In Medical Ethics [Dr.

Kabra]
The profession of doctor is the noblest profession, but there are always issues on
which a doctor has to take his decision, whether he should follow the rules of
conduct or should he not care about the rules and act in accordance to his morale.
In medicine the ethics and law run parallel. Doctor Kabra with a few case studies
threw some light on some of these dilemmas of the doctor.

Case 1: A case of unmarried pregnant girl

An unmarried pregnant girl aged 17 years had sudden pain in abdomen, when
condition worsened brought to hospital; doctors diagnosed her and found an intra-
abdominal bleeding and advised her for immediate operation .Emergency operation
was done and the ruptured tube with the conceptus and the adhered ovary was
removed.

The questions now arises are

Q. Should the doctor disclose this information to the girl’s parents?

A. Yes, since the girl is not mature enough and she is not paying for her operation.

Q. If the medical report should carry this information about the girl?

A. Yes, but the report should be kept secret between the doctor and the girl’s
parents.

Q. If in future someone relative asks for the medical report of the girl, should the
report be disclosed to the person?

A. Yes, if the info be kept secret it may harm girl’s health in some other medication,
or procedure. After looking at the report only her current doctor would follow the
procedure that would not harm girl’s health in any way.

Q. If the information can damage the future of girl in some way, should doctor still
abide the law and disclose it to girl’s relatives?

A. Yes the doctor should disclose the information as he’s been abided by law to do
so, and morally it’s not wrong to do so as there may be something serious affecting
the girl’s health, or may be some wrong data may be fed to relatives by some other
doctor, so the doctor should clarify the situation with the girl’s relatives.

Q. If the legally permitted relative comes to the doctor to ask about the girl’s
medical procedure, should doctor disclose the information to the person?

A. Yes, the doctor should tell them why the procedure was necessary, under what
conditions were the girl brought in the hospital, what were the diagnosis, what the
end results were, and what could have been the future side effects of the
procedure.
Q. Should doctor discuss personally with the girl before revealing any of her info to
the closest relative?

A. Yes, but only if the girl is self dependent and no law are there to disclose the info
to the closest relative.

Voluntary blood donor (HIV Positive):

A young, healthy, unmarried lady lecture came to donate her blood, but blood-bank
found her HIV positive and was for a confirmation test. She did her western-blot test
it was found negative, then she got angry with hospital authorities for declaring her
HIV-positive.

Questions Arise

Q. Should the donor’s identity be disclosed?

A. No, the identity should not be disclosed, as it would affect her social relationship.

Q. Should the person be told about the HIV without being confirm?

A. The doctor should clarify that it’s not a perfect test, and that she should get
herself tested by a better and more accurate test.

Q. The doctor’s duty is for the donor or the society?

A. The doctor’s duty is for both, its doctor’s duty to reject the donated blood for the
social cause, and inform the donor for the rejection causes.

HIV positive young man:

A man found HIV positive. And the doctors got to know that he was married but
‘gauna’ hasn’t happened. And he has been visiting a girl with his friends. Here the
question arises:

Q. Should doctors call his friends and test them for HIV?

A. Yes, the doctor should tell the boy to get to his friends and tell them to get
checked up, as they may be carrying some disease, and if dangerous disease they
may be transmitting it to other close ones too.

Q. The girl whom HIV was alleged to been picked up, should be identified and
tested?

A. Yes, as she may have been with other people too, and may be she’s the main
transmitter of the disease, so for the social cause she should be called in.

Q. Should the doctor call the girl’s, whom he was getting married, parents and tell
them about the boy’s situation?
A. Yes, the doctor should tell the girl’s parents about the boy’s situation, as the girl
is not having HIV, and after marriage she may get affected by the disease, so for
the social and moral cause the doctor should disclose the info.
A case of terminal breast cancer:
A lady, a known case of breast cancer, comes to Bombay to consult cancer
specialists of a leading cancer hospital of the country. On examination, specialists
find the cancer to have widely metastasized (spread) to abdomen – a stage where it
is considered no more curable (treatable). The specialists, after full evaluation,
explain the condition to the patient, and tell her that nothing curative is possible at
the stage.

