medical profession in india essay

The History of Medical Ethics in India Looking at the Past as We Try to Change the Future

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India has had a solid standard for medical ethics since the birth of Ayurvedic holistic science over 5000 years ago. The country’s views on healthcare policy, counsel on how to deal with patients, and what constitutes good behavior within the profession stem from ancient outlines for medical practice. These “codes of conduct” were heavily influenced by religious and spiritual practices, emphasizing the sanctity of life and transcending the needs of the body. With time, however, medical care evolved through shifting priorities in education and governmental pressures. These once-cherished “codes of conduct” were referred to less often, while malpractice issues have steadily increased. There is a need for an open discussion of why this spike in medical malpractice is happening in a country that used to condemn it and how improving ethics, limiting the role of profits, and returning traditional philosophies to the medical ethics curricula could help.

INTRODUCTION

Currently, India has the largest number of bioethics units of any country, reflecting the importance of ethical behavior in Indian society. These centers do not affiliate with schools, yet they serve as spaces for bioethical discourse. The Indian Psychiatric Society (IPS) was the first to address escalating malpractice cases. Other major medical organizations (e.g., the Indian Medical Association and the Medical Council of India) followed, stressing the importance of standardized ethics. Some have formed symposiums and organized conferences to address these concerns. [1] There have been several calls to revisit the classic “codes of conduct” and their focus on the spiritual concept of life-death-rebirth.

Toward this end, modern Indian doctors were reminded that physicians existed not for fortune or status but for the welfare of their patients. These altruistic teachings came from the seminal Ayurvedic texts, the cornerstone of India’s modern medicine. Happiness for the “healer” was to come out of showing compassion for all living beings and prolonging the precious gift of life. [2] In contrast, Indian novelist, Shashi Tharoor, speaking on the current state of medical practice, recently remarked: “India is not an underdeveloped country, but a highly developed one in an advanced state of decay.” [3]

Taking a closer look at what caused the core values of an ancient healthcare system to change so drastically involves evaluating how the Indian medical education system evolved. This paper examines the development of medical principles, their influence across the subcontinent, commercialization, and the government’s role in India’s healthcare instability. This paper then lists some of the measures taken by bioethical units to counteract some of the issues brought on by corruption.

l.     Western Influence

Western influence on medical practices came when the French, Portuguese, and British arrived in India. They almost completely reinvented India’s healthcare system. Medical ethics based on the values of spirituality were almost completely stripped away and replaced by Western concepts. [4] Established traditional ethical standards were no longer taught, resulting in less deference to traditional moral beliefs. Coupled with an increase in medical misconduct, the general population lost trust in their healthcare leaders. [5]

Before the influence of Western medicine, the Carakha Sumhita, a millennia-old Sanskrit text detailing Ayurveda, helped establish healthcare guidelines. A passage from the text sums up the ethics of that time: “He who practices medicine out of compassion for all creatures, rather than for gain or for gratification of the senses, surpasses all.” [6]  The Carakha Sumhita’s focus on medical ethics was ahead of its time, centuries before bioethics became a subject in its own right. Healthcare was predicated on aphorisms that all medical students internalized rather than on business models, as in many developed nations. India’s caste system, established generations ago, permeated every aspect of South Asian society except for when it came to medicine. Healers tended to ignore the conventions of adhering to an individual’s caste. Instead, they treated patients as if they were family and incorporated elements of spirituality when dealing with patients, making ethical misconduct a rare phenomenon. This was the case for almost two centuries. [7]

To become practicing physicians, doctors committed to a consecration ceremony to prove their good moral standing to the people they were to serve. [8] Their schooling prepared them for a profession designed to “give back,” not for monetary gain. The core values taught in medical school affect the mentality doctors carry with them.  The lack of ethics training may have been at fault for the underlying corruption levels that now plague the healthcare space in India. 

There is a 110 percent increase in the rise of medical negligence cases in India every year. [9]   To pinpoint why this occurred, we must look at current medical training practices and how they influence doctors of our time period. After colonization, many established core values were stripped from the medical curriculum. [10] In fact, by 1998, only one medical college in India, St. John’s in Bangalore, even addressed medical ethics in its curriculum. [11] Graduates across the country were left ill-equipped to deal with the ethical issues that cropped up once they made it into the field. As a result, they were not prepared to think through consequences pertaining to patients and their families. Some suggest that the curriculum changes were linked to rising malpractice cases.

