Context

The Ethics and Medical Registration Board at National Medical Commission has got its new president, duly appointed by Ministry of Health and Family Welfare as per the National Medical Commission Act, 2019.

Background

• There are plethora of ‘codes of conduct’ and laws in place to regulate the medical profession in India both at individual and organisational levels but complaints have been increasingly large against the unethical practices of physicians due to the increasing public awareness.
• Prior to 2019, The Ethics committee of Medical Council of India was in charge of upholding the principles of Medical Ethics and impart punishment to errant doctors in violation of MCI code of Medical Ethics
• After the enactment of NMC Act, 2019 MCI was dissolved and a fresh board for Ethics and Medical Registration was constituted.

Analysis

What is medical ethics?

• Medical ethics is that applied branch of ethics which describes the moral principles by which a medical practitioner must conduct themselves.
• It is astonishing to know that medical ethics is a changing yardstick. Something that might have been considered ethical during last century may not be today – and what we think is ethical at present may change with passing time.
• The four pillars of medical ethics are:
• Beneficence
  • The idea that medical interference will do good to the patient
• Non-maleficence
  • Not to harm your patient, than to do them good, which is part of the Hippocratic oath that doctors take.
• Autonomy
  • Right of the patient of self determination regarding their own treatment
• Justice
  • The fair distribution of healthcare resources

What are the ethical issues faced by medical practitioners?

• PHYSICIAN-ASSISTED SUICIDE AND EUTHANASIA: The Hippocratic Oath states: 'I will give no deadly medicine to anyone if asked, nor suggest any such counsel'. This has been ordained to maintain sanctity and dignity of life so that doctors' professional capabilities are not abused. Nevertheless, during the course of a terminal illness and in the care of patients with irreversible life-threatening disease, a time comes when it is appropriate for the doctor to stop further attempts to prolong misery and allow death with dignity
• OBLIGATIONS TOWARDS PATIENTS: A physician is not duty bound to treat each and every patient requesting his services. However, he has a moral obligation to provide emergency care to his regular patients. In the absence of a pre-existing relationship, the physician is not ethically obliged to provide care to every patient unless no other physician is available in the vicinity in the event of a dire emergency
• RELATIONSHIP WITH OTHER PHYSICIANS: The relationship between physicians should be one of cooperation and friendship. They should be willing to provide mutual consultation to each other without any commission. While evaluating a referred patient, it is unethical for a physician to ridicule the professional competence, knowledge and services provided by the referring physician.
• EXPERT WITNESSES: Physicians cannot be compelled to participate as expert witnesses but the profession in general has a moral responsibility and ethical duty to assist patients and society in resolving disputes. They must give an honest, objective and unprejudiced interpretation of medical facts
• ADVERTISING: Self-promotion, display of large signboards, self-aggrandizement through media and press, claims for unusual miracle cures are unethical
• STRIKES BY PHYSICIANS: Despite the fact that medical services are essential, it is not uncommon for doctors to go on strikes. It is unethical for physicians to withhold medical services through strikes
• REBATES, COMMISSIONS AND COURTESIES: It is undesirable and unethical for physicians to give and solicit any gift, bonus or 'kickbacks' for referring patients for consulta- .tion and investigations. It is also unethical for physicians to receive courtesies, favours and gifts from manufacturers or suppliers of equipment and pharmaceuticals.
• RESEARCH AND PUBLICATIONS: Fraud in research either by plagiarization or quantumjugglery should be condemned and those indulging in such acts should be punishable on grounds of professional misconduct. The stipulated code of conduct and format should be followed for scientific publications.
• PROFESSIONAL CERTIFICATES: Physicians are expected to issue a number of medical certificates-birth, death, vaccination, sick leave, disability, etc. It is common to see false medical certificates issued by physicians for monetary gain or due to political bureaucratic pressures.

Medical Ethics in Ancient India

Charaka clearly outlined four ethical principles of a doctor:

• Friendship towards the sick
• Sympathy towards the sick
• Interest in cases according to one’s capabilities and
• No attachment with the patient after his recovery

The Charaka Samhita has extensively emphasised the values that are central to the nobility of this profession thus, ‘Those who trade their medical skills for personal livelihood can be considered as collecting a pile of dust, leaving aside the heap of real gold’.

Conclusion

The declining image of the medical profession needs a moral boost and rejuvenation through a process of soul-searching in the light of existing social realities.

There is a need to introduce regular education programmes in the field of behavioural sciences and medical ethics for graduate and postgraduate medical students in all the medical schools of the country

When practising physicians are more considerate, cautious, honest and ethical in their dealings with their patients, there should be no fear of consumer fora.