The cancer specialists are persuaded to comply with the wishes of the patient’s
husband, and they certify that as no treatment is possible in the country, the case is
referred to an international center. On the basis of the certificate issued by the top
specialists of the country, the patient’s husband gets a government sanction to take
the patient to the international center.

Q. Was it ethical for the specialist to refer the patient to a foreign center, knowing
fully will that at the stage of the patient’s disease, no treatment was possible?

A. Yes, since there may be some procedure or medication that may let her live a
little longer or may cure her.

Q. Was it ethical for the government to sanction, money out of its scarce resources,
for this patient who was unlikely to benefit from the referral, as this would lead to
denying the same to other medically more deserving cases on the grounds of
scarcity of funds?

A. No, since the doctors were aware of her situation and were clear that no possible
treatment can cure her.

Later, the consulting surgeon advised immediate admission to a hospital and wrote
a referral slip recommending that the patient, a breast cancer case with metastases
to abdomen and bleeding from uterus, be admitted to the hospital. The patient was
taken to the hospital where the referring surgeon worked. No bed under the
recommending surgeon was available. The recommending surgeon worked in the
unit of an honorary surgeon. Since the patient needed immediate admission, she
was admitted on a bed of the honorary surgeon in whose unit the referring surgeon
worked. The honorary surgeon was not informed of the admission.

Q. Did the duty of the consulting surgeon to the bleeding patient end with the
advice of admission?
A. No, as the doctor’s advice would be affecting the future of the woman. So it’s his
duty to continue the treatment course. The patient’s admission to the hospital
where he worked, he should ensure that the patient received treatment for the
condition for which she had been advised admission.

Q. Was it ethical to give her a bed in other surgeon’s ward?

A. Yes, since the patient needed immediate attention, and for treatment she needed
a bed, so even if she’s been given a bed not on anyone’s account, it was ethical.

Q. Should the surgeon, under whom the bed was given, be consulted first?

A. No, depending on the situation and emergency, it was ethical to give her bed,
and be told to the surgeon later.

Later, the husband of lady requested the operating surgeon to swap with the
surgeon under whom the bed was given, but the “bed providing surgeon” denied
the request to take the case in his hands, but promised to give help.

At the day of operation, the “bed providing surgeon” was operating on one of his
own patient, when the lady’s surgeon arrived to him and asked him to help with the
breast cancer lady, but the “bed providing surgeon” refused, since he was already in
operating mode.

Q. Was it ethical for “bed providing surgeon” to refuse to take over the breast-
cancer lady’s case in his own hand?

A. Yes, since he was aware of the situation of the lady, and was confident about the
capabilities of currently operating surgeon.

Q. Was it ethical for “bed providing surgeon” to refuse to look at the operation of the
breast-cancer lady?

A. Yes, since the “bed providing surgeon” was already engage in the operation of his
own patient and his responsibilities were of higher priority with his own patient.

Q. Since the breast-cancer lady was admitted in “bed providing surgeon”

department, was she now the responsibility of the “bed providing surgeon”?

A. No, since the “bed providing surgeon” was not aware of the time when the lady
was admitted in his ward, she was not his responsibility, and the admission was
ethical as she needed immediate attention.
WILL TO DIE WITH DIGNITY: SANTHARA? SUICIDE?
EUTHANASIA?
Q. If law allows SANTHARA, why is suicide illegal?

A. SANTHARA, means that a mature person, in his right mental state, fully
competent, decides to relinquish his life, with consent and long discussion with
concerned family members. Whereas, suicides are instinctual, done in depression or
in worst mental state, without any fully considered and perfected discourse.