“When society at large is corrupt and unethical, how can you expect doctors to be honest?” [12] This topic arises regularly in bioethics discussions and the answer lies in education. Reverting to a system of medicine that encourages students to recognize ethical consequences can solve many of the ethical problems in contemporary society.

ll.     Privatization and Tuition

Some argue that the global increase in capitalism caused the subcontinent’s ethical problems, that the Indian medical education system began its descent into corruption and nepotism, and its loss in prestige, with the privatization of their colleges. [13] In India, just over 50 percent of medical schools are public, and just under 50 percent are private. [14] Through changing policies, private medical schools became increasingly for-profit like other businesses. [15]

Despite having more medical schools than any other country, India has a shortage of doctors, primarily due to low enrollment rates and high university fees. While there are 202 medical schools in India, its large population means there are 5 million people per medical school. [16] Christian Medical College, a top-ranked university in Vellore, once had an acceptance rate of 0.25 percent, with only 100 seats for medical students. [17] Now its acceptance rate hovers around 5 percent. There has been minimal progress in making it easier to get a medical school acceptance; there is still a long way to go in equalizing access to education.

India’s system for training doctors is now rife with corruption, with bribes accepted under the guise of “donations” and new curricula completely devoid of traditional Indian training methods. [18] Nepotism in the industry has made qualifications even less significant. In 2010, 69 hospitals and medical colleges were reported for selling exam papers to students, and most employed staff lied about their clinical experience. [19] In a cheating scandal in 2013 involving several Indian universities, students purchased falsified entrance exam results. Not only are these students unqualified for the placements they secured, but legal action by the government did not materialize. [20]

Dr. Anand Rai, a physician who had to go into protective hiding following death threats for being a whistleblower in the 2013 scandal subsequently remarked: “...the next generation of doctors is being taught to cheat and deceive before they even enter the classroom.” [21] The effects of this scandal can be felt far beyond its borders - India also happens to be the world’s largest exporter of doctors, with about 47,000 currently practicing in the United States. [22]

lll.     Hospital Privatization

With the privatization of major hospitals and the shift to a “United States” business focus, another serious problem emerged. In the recent past, patients hailing from rural villages and often living in poverty could access quality health care from public hospitals. They had access to highly trained doctors, and all costs were usually fully subsidized. [23] This was in keeping with the old tradition that believed in aid no matter the circumstance. As the focus shifted towards maximizing profitability, these opportunities for poor patients vanished.

Chains of private hospitals are rapidly replacing public ones. Their purchasing model is to consolidate through a centralized subsidiary. [24] This usually results in significant savings. Instead of passing on some savings to patients through reduced pricing, any savings are used to fulfill a key objective of privatized businesses: maximize profitability.

The poor now contend with inflated prices and are being turned away from facilities that once treated them at no cost, all while levels of trust in the healthcare system have plummeted. This distrust can discourage people who cannot afford care from seeking medical aid when they need it. The healthcare system has devolved to the point whereby remaining public hospitals are overrun by huge numbers of patients unable to afford the hugely inflated prices at private institutions. This, coupled with healthcare workers that often have substandard training, has created deplorable public health conditions.

lV.     Corruption

This deplorable public health condition reflects a failing healthcare system. To make matters worse, hospitals hire unqualified graduates untrained in medical ethics to meet India's urgent need for large numbers of qualified doctors. Many hospitals have even resorted to employing corrupt doctors to counteract the physician shortage.

According to the Indian Medical Association (IMA), about 45 percent of those who practice medicine in India have no formal training. [25] IMA also reported that close to 700,000 doctors employed at some of the biggest hospitals, who are currently diagnosing, treating, and operating, have neither the training nor experience to do so. A large-scale forgery ring, broken up in 2011, revealed that buyers could pay as little as 100 US dollars for a medical degree from a non-existent college. This “cleared” them for practice. [26] It has been estimated that over 50,000 fraudulent medical degrees have been purchased in the past decade.

Government level corruption is widespread, as one can gain placement into medical school, “graduate” with fake degrees, and sell fake practicing licenses.

V.     Solutions

These topics, raised by bioethics centers, are now being taken more seriously by healthcare professionals taking steps to address medical misconduct. As many as five million people in India die each year due to medical negligence. [27] By requiring each physician to complete a new comprehensive Acute Critical Care Course (ACCC), specialists estimate that physicians can reduce the rate of malpractice deaths by as much as 50 percent in rural areas. [28] This intensive two-year course contains detailed training methods built off of current knowledge and walks healthcare professionals through crucial steps designed to reduce errors. Even small errors, such as a poorly inserted IV for fluid or a minor surgery mishap, can be life threatening. The course thoroughly covers these as mandated. [29]   The ACCC is unfortunately not a widely spread concept in a lot of rural areas. For now, while many major hospitals continue to ignore the high rates of avoidable deaths, implementation of the ACCC program seems slow.

