Indian journal of medical ethics最新文献

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.

Over the last few months, established data systems in India have been the target of heated dispute, chiefly by members of the Economic Advisory Council to the Prime Minister, ranging from the inflation numbers [1], to the sampling frame for surveys done by the National Sample Survey Organisation (NSS), the National Family Health Survey (NFHS) and the Periodic Labour Force Survey (PLFS)[2], haemoglobin cut-offs for anaemia [3] and childhood growth standards, female labour force participation rate and life expectancy at birth [4]. The attempts to revise economic data systems has invited a raging debate [5, 6], prompting the government to set up a panel to review the NSS's methodology. However, the arguments being made in favor of downward revision of nutritional standards have received much less scrutiny, except for a recent editorial which comments on the general problem of drawing up standards [7]. This is despite the fact that these proposals have already caught the fancy of the government. A policy decision has already been taken to discontinue gathering of data on Hb-levels as part of the quinquennial National Family Health Surveys, which would now be collected as part of a new Dietary and Bio-markers Survey. Neither the rationale for such a move, nor the details of the methodology of the new survey, or the time-frame within which such data would be released have been made available for public deliberation. Similarly, discussions have been initiated on devising "indigenous" growth standards for children [8]. Hence, it becomes imperative to examine the basis of these renewed calls for revision of existing standards.

In the twenty-first century, there is still a taboo on frank discussion of menstruation in Indian society, particularly with men. This inadvertently widens the gender/equity gap in families and in society. Even men in the healthcare sector are uncomfortable talking about this because the societal norms often overpower professional knowledge. Indian society needs to move forward and normalise menstruation in the perceptions of boys and men in all settings. We highlight below some salient points on the orientation of men regarding menstruation.

Background: An outbreak of the Covid-19 has led to substantial mortality globally. The entire world is carrying out studies to understand the pathophysiology, clinical features, diagnosis and treatment of Covid-19. We investigated the possible association of type of funding, corporate or academic, and conflict of interests on the outcomes reported in clinical trials on Covid-19.

Methods: Studies containing the keywords "clinical trial" AND "Covid 19" or "Corona" were located by a search on PubMed published between September 2019 to August 2021. Filters were used to select only papers in the English language and on "humans". The data were analysed using descriptive statistics and the Chi-square test.

Results: We found a significant association between the existence of a conflict of interest and reporting of a positive outcome (X2 value = 18.751, p less than 0.001). We also found a significant association between industry funding and reporting of a positive outcome (X2 value = 18.041, p less than 0.001).

Conclusion: We conclude from this study that the presence of conflict of interest and pharmaceutical industry funding is associated with reporting a positive outcome.

Background: The sensitivity and skill of care providers, especially physicians, while communicating bad news to patients can improve patients' acceptance of treatment and their emotional adjustment. We aimed to determine how to break bad news to cancer patients and consider their preferences in this regard.

Methods: This is a cross-sectional study in which 249 patients participated. The Poisson sampling method was used. Data were collected using the Measure of Patient Preferences (MPP) and patient demographic profile forms.

Results: Of the 249 participants, 178 (71.5%) were aware of their cancer diagnosis and 201 (80.7%) preferred to be informed of their cancer diagnosis. Patients' preferences included: "Having his/her doctor take the time to answer all of his/her questions completely", "Feeling confident about his/her doctor's technical competence and skill", and "His/her doctor telling him/her the best treatment option".

Conclusion: According to our results, care providers should consider patients' preferences in communicating and delivering bad news. Achieving this goal requires managers to plan for improving the communication skills of healthcare providers.

There are gross inequities in access to non-communicable disease (NCD) care in India. The Indian state of Tamil Nadu recently launched the "Medicine at people's doorstep" (Makkalai Thedi Maruthuvam - MTM) scheme in which screening and medications for NCDs are delivered at people's doorsteps. This is likely to improve geographical access to NCD services in the community. The objective of this study is to analyse the MTM scheme and recommend policy interventions for improved and equitable access to NCD services in the community. We analysed the MTM policy document using the intersectionality-based policy analysis framework. This analysis was supplemented further with literature review to enhance understanding of the various intersecting axes of inequities, such as gender discrimination, caste oppression, poverty, disabilities and geographical access barriers. The MTM policy document, while it removes the physical access barrier, does not frame the problem of NCDs from an intersectionality perspective. This can increase the chances of inequities in access to NCD services persisting despite this scheme. We also recommend interventions for the short, intermediate and long term to make NCD care more accessible. Creation of a gender, caste, class, geographical access, and disabilities disaggregated database of patients with NCDs, using this database for monitoring the delivery of MTM services, dynamic mapping of vulnerability of the target populations for delivery of MTM services and long term ongoing digital surveillance of factors inducing inequities to access of NCD services can all help reduce inequities in access to NCD care.

Carrying out fieldwork in private infertility clinics poses its own specific set of challenges. Gaining access to these field sites not only obliges researchers to negotiate with gatekeepers but also to deal with structures of hierarchy and power. Based on my preliminary fieldwork in Lucknow city of Uttar Pradesh, I discuss the challenges of conducting fieldwork in infertility clinics and how methodological challenges push the researcher to question the academically established notions of the "field", "fieldwork" and "research ethics". The paper stresses the importance of discussing the challenges of doing fieldwork in private health setups and is an attempt to answer vital questions about the nature of fieldwork, how the fieldwork was conducted, and the need to include questions and dilemmas that anthropologists might face in the process of making decisions in the field.