The motivation behind SANTHARA is not to burden the family, but to make them
comfortable. But, the suicides always cause agony and mental suffering to the
related person.
Naitik-Chintan [Ethical Thinking] [Shri Yashdeo Shelya]

Ends-based thinking - deciding to do whatever provides the greatest good for the
greatest number. This is known as the principle of utilitarianism. It relies on being
able to predict the consequences of different actions.

Rule-based thinking - deciding what to do, based on a rule that you believe should
be a general principle that is always followed. Rule-based thinking acknowledges
that you can never really know all the consequences of your actions and that it is
better to stick to one's principles.

Care-based thinking - deciding what to do, based on the idea that this is what we
would want others to do to you. This is known as the principle of reversibility and is
at the center of most religious teachings.

Can moral thinking and success go together?

Yes, they can. May be the wrongdoers succeed at much faster pace, but deeper
they would always fear of being caught, and no deed goes unpunished, but a person
with moral thinking would never fear of anyone, he would succeed and reach the
pinnacle. Everything is written, and its god who decides for you.

The speaker talked about day to day life philosophy. Take one step at a time, and
think of not hurting someone. Further he added, all we have to do whatever God has
written in our fate, but we can have betterment and excellence in that task by
adding moral values. Naitik-Chintan includes the thinking of betterment of all
human kind. Serve poor and elder person; provide education on the level you can
provide. Now or then you would definitely get its result. He ended the discussion
with words “Be happy and keep people around you happy”.
Dr Amitabh Das Gupta:
Ethics is not act of prohibition; it is noble theory which can be practiced easily if
believed in. Ethics in concern with human action is related to society. Don’t lie, don’t
cheat, don’t kill does solve some of the complicacies of human kind, but not all.

Deontology: follow ethics as it is all about rules to make a better human race.
Abide the rules, breaking them would be unethical.

Consequentiality: We decide what is right and wht is wrong on the basis of

consequences of our past experience of decisions.

Ethics as a part of religion:

Jules' speech from Bible 25:17:
'The path of the righteous man is beset on all sides with the iniquities of the selfish
and the tyranny of evil men. Blessed is he who in the name of charity and good will
shepherds the weak through the valley of darkness, for he is truly his brother's
keeper and the finder of lost children. And I will strike down upon those with great
vengeance and with furious anger those who attempt to poison and destroy my
brothers. And you will know that my name is the Lord when I lay my vengeance
upon thee.'

God is one, and he approves what is good or what is bad? Based on your action you
would be rewarded, the good action would be counted as ethical and moral.

Religion provides theory for doing what is right.

Social Ethics is relative to society, and varies according society.

Ethics involve reasoning, ethical judgment does not describe any fact they express
our attitude. Ethics is perception of a person; they describe the course of action the
person would follow. Ethics can’t be said to be wrong or right.

Universality and impartiality should be there to differentiate the right from wrong,
regardless of society.

Human beings are equal, the caste, creed, color, religion are manmade distinctions,
but in the core differentiates no one. The theory faced some challenges as:
Researches of Hans J. Eysenck and Arthur R. Jensen reveals that that blacks scored
lower on I.Q. tests than whites at least partly because of their genetic makeup.
And this principal is also contradictory to the notion that children with
disadvantages background should be given priority.

Complete equality is not possible as inequality is a fact; there are differences

everywhere, in every quality someone always lacks behind.

Social Contract Theory:

It is nearly as old as philosophy. It is the view that persons' moral and/or political
obligations are dependent upon a contract or agreement between them to form
society. If you are good to me I’ll be good to you as well.

Initially human had STATE OF NATURE, when he only cared about himself, he was
violent, but later in evolution he learned to live in group, after then only the STATE
OF SOCIETY came into the scene.

Contract theory of ethics: If you are good to someone, in return he’ll be good to you.

Principle of Equal consideration of interest: it describes that the different person

suffering from unequal pain, then it’s not about the equal treatment, but treat the
worst pain so that pain and suffering can be equalized.

The change is inevitable, and if stopped then there would be revolution. The
philosophers have different views on the topic.