The current Medical Council of India needs to be more effective at addressing malpractice cases, as there are so many of them. [30] One possible solution to the growth of unethical business practices in medicine is to offer physicians incentives to make ethically sound decisions. This can start by increasing the number of slots available for medical students at government-run medical schools. Less student debt would lead more doctors away from overbilling their patients. This is a strategy currently being employed in the state of Tamil Nadu, where a centrally sponsored scheme has approved the induction of an additional 3,496 MBBS seats in government colleges. [31] More students studying at subsidized costs with less competition lowers the inclination toward deceit and profiteering.

Another incentive for ethical practice can come from accountability and transparency. The background of every doctor operating should be public information, including the rate of successful surgeries versus unsuccessful ones resulting from personal negligence. This would encourage doctors to keep a clean record and, in turn, encourage hospitals to hire and train those who will preserve or improve their reputation. This information is kept in a medical record monitored in most parts of India through a traditional paper method. [32] While eliminating paper in medical recording and reverting to digital use is the ultimate aim, it will take time to implement a system that takes into account e-signatures and verifiable witnesses.

India’s history of leadership in medical ethics has undergone some major changes. A relatively recent privatization of the education system has caused a shift in values and decimated the medical industry on many levels. The moral principles of doctors have come into question. While industry and government leaders are trying to solve the multi-faceted issues facing the medical industry, it is obvious that this is an undertaking requiring inventive solutions.

Prioritizing ethics in medical education, de-privatizing medical schools and hospitals, offering affordable options, and limiting corruption would improve India’s ability to offer high-quality medical care. Adding traditional Indian medical ethics back into the curricula would foster a workforce dedicated to serving patients over profiteering.

[1] Deshpande, SmitaN. 2016. “The UNESCO Movement for Bioethics in Medical Education and the Indian Scenario.” Indian Journal of Psychiatry 58 (4): 359. https://doi.org/10.4103/0019-5545.196722.

[2] Mukherjee, Ambarish, Mousumi Banerjee, Vivekananda Mandal, Amritesh C. Shukla, and Subhash C. Mandal. 2014. “Modernization of Ayurveda: A Brief Overview of Indian Initiatives.” Natural Product Communications 9 (2): 1934578X1400900. https://doi.org/10.1177/1934578x1400900239.

[3] 2020. Eubios.info. 2020. https://www.eubios.info/EJ102/EJ102E.htm.

[4] Arnold, David, ed. 2000. “Western Medicine in an Indian Environment.” Cambridge University Press. Cambridge: Cambridge University Press. 2000. https://www.cambridge.org/core/books/abs/science-technology-and-medicine-in-colonial-india/western-medicine-in-an-indian-environment/28BAB761BE205B06D32BC3DC972E9384.

[5] Kulkarni, Vani, Veena Kulkarni, and Raghav Gaiha. 2019. “Trust in Hospitals-Evidence from India.” https://repository.upenn.edu/cgi/viewcontent.cgi?article=1026&context=psc_publications.

[6] Bhasin, Dr Sanjay K. 2005 “What Ails Medical Profession.” Www.academia.edu . Accessed September 17, 2022. https://www.academia.edu/7631547/What_Ails_Medical_Profession.

[7] Shapiro, Natasha, and Urmila Patel. (2006) “Asian Indian Culture: Influences and Implications for Health Care.” https://www.molinahealthcare.com/~/media/Molina/PublicWebsite/PDF/providers/fl/medicaid/resource_fl_asianindianculture_influencesandimplicationsforhealthcare.pdf.

[8] Swihart, Diana L, and Romaine L Martin. 2021. “Cultural Religious Competence in Clinical Practice.” Nih.gov. StatPearls Publishing. 2021. https://www.ncbi.nlm.nih.gov/books/NBK493216/ .

[9] “India’s Mighty Medical Education Mess.” 2022. Education World. July 11, 2022. https://www.educationworld.in/indias-mighty-medical-education-mess/ .

[10] Pandya, Sunil. 2020. “Medical Education in India: Past, Present, and Future Perspectives. in Sun Kim, ed. Medical Schools Nova Science Publishers, Inc. (=

[11] Ravindran, G. D., T. Kalam, S. Lewin, and P. Pais. 1997. “Teaching Medical Ethics in a Medical College in India.” The National Medical Journal of India 10 (6): 288–89. https://pubmed.ncbi.nlm.nih.gov/9481103/ .

