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Regulate hi-tech healthcare now

Modern medical technology has bent, if not broken all the prevailing rules. Tissue and organ transplant processes, pre-natal diagnostic procedures, genetic engineering feats and opportunities of assisted artificial reproduction have subtly but surely changed our perception of the possible.

india Updated: Jan 22, 2006 23:32 IST

Modern medical technology has bent, if not broken all the prevailing rules. Tissue and organ transplant processes, pre-natal diagnostic procedures, genetic engineering feats and opportunities of assisted artificial reproduction have subtly but surely changed our perception of the possible. It has also broadened the concepts of right and wrong, altering what is considered `the ethical', in the line of medical duty.

Demands of abortion, transplants and physician-assisted death have displaced the meanings of universally accepted concepts in medical ethics, such as accountability, efficiency, transparency and privacy. The result: angst within doctors, insecurity among patients.

In an environment of increasing specialisation, doctors are asking questions regarding the relevance and ethics of the 2000-year old Hippocratic oath. Should a doctor maintain a patient's privacy with increasing pressure from governments and health care organisations? Are physicians morally obligated to treat patients with infectious lethal diseases?

Hence, there have evolved various modern versions of the oath. A survey of 150 American and Canadian medical schools showed that only 14 per cent of the modern oaths prohibit euthanasia, 11 per cent of them talk of accountability to God, 8 per cent renounce abortion and only 3 per cent forbid sexual contact with patients— all maxims held sacred in the original version. But the most telling fact is that most of them do not insist the doctor be held accountable for keeping this pledge. These are efforts to redefine the role and social responsibility of doctors.

One of the most vulnerable group is that of HIV/ AIDS patients. They not only face societal discrimination but also medical discrimination, with some doctors refusing to treat them due to fear of infection or social pressure. Equally controversial are clinical trials conducted on unsuspecting patients without their consent or knowledge. Prescriptions by doctors are often irrational, and contain unnecessary drugs.

Advances in medical technology have further provoked the debate on medical ethics or the lack of it today.

The number of unnecessary surgeries has been increasing and so have the incidents of female feticide using high tech diagnostic technologies. Recent data shows the rate of caesarian section deliveries in urban private nursing homes is as high as 50 to 60 per cent. Considering the pervasive nature of the misuse of the available technology, it can no longer be blamed on a handful of black sheep within the fraternity. Undoubtedly a sizeable section indulges in it.

Suggesting a blanket ban on the use of these technologies is naive if not obnoxious. The medical system thrives on technological innovation. And since the potential of this technology is unlimited, it makes perfect sense to regulate it and lay down or re- define the ethics of its use.

This explains why many nations are taking their medical technology seriously. Canada, EU and the British Columbia have specific bodies for the sole purpose of assessing the various social and ethical implications of new and upcoming health technologies. These bodies are not mere watchdogs, they are active contributors to decision making at both general health care and patient care. Realising societal pressure, at least 30 countries have already passed comprehensive HIV/AIDS laws against medical discrimination, ensuring confidentiality and epidemiological control. India and Nepal among others have amended their existing laws to enlarge access to safe abortion services.

The next story goes on to analyse the current regulatory framework and call for systemic changes to make our doctors responsive and responsible.

First Published: Nov 16, 2005 19:40 IST