Indian journal of medical ethics最新文献

In this essay, we talk about the importance of the relationship between doctors and patients, and the need for patient-centric communication rather than that with a paternalistic approach. Training of a medical student should include communication skills besides technical training in healthcare. As patient care evolves, communication becomes more crucial; therefore, it is important to understand the repercussions of poor communication skills and how improvement in this vital area can be beneficial.

Dr Thirunavukkarasu Arun Babu has written a very important and interesting reflection titled "Are doctors allowed to cry at work?" published online first in this journal on June 2, 2023 [1]. Reading this reflection brought back personal memories of several situations where I have struggled with my emotions while caring for patients. Having engaged with this very same question in the past, I would like to both agree with his perspective and share my thoughts on restoring the human element to the uncontrolled commercialism and dehumanisation in the field of medicine.

We report the dilemmas faced by the investigators while conducting a study on the social and environmental factors for protection of the mental health of adolescents placed under State protection in Kerala, India. The proposal received counsel and directives from the Integrated Child Protection Scheme authorities, under the Social Justice Department of Kerala state and the Institutional Ethics Committee of the host institution. The investigator faced and had to reconcile conflicting directives and antithetical field realities, with respect to seeking informed consent from the study participants. The physical act of adolescents signing the consent form, rather than the actual process of assent, received disproportionately more scrutiny. The authorities also questioned the privacy and confidentiality requirements raised by the researchers. Of the 248 eligible adolescents, 26 chose to dissent from participating in the study, demonstrating that choices would be made if they are offered. There is a need for more discourse on achieving steadfast adherence to the principles of informed consent, particularly in research on vulnerable groups such as institutionalised children.

I read the editorial "Ethics regulation by National Medical Commission: No reason for hope" by Amar Jesani with keen interest [1]. The article raises many pertinent issues which need urgent policy attention. Institutions and governance for regulating medical education and practice in India carry a significant colonial legacy of British rule [2]. No major reform was carried out to change the status till 2019. The recent reform in apex medical regulatory institutions, replacing the erstwhile Medical Council of India (MCI) with National Medical Commission (NMC), was a result of long-term demand. Several previous attempts to reform MCI had failed, despite recommendations by various committees, including the high level parliamentary standing committee [3].

Chhaya Pachauli's editorial in IJME [1] is a firsthand authentic account of The Right to Health Act in Rajasthan. It deals with different aspects of the process of enacting this law and the content of the Act itself in a dispassionate, objective manner. I think three points need to be added to this account in order to make it comprehensive.

From the British era, regular medico-legal autopsies have never been done in India after sunset, except for those specially permitted by the law enforcement agencies. The Ministry of Health and Family Welfare, Government of India, issued a notification on November 15, 2021, regarding the "Conduct of post-mortem in hospitals after sunset". This has given rise to much debate on whether post-mortems can be conducted after sunset in an ethical manner. Here, we briefly discuss the various issues related to the carrying out of post-mortems after sunset in India.

Bioethics originated in the 1970s and has now been around for half a century. During that half-century, brilliant achievements have been made, especially in the West. Basic bioethics theories have been developed that have proved useful in solving many bioethical issues including policies. Moreover, ethics committees and clinical ethics consultations have been implemented in the medical field. However, there seems to be a pessimistic discourse in bioethics in developed countries. For example, mid-career researchers from the world's leading bioethics centres in the UK and North America, Blumenthal-Barby et al, expressed concern and frustration about the current situation of philosophy in bioethics in their 2021 paper "The Place of Philosophy in Bioethics Today" [1]. The authors pessimistically say that.

Covid-19 has devastated human lives and stretched the limits of the medical profession and health systems. Using the mixed methods of online survey and online focus group discussions, we assessed how medical students and interns of two medical colleges in South India viewed the profession they had chosen. Of the 900 participants, 571(63.4%) had a positive perception of the medical profession, 77(8.6%) a negative perception and 252(28%) were undecided. The year of study in medical school was significantly associated with their perception of the medical profession, with interns more likely to have a negative perception. An overwhelming 823(91.4%) participants remained confident of their career choice, but a higher proportion of interns were less confident or regretful about their choice of profession compared to first to fourth year students. Most participants experienced moral distress; they acknowledged a duty to care but were troubled by personal risk, inadequate protection, and limited resources. Gaps were identified in medical and ethics training particularly regarding uncertainties and coping with deficiencies of the health system as encountered in the pandemic. The essential role played by doctors with its required competence, care and ethics cannot be assumed or expected without investment in the making of the future doctor through more socially embedded medical education imparting the skills of understanding the public, responding to them and being the advocate for their equitable and optimal care. An ethics of responsiveness emerges as important for healthcare, also for medical education in preparation for future health crises.

Emergency care is largely seen as synonymous with resuscitation and saving lives. In most of the developing world where Emergency Medicine (EM) is still evolving, the concept of EM palliative care is alien. Provision of palliative care in such settings poses its own challenges in terms of knowledge gaps, socio-cultural barriers, dismal doctor-to-patient ratio with limited time for communication with patients, and lack of established pathways to provide EM palliative care. Integrating the concept of palliative medicine is crucial for expanding the dimension of holistic, value-based, quality emergency care. However, glitches in decision-making processes, especially in high patient volume settings, may lead to inequalities in care provision, based on socio-financial disparities of patients or premature termination of challenging resuscitations. Pertinent, robust, validated screening tools and guides may assist physicians in tackling this ethical dilemma.

Ayurveda is based largely upon two classics - Charaka-Samhita, representing the school of medicine, and Sushruta-Samhita representing that of surgery. These two texts mark the historic switch in the Indian medical tradition, from faith-based therapeutics to its reason-based variant [1]. The Charaka-Samhita, which acquired its present form in circa 1st century CE, uses two remarkable terms to designate the distinctness of these approaches: daiva-vyapashraya (literally, dependence on the unobservable) and yukti-vyapashraya (dependence on reason) [2].