[12] “Chapter 9: Opinions on Professional Self-Regulation”(2016) https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-9.pdf .

[13] Sanjiv Das. 2020. “The Pill for India’s Ailing Medical Education System.” Express Healthcare. February 3, 2020. https://www.expresshealthcare.in/education/the-pill-for-indias-ailing-medical-education-system/416711/.

[14] https://www.marketresearch.com/Netscribes-India-Pvt-Ltd-v3676/Private-Medical-Colleges-India-30399614/ ."There are ~50.89% government medical colleges and ~49.11% private medical colleges in the country.”; NPR.org. (2021) “When Students in India Can’t Earn College Admission on Merit, They Buy Their Way In.” Accessed September 19, 2022. https://www.npr.org/2019/08/04/745182272/when-students-in-india-cant-earn-college-admission-on-merit-they-buy-their-way-i . 

[15] https://timesofindia.indiatimes.com/india/how-medical-colleges-in-india-became-a-business-one-policy-change-at-a-time/articleshow/69707594.cms

[16] Muula A. S. (2006). Every country or state needs two medical schools. Croatian medical journal, 47(4), 669–672. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080437/

[17] Miglani, Andrew MacAskill, Steve Stecklow, Sanjeev. 2015. “Why India’s Medical Schools Are Plagued with Fraud.” Mint. June 17, 2015. https://www.livemint.com/Politics/BDGOx3SApU3QbsRMjZUK9M/Why-Indias-medical-schools-are-plagued-with-fraud.html.

[18] Clark, J. 2015. “Indian Medical Education System Is Broken, Reuters Investigation Finds.” BMJ 350 (jun18 3): h3324–24. https://doi.org/10.1136/bmj.h3324 . 

[19] Reuters . 2015. “Special Report - Why India’s Medical Schools Are Plagued with Fraud,” June 16, 2015, sec. Special Reports. https://www.reuters.com/article/uk-india-medicine-education-specialrepor/special-report-why-indias-medical-schools-are-plagued-with-fraud-idINKBN0OW1N520150616 .

[20] Andrew Emett. (2015) “Over Two Dozen Witnesses and Suspects Mysteriously Die in Indian Cheating Scandal | NationofChange.” Accessed September 19, 2022. https://www.nationofchange.org/2015/07/08/over-two-dozen-witnesses-and-suspects-mysteriously-die-in-indian-cheating-scandal/ .

[21] ( Reuters 2015)

[22] Clark, J. 2015. “Indian Medical Education System Is Broken, Reuters Investigation Finds.” BMJ 350 (jun18 3): h3324–24. https://doi.org/10.1136/bmj.h3324 .

[23] Barik, Debasis, and Amit Thorat. 2015. “Issues of Unequal Access to Public Health in India.” Frontiers in Public Health 3 (October). https://doi.org/10.3389/fpubh.2015.00245 .

[24] “Investment Opportunities in India’s Healthcare Sector.” (2021) https://www.niti.gov.in/sites/default/files/2021-03/InvestmentOpportunities_HealthcareSector_0.pdf .

[25] Clark, J. 2015. “Indian Medical Education System Is Broken, Reuters Investigation Finds.” BMJ 350 (jun18 3): h3324–24. https://doi.org/10.1136/bmj.h3324 .

[26] “Are We Importing Fake Doctors?” (2015) Www.workerscompensation.com. Accessed September 19, 2022. https://www.workerscompensation.com/news_read.php?id=21672&forgot=yes .

[27] Boston, 677 Huntington Avenue, and Ma 02115 +1495‑1000. 2013. “Millions Harmed Each Year from Unsafe Medical Care.” News. September 19, 2013. https://www.hsph.harvard.edu/news/press-releases/millions-harmed-each-year-from-unsafe-medical-care/ .

[28] “Specialised Course for Doctors Can Help Cut the Deaths due to Medical Errors; Experts.” 2018. DailyRounds. October 29, 2018. https://www.dailyrounds.org/blog/specialised-course-for-doctors-can-help-cut-the-deaths-due-to-medical-errors-experts/ .

[29] Sokhal, Navdeep, Akshay Kumar, Richa Aggarwal, Keshav Goyal, Kapil Dev Soni, Rakesh Garg, Ashok Deorari, and Ajay Sharma. 2021. “Acute Critical Care Course for Interns to Develop Competence.” The National Medical Journal of India 34 (3): 167–70. https://doi.org/10.25259/NMJI_103_19 .

