case study is to improve understanding of the assent of adolescents through intensive study of research conflict, reinforced using existing research and to understand how relational ethics can be used as an approach in decision-making, especially in conflicts between parental permission and assent from adolescents.

The present commentary reviews the goals and differing positions on the Movement for Global Mental Health (GMH), with a distinct emphasis on the cultural differences in the understanding of the aetiology of mental health issues. The proponents and advocates of GMH support its intentions and primary agenda of scaling up mental health services, especially in low-income and middle-income countries where the prevalence of mental health disorders is continually rising. However, many cultural psychologists and sociologists critique the movement for universalising psychiatric symptoms, as this universalisation could actually suppress local voices and might also undermine the significance of culture and political and psychosocial predictors which may contribute to mental health challenges. After discussing the pros and cons of the GMH movement, this commentary concludes with a conceptual analysis of the GMH position and offers predictions about its future discourse.

Background: There has been a gradual increase in disputes between doctors and patients in the healthcare system over the years. The aim of this review was to determine the speciality-wise prevalence of medical negligence in cases decided by the National Consumer Disputes Redressal Commission (NCDRC) and the factors responsible for it.

Methods: A total of 253 cases of medical negligence decided by the NCDRC from 2015 to 2019 were reviewed and categorised with respect to the number of cases compensated, the speciality involved, the compensation payout for the specialities involved, and the nature of the error leading to negligence.

Results: Among the cases analysed, negligence was identified in 135(53%) cases. Of these, the incidence of negligence was highest in surgery [37(27%)], followed by obstetrics and gynaecology (OBG) [29(21%)]. The highest compensation payouts were Rs 1.38 crore and Rs 1.1 crore in the paediatrics and OBG specialties, respectively. The common errors were lack of skill/care in the treatment of the patient [62(36%)] and failure to maintain accurate medical records [38 (22%)].

Conclusion: The study of adverse events in healthcare practice can improve the quality of patient care, and steps can be taken to reduce such events. Many adverse events are preventable by improving the skill/care in treatment and meticulous record keeping.

Background: Mobile phone-based interventions are being increasingly used in community health work in India. The extensive use of mobile phones in community health work is associated with several ethical issues. This review was conducted to identify the ethical issues related to mHealth applications in community health work in India.

Methods: We performed a scoping review of literature in PubMed and Google Scholar using a search strategy that we developed. We included studies that mentioned ethical issues in mHealth applications that involved community health work and community health workers in India, published in peer reviewed English language journals between 2011 and 2021. All three authors screened the articles, shortlisted them, read them, and extracted the data. We then synthesised the data into a conceptual framework.

Results: Our search yielded 1125 papers, from which we screened and shortlisted 121, after reading which we included 58 in the final scoping review. The main ethical issues identified from review of these papers included benefits of mHealth applications such as improved quality of care, increased awareness about health and illness, increased accountability of the health system, accurate data capture and timely data driven decision making. The risks of mHealth applications identified were impersonal communication of community health worker, increased workload, potential breach in privacy, confidentiality, and stigmatisation. The inherent inequities in access to mobile phones in the community due to gender and class led to exclusion of women and the poor from the benefits of mHealth interventions. Though mHealth interventions increased access to healthcare by taking healthcare to remote areas through tele-health, unless we contextualise mHealth to local rural settings through community engagement, it is likely to remain inequitable.

Conclusion: This scoping review revealed that there is a lack of well conducted empirical studies which explore the ethical issues related to mHealth applications in community health work.

Since the Delhi High Court judgement (2009), reading down IPC 377 that criminalised homosexuality, the Indian judiciary has been at the forefront of invoking constitutional morality to uphold LGBTQIA+ rights. In contrast, the mainstream mental health systems have failed to uphold human rights and protect LGBTQIA+ people ethically, except for a few position statements. Though the Supreme Court directed the mental health fraternity to exercise utmost sensitivity to LGBTQIA+ issues, they have not risen to the occasion. The absence of gender affirmative guidelines and failure to put in place punitive action against those practising conversion therapies set apart Indian mental health systems, in stark contrast to international mental health associations. Here, we review landmark judgments and the actions of professional mental health bodies regarding LGBTQIA+ rights in India, from 2009 to 2022 - especially those regarding conversion therapies and the discriminatory medical curriculum - to examine the deepening crisis of public health ethics.