Role of Medical Ethics in India

The legal thinking, philosophy and ethics of ancient India developed with a rational synthesis and continued new concepts. The basic foundation of ethics comes from the Hindu belief that we are all part of the divine Paramatman. Ayurveda is the ages old science of life. It sets out the principles of health and disease management and the Code of Conduct for Doctors. Charaka described the goal of medicine to be twofold: preserving the good health and fighting the diseases.

The humanistic ideal of Charaka is incontestable in his advice to the doctor. Those who do not practice for money or whim, but compassion for living beings, are the best among all doctors. It is hard to find a factor of religious blessing comparable to that of the doctor who takes the traps of death for his patients. The physician, who sees compassion for living beings as the highest religion, fulfills his mission and achieves the greatest happiness.

Justice Brace Jennings observed that moral decision-making in medicine is becoming increasingly institutionalized and subject to formalized procedures and limitations in a variety of areas of contemporary medicine, such as a research on humans, organ procurement, and transplantation, assisted reproduction, rationing of health care and renouncement of life-sustaining treatment.

Medical ethics is a field that separates a legal obligation from a moral obligation, and relationships require the trust of medical fiduciary duty towards one's patient. The reasons for the need for confidentiality are complementary. First, if sick people do not trust doctors to treat the information they disclose confidentially, they will not go to treatment. This is particularly important in the case of an infectious disease, such as infection with the Human Immunodeficiency Virus (HIV). The doctor must also believe that patients have a complete history of their condition; otherwise risks can arise because the doctor can misdiagnoses and prescribe inappropriate treatment.

The legal obligation is not absolute and can be changed. The case analysis that helps define and delineate the law in this area demonstrates the importance of patient disclosing complete information related to him in the public interest. The private interest of the individual is relatively unimportant.

The law is concatenated to medical law and medical ethics. Morality is sometimes explicitly included in the legal doctrine and is inevitably integrated into the law in the controversial ethical issues elevated by the health care system. Medical law is inextricably linked to medical ethics. We will not be able to understand medical law without understanding the ethical tensions in the field of medicine.

Theories of medical ethics

Moral realism, moral objectivism and moral pluralism

Moral relativism is the view that what is morally right or wrong depends on what a person thinks. Now that can be either subjective, that is, what is morally right or wrong for someone depends on what one considers morally right or wrong or conventional, that is, what is morally right or wrong is based on what this society we are living in thinks as the conventions of society affect. Moral facts can vary from society to society. Moral objectivism is the view that what is right or wrong does not depend on what everyone thinks is right or wrong. That is, as per this view moral facts are like physical facts, since the facts do not depend on what anyone thinks. Moral pluralism is the idea that there may be conflicting moral views and all of them are needed to be respected. Moral pluralists tend to be open to competing positions. They analyze problems from several moral points of view before deciding and acting. This theory believes that many moral issues are extremely complicated. Therefore, not one philosophical approach will always provide all answers.

Utilitarianism

Utilitarianism is a set of moral theories that are morally needed to find the best possible balance between utility and inutility. Classic or hedonistic utilitarianism is the most famous version that requires the pursuit of maximum pleasure over pain. See, Gandyour and Lauterbach 2003 for a brief summary of many popular versions of utilitarianism. For instance there is a doctor who is facing a number of cases where there are four patients who are in a need for life saving donation of organs and tissue and there is a person who is potential in donating organs and tissues, from whom these tissues can be removed in a relatively safe manner, but he is undesirable to do so.

For an act of utilitarianism to maximize the utility, and the ability to remove certain tissues (such as a single kidney, a segment of the liver, bone marrow and blood) to save the lives of those four patients which will be outlined on the inclusive utilitarian balance of doing this. The utility of rescuing four patients is likely to be very high, especially if these patients contribute to the lives of others. Rather high enough that under certain circumstances the inutility to resort to a reluctant donor can be weighed. This commitment to equality has meant that utilitarianism is associated with the phrase - the greatest benefit to the greatest number.

Right Based Theory and Duty Based Theory

Theories based on right and duty is based on the interest of the individual and not on the collective. It follows that, unlike many versions of utilitarianism, when all else is equal, the combined moral claims of a large number of people needing the removal of warts cannot override the claims of a person who dies of heart disease.

The difference between right-based and duty-based theories rests on the availability of advantage of moral obligations. The right-based theory states that all moral obligations are limited to moral rights, which are understood as legitimate claims that impose correlation rights from which the right holder can benefit. On the other hand, rights-based theories do not automatically give the recipient the obligation to relinquish his advantage in the sense that he releases the obligation-holder from his obligation.