[30] Singhania, Meghna A. 2020. “How Much Punishment?- MCI Formulates Sentencing Guidelines for Cases of Medical Negligence.” Medicaldialogues.in. February 13, 2020. https://medicaldialogues.in/news/health/mci/how-much-punishment-mci-formulates-sentencing-guidelines-for-cases-of-medical-negligence-62645 .

[31] “Health Ministry Reports 30% Increase in Number of Functional Medical Colleges in Five Years.” (2022) Www.pharmabiz.com. Accessed September 19, 2022. http://www.pharmabiz.com/NewsDetails.aspx?aid=152299&sid=1 .

[32] Honavar, Santosh G. 2020. “Electronic Medical Records – the Good, the Bad and the Ugly.” Indian Journal of Ophthalmology 68 (3): 417. https://doi.org/10.4103/ijo.ijo_278_20 .

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Doctor sahab: Doctors and the public in the 'golden era' of the Indian medical profession

Affiliation.

• 1 South Asian Studies Council, Yale University, New Haven, Connecticut, USA.
• PMID: 36896649
• DOI: 10.1111/1467-9566.13630

This essay analyses and historicises a contemporary dominant narrative among India's biomedical doctors, that the early post-independence period (1940s-1970s) was characterised by immense public trust and confidence in the biomedical profession, with the patient-doctor relationship experiencing a 'golden era'. By exploring people's experiences with and perceptions of doctors during these decades, I show that contrary to contemporary understanding, public dissatisfaction with doctors was substantial even in the early post-independence period. I argue that the dominance of privileged-caste and -class Indians in the medical profession nurtured a caste privilege-based elitist outlook within the mainstream profession and its leadership and created an insurmountable socioeconomic distance between doctors and the large majority of the public. What doctors deemed as people's 'trust' in them and their profession was often simply a manifestation of people's general deference towards the elites of the society. This incorrect interpretation of patient-doctor dynamics in the past has been a constant feature of mainstream narratives around the doctor-society relationship in post-independence India and has remained largely under-explored and under-historicised in the medical, scholarly and public discourses.

Keywords: India; caste; doctor‐patient relations; medical profession; trust.

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Medical profession and public perceptions: an Indian perspective

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In the West, medical professionals are subject to increasing levels of public scrutiny. In India, the medical profession has remained pretty much unscathed, and doctors are widely praised, thinks Balaji Ravichandran

Our society undervalues doctors yet expects, and will accept nothing short of perfection… Even with perfect risk management, mistakes will be ‘made’… people will die young or decline with age, and not all pregnancies will have a good outcome. Unfortunately, doctors are more easily sued than God, and, moreover… pay cash.” 1

Even respected doctors get confused

This is how an Israeli intern responded when the BMJ asked its readers to define a good doctor two years ago. The quotation succinctly summarises the heavy scrutiny to which medical professionals are increasingly subject, especially in Western communities. And this begs the question: can the increasingly prevalent negative sentiments towards doctors be fully justified? A moment's reflection made me think otherwise. A doctor ought to be respected not just for his academic and human qualities, but the very name of his profession should command instant respect.

The Indian perspective

India, the second most populous nation in the world, obviously presents a huge challenge when it comes to health care. As in Western societies, the Indian medical profession is increasingly subject to public scrutiny, especially due to a recent and unimaginable growth in the hold of mass media over its viewers. From the recent announcements of a breakthrough in stem cell research by Korean scientists to the subsequent allegations that eggs were acquired using unacceptable practices and that two pieces of research into cloning human stem cells were faked, no issue of medical importance escapes the eye of the public.

Most Indians hold doctors in remarkably high esteem. Consider, for example, how the entertainment industry portrays an average medical student or doctor. Regardless of …

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Doctor sahab : Doctors and the public in the ‘golden era’ of the Indian medical profession

Corresponding Author

Kiran Kumbhar

• [email protected]
• orcid.org/0000-0002-9221-4297

South Asian Studies Council, Yale University, New Haven, Connecticut, USA

Correspondence

Kiran Kumbhar.

