Indian journal of medical ethics最新文献

Rajasthan's Right to Health Act, 2022, analysed in an editorial in IJME [1] is a well-drafted Act on public health as a citizen's right and a government's duty. It is a milestone in India's public health history. Much remains to be clarified in the details of rules and regulations to be drafted under this Act. Jan Swasthya Abhiyan, Rajasthan, has done tremendous hard work and sustained its contribution to the government in drafting and facilitation of the Act, in spite of the difficulties and limitations imposed by the Covid-19 pandemic and lockdowns.

The provision of government-funded public health services in India is grossly inadequate and 48.2% of "total health expenditure" for India is paid "out of pocket" [1]. When the total health expenditure in a household exceeds 10% of the annual income, it is considered catastrophic health expenditure (CHE) [2].

As medicine becomes ever more technologically advanced, "human skills" are becoming increasingly important. Medical ethics or bioethics and medical humanities may have been formally introduced into the curriculum about the same time around the 1970s in certain developed nations. However, in many developing nations, medical/health humanities is much more recent and only came into prominence during the first two decades of the twenty-first century. The term "bioethics" was coined by Potter in 1970 [1]. During the ensuing five decades, however, medical ethics has become the dominant discipline of the two, globally. Medical ethics is more well-known and has greater resources allotted. Medical ethics may be a less radical and more comfortable concept and the study of ethical issues in medical practice may not challenge the traditional knowledge and power structures inherent in medicine. While we have a Centre for Bioethics and Humanities at my present university, I feel a more logical and correct name would be Centre for Humanities and Bioethics, emphasising the greater scope of the humanities.

Background: Medical ethics teaching has received little attention in India's undergraduate medical curriculum, so the National Medical Commission's formal inclusion of medical ethics in the new competency-based curriculum (CBME) is creditable. However, the policymakers have left out the most crucial stakeholders - the teachers. This study was conducted to find out how physiology educators in Delhi felt about the implementation of ethics teaching in physiology in the CBME.

Methods: This was a pilot, cross-sectional, observational, feasibility study conducted using a questionnaire, involving faculty and senior residents (post-MD) in the departments of Physiology at nine medical colleges in Delhi, conducted over the period from February to October 2020.

Results: The response rate was 76% (60/79), of which 40% (24/60) were senior residents and 60% (36/60) were faculty. Around 55% (n=33) felt bioethics and clinical ethics are not synonymous; 53% (n=32) believed ethics education can be accomplished in a large group setting; 75% (n=45) believed it should be the responsibility of the physiology faculty, rather than the clinical faculty, and 61.7% (n=37) wanted it to be included in the formative assessment. The respondents shared ethical concerns that should be included in the physiology curriculum and the best candidates to teach them to achieve integration. Despite the challenges, the majority 65% (n=39) felt ethics in the physiology CBME should be an inseparable part of teaching in all instructional modalities.

Conclusion: Early clinical exposure was considered preferable to the Attitude, Ethics, and Communication (AETCOM) programme. Using the five W's and one H method, we talk about how our findings can be used as a road map to help physiologists teach ethics to medical students in the new CBME.

In low- and middle-income countries, caring for the elderly is a responsibility that is undertaken within households with minimal institutional support from the community or structural support from the state [1,2]. Usually, this responsibility is shared within the home, with the physical and emotional work of caring falling to the one who does not have too many extra-residential responsibilities. The gendered nature of caring responsibility is such that, usually it is women who are not in the formal or informal labour markets who share the responsibility [2,3].

The government healthcare system unintentionally excludes the destitute in several ways. In this article, a "slum's-eye" perspective on the public healthcare system is offered through reflections on stories of tuberculosis patients in urban poor neighbourhoods. We hope these stories contribute to discourse on how to strengthen the public healthcare system and make it more accessible for all, especially the poor.

This article recounts a poignant interaction between the author and a mother of a child with cerebral palsy. The mother's remarkable strength and optimism in the face of adversity deeply moved the author, leading to a tearful moment which prompted a comforting response from the mother. The ongoing debate regarding whether doctors are allowed to display emotions in their professional lives centers around the challenge of balancing professionalism with the emotional impact of providing healthcare to patients. While doctors are expected to uphold professionalism and make sound decisions in their work environment, simultaneous expression of emotions, empathy, and vulnerabilities becomes inevitable.

Custodial death is generally linked in the public mind with police brutality and torture, not with indirect brutality through negligence and callous treatment in jail custody. Yet it is not known how many of the thousands of prisoners who die in our jails every year die due to neglect by the jail authorities. The official Prison Statistics India (PSI) in its most recent report states that 1,879 men and women died due to "natural causes" in prisons across India in 2021. Natural causes are defined in the report as "illness" and "ageing". According to the report, 185 more prisoners died of "unnatural" causes, and 52 of "causes not yet known". [1: p 179]. "Unnatural deaths" include "deaths due to negligence or excesses by jail personnel"a. The vagueness of this classification in the PSI data had been noted by Justice Lokur in a landmark Supreme Court judgment, in 2013, when he said: "The distinction made by the NCRB [National Crime Records Bureau] between natural and unnatural deaths is unclear. For example, if a prisoner dies due to a lack of proper medical attention or timely medical attention, would that be classified as a natural death or an unnatural death?" [2].

Publication and citation metrics have been used for many years now as apparently objective parameters to evaluate educational institutions as well as individual researchers. A recent report in Science, about the Saveetha Institute of Medical and Technical Sciences (SIMATS), near Chennai, Tamil Nadu [1], highlights concerns about the value and limitations of such metrics in evaluating the importance of research publications, authors, journals and institutions.

Scientific writing and publishing are significant for an early-career researcher (ECR). For entry into doctoral studies, new jobs, or promotion, publications are among the essential requisites any selection committee will look for. Unlike interpersonal skills such as team building or communication, academic outputs are easier to assess and quantify but producing them may not always be easy for an ECR.