Virtue Ethics

Virtue ethics rejects any action based on moral principles, including utilitarian, rights-based and duty-based theories of character values. Even then, the ethic of virtues is not intended to provide universal rules or principles, such as the principles of utility (the goal is not to maximize virtuous behavior) or those associated with rights-based theories and theories.

Compromise Position

Positions of Compromise, is a collection of moral positions that draw elements from the other four. These positions are rarely well-founded and tend to be closer to the ethical considerations of a layperson. It is essentially a diversified category that covers almost countless moral positions that are not all coherent. The classic compromise position in medical ethics is illustrated in the "principlism" of Beauchmp and Childress. Both of these authors represent four principles of biomedical ethics. Their position explicitly seeks a compromise between global deep moral theory and practical ethics by adopting an element of utilitarianism, a theory based on rights and duties, and virtue ethics.

Informed Consent

It is generally believed that the patients cannot make a rational choice because they cannot assess the intricacies of alternative medical treatments, procedures or drug trials, and therefore often have a paternalistic view "the doctor knows best". But to the contrary, to determine what needs to be done with your own body is the right of every person. A surgeon who performs a surgery without the consent of his patient commits an act of assault towards him for which he is responsible.

What is the old teaching in such circumstances? Charaka recommends that the physicians should to gain the confidence of close relatives, community elders, and even government officials before they begin with the treatment that can lead to death of the patient. The doctor must then proceed with the treatment. In India, the doctor has great trustworthiness, but presently more and more people question the practice. Trust, based on the goodness of doctors, is slowly disappearing and giving way to the concept that decision-making is the right of the patient. The consent of the patient is relevant in this context.

Disclosure of the Information

People argue with a doctor who, by disclosing information, evades his obligation of secrecy. In this context, the patient would have the right to know what information and how much information is disclosed and to whom it was revealed. Disclosure of information is therefore another area of ​​concern for medical ethics, and disclosure of information also creates conflicts. But there may be some circumstances where a doctor has to disclose the information for e. g. disclosure to the parents, insurance company, police, etc. According to Charaka and Susrata, the doctor must exercise care to expose the patient to the incurable nature of his illness. It should not be said openly or bluntly.

It may shock the patient and is preferable to make the patient's relatives aware. A heroic treatment may only be done with the consent of the patient's relatives. Current doctors have different opinions about when to tell the truth and how much to tell the dying patient. There are many conflicting interests such as the right of the patient to know about his condition and the benefit to the patient and possible harm related to the situation.

Confidentiality

The rules of confidentiality and medical ethics are decided by health professionals through their control of professional associations. In terms of history, the Hipporatic Oath is the foundation of the medical profession. The policy that governs the GMC comes out of it, and that is why the oath binds the doctor at least theoretically. The GMC attaches great importance to professional secrecy, but before considering further details, two terms of the Hippocratic Oath should be mentioned. First, the confidential relationship is not limited to what happens between the patient and the doctor. The doctor must maintain confidence even when it is an informal conversation, regardless of what is the source of that information.

Patient’s Autonomy

The expectations of the patient are that everything that is told about his illness is part of the ethical concept of autonomy or self-determination. At the same time, it is generally acknowledged that the right to behave independently can sometimes be ignored because of the interests of others. There is no independent right to kill someone, even if they make an autonomous decision to do so, because the good of the society demands that this behavior be banned.

Respect for autonomy is one of the cornerstones of the relationship between doctor and patient. Doctors' professional ethics require them to make use of their expertise along with the patient's right to self-determination in their mind, and overall, physicians will take this commitment very seriously, even in cases where the patient's capacity may be in a doubt. Both ethically and practically, the self-determining patient is the ideal model from the point of view of doctors and patients.

Organ Transplantation. There is a growing demand for organ transplants such as kidneys, and these demands often lead to ethical nightmares. A small number of kidneys are donated by relatives and the vast majority of transplants are on a commercial basis. Some doctors are involved in kidney business and cure rich patients in India and the Middle East.

A new class of agents is actively involved as an intermediary. Some doctors do not care about ethical values and steal kidneys without the knowledge or consent of the person concerned. Illiterates and the oppressed are forced to donate their kidneys because of the desperate need for money. This type of organ transplant raises many ethical issues which must be dealt with.

Terminally ill

A doctor preserves human life and prevents death. As long as the patient is breathing, it is the doctor's duty to offer treatment (tatvat pratikriya karya yavae chvasiti manavah).

The terminally ill patient must be treated carefully to reduce the suffering. Current thinking is in this perspective and does not foster the extension of life with machines when there is no chance of healing.

Code of Medical Ethics

The Code of Medical Ethics aims to preserve the medical ethics of physicians. The main goal of the medical profession is to serve humanity. Professionals should act according to their ideals. He must be noble in his character and must be modest, sober, patient and quick to do all his duty without fear, with caution in his profession and in all actions of life.

The code specifies the responsibilities of the doctors. The primary goal of the medical profession is to serve humanity. Doctors should be available to their patients and colleagues and enjoy the benefits of their professional skills. The doctor must use a science-based cure and is not allowed to communicate professionally with anyone who violates this policy. The honored ideals of the medical profession include the responsibility of the doctors, which extend not only to individuals but also to society. The Code has established guidelines for the payment of services. The remuneration for services must be in the form and the prescribed amount must be expressly communicated to the patient at the time of service.

It is unethical for doctors to follow the service of no pay without care. Commitment to patients listed in the Code. A doctor is not required to treat every people in need, except in an emergency for humanity and the noble traditions of the profession. He must not neglect the calls of the sick and the wounded, but must responsibly pay attention to his mission.

The Code ensures the confidentiality, patience and delicacy of the doctor. Details about the individual life of patients should not be disclosed unless it is required by law. A doctor can determine whether his or her duty requires disclosure of confidential communications in the interest of the company. The doctor must act as he would like another to proceed with one of his family under similar circumstances. A doctor can choose the patients freely. But it should respond to any request for help in emergency situations. The doctor must not neglect the patient and may not withdraw him without informing the patient or his relatives. No registered physician may intentionally commit negligence that could deprive the patients of the necessary medical care. The Code also provides for the disclosure of unethical behavior. A doctor should, without fear or apprehension, expose incompetent, corrupt, dishonest or unethical behavior of other members of the profession.

Medical Ethics under Medical Council Act

The Medical Council Act contains numerous provisions for the prevention of misconduct. Professional misconduct may be brought before the Medical Council of India or the State Medical Councils for disciplinary action under the Act or the laws of the State Council.

The competent councils shall, if necessary, impose such penalties or order the withdrawal of doctors from the registry for a certain period of time. The Medical Council of India or the State Medical Council should, in person or through a lawyer, hear the accused of serious professional misconduct. The appropriate medical council may also provide instructions for removal or restoration.

In many cases, mistreatment issues cannot be included in any of these categories. In such cases, the Medical Council of India or the State Medical Council must decide the facts presented to the Medical Council of India or the State Medical Councils. The Indian Medical Council Act has provided various sanction systems. Any doctor who abuses his or her job by committing adultery or inappropriate behavior in a patient or maintaining an inappropriate connection with a patient is subject to disciplinary action. Apart from that, there is the possibility of a criminal conviction for offenses with moral depravity.

He was held by Apex Court that the medical profession is one of the oldest professions in the world and the most humanitarian. There is no better service than to serve the suffering, wounded and sick. A code of ethics containing the fundamental ethic that emphasizes the moral values ​​of professional practice aims to preserve its dignity. At the same time, none other than a doctor with a qualification recognized by the Medical Council of India or the State Medical Council is entitled to practice a modern surgical system. A person who qualifies for another medical system should not practice under this system.

As per Medical Council Act advertising for the profession as unethical. It is unethical to ask patients directly or indirectly about a doctor or group of doctors or about an institution or organization. A doctor, however, is allowed to make in the press an official announcement of the beginning of the practice, changing the nature of the practice, changing the address, the temporary absence, the resumption of another practice, and public statement of change. Lately, the self-regulatory standards of the profession have declined due to the commercialization of the sector.

There are reports against the medical practices of exploitation, the misuse of diagnostic procedures, the booking of offers to sell human organs, etc. External regulation and self-regulation are needed. The balance between service and business is worrying and shifting towards the business. Doctors must perform individual and collective introspection. They have to face up to this and maintain discipline and high standards in their profession. Even after the implementation of the Medical Council Act, many unethical activities exist in the medical profession. It is therefore important to amend the Act so that all the malformations are eliminated.

The medical profession needs strict disciplinary measures. MCI only takes the disciplinary action for complaints. Most victims of medical negligence may not be interested in going against the doctor or they might not be unaware of what to do. In such a case, the Council has nothing to do. Apart from this, the 1956 Medical Council Act does not provide for a procedure for conducting an enquiry or setting a deadline for its completion. Such an investigation is often done by ad hoc committees and it takes a long time to submit reports because they are unaccountable.

In summary, there are hardly any disciplinary measures against negligent doctors and doctors are almost never punished. Advances in medicine and technology have created new challenges in the medical field. Problems related to the treatment of infertility, artificial nutrition and hydration as well as the treatment of patients in coma are among the controversial issues in this regard. The regulation of medical practice cannot be carried out by the Council alone. The new world of medical technology requires formal and informal regulations from professionals and institutions. Effective law can therefore create a better atmosphere in medical practice.