Email: [email protected]

Contribution: Conceptualization, Data curation, Formal analysis, Funding acquisition, ​Investigation, Methodology, Project administration, Resources, Software, Writing - review & editing

This essay analyses and historicises a contemporary dominant narrative among India’s biomedical doctors, that the early post-independence period (1940s–1970s) was characterised by immense public trust and confidence in the biomedical profession, with the patient-doctor relationship experiencing a ‘golden era’. By exploring people’s experiences with and perceptions of doctors during these decades, I show that contrary to contemporary understanding, public dissatisfaction with doctors was substantial even in the early post-independence period. I argue that the dominance of privileged-caste and -class Indians in the medical profession nurtured a caste privilege-based elitist outlook within the mainstream profession and its leadership and created an insurmountable socioeconomic distance between doctors and the large majority of the public. What doctors deemed as people’s ‘trust’ in them and their profession was often simply a manifestation of people’s general deference towards the elites of the society. This incorrect interpretation of patient-doctor dynamics in the past has been a constant feature of mainstream narratives around the doctor-society relationship in post-independence India and has remained largely under-explored and under-historicised in the medical, scholarly and public discourses.

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No primary empirical data were collected for this research.

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Medical Ethics

Published: 21st Jun, 2021

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.

• 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.

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:
• The idea that medical interference will do good to the patient
• Not to harm your patient, than to do them good, which is part of the Hippocratic oath that doctors take.
• Right of the patient of self determination regarding their own treatment
• 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’.

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.

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A simple conclusion: Medicine is a truly noble profession

I’m aware that it’s only when you, or someone you love, is unwell that you realise the importance of doctors and nurses. But that’s not quite my subject today. Instead, I want to draw your attention to a quality that reveals itself after doctors and nurses become critical: the goodness we take for granted. It’s what we all rely on but often do not see or, at least, fully appreciate.

For the last three weeks Mummy, who’s now 98, has been at the Army’s Research and Referral Hospital (R and R). Her stay has given me a unique and invaluable vantage point to observe and admire the way the hospital’s doctors and nurses tend to the truly sick. Today I want to write about it not simply in gratitude but also to place on record qualities we often do not notice but which lie at the heart of the medical profession.

The first thing you will notice about nurses and doctors is a re-assuring, comforting calmness. They seem to radiate stillness and stability. Their presence provides solace. Their behaviour offers hope. It’s the perfect anti-dote to the concern or even panic in your heart.

Then there is their bedside manner. I’ve watched this closely. In tone and voice it’s gentle and soothing but, at the same time, it’s also tactile and physically comforting. Consequently it embraces the patient with attention and concern. And, yes, it clearly suggests the sick person matters and the doctor genuinely cares.

Finally, there’s the matter-of-fact manner they handle embarrassing or distressing developments. Incontinence or emotional breakdowns don’t affect them. Their equanimity and undisturbed sang froid makes the unfortunate and awkward seem pedestrian and humdrum. It’s the absolute opposite of making a drama out of a crisis.

I’m sure doctors and nurses are similar in every hospital in every country though I believe the ones at the R and R are truly special. My aim today is not to differentiate and discriminate between them. Instead, my intention is to ask a question I do not know the answer to but which has long puzzled me: What is it about doctors and nurses, as individuals or as a profession, that brings forth this goodness?

Quite frankly, you don’t see it in lawyers and journalists, in industrialists or accountants, in sportsmen or artists. But you do often see it in teachers and aid-workers and, yes, on occasion, in trade-unionists and even politicians.

As I said, I don’t have the answer but the follow-up questions that occur to me could point towards one. Perhaps because these are caring professions they attract people with these qualities? Or perhaps the nature of the duties doctors and nurses perform first creates and thereafter nurtures this goodness? Who knows, it’s probably a chicken and egg syndrome.

However, the question intrigues me because we see, rely on and draw comfort from this goodness all the time my sisters and I are with Mummy. I suppose it’s a question that matters to those whose loved ones are ill and, I guess, it’s forgotten once they recover.

Finally, I’m not sure what these people are like off-duty in their private lives and, quite frankly, I don’t care. It’s the doctor or nurse on duty that patients and their families meet. Therefore, it’s their public persona I’m writing about. That is the side of them I’ve seen, studied and admired and it’s led me to a simple conclusion: medicine is a truly noble profession.

(The views expressed by the author are personal.)

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The Transformation of The Indian Healthcare System

Ankit kumar.

1 Respiratory Medicine, King George's Medical University, Lucknow, IND

The Indian healthcare system is a diverse and complex network of public and private sectors that provide a wide range of medical services to India's 1.4 billion inhabitants. Despite undergoing significant changes over the years, the system continues to face multiple challenges. These challenges include inadequate infrastructure, a shortage of healthcare professionals, urban-rural disparities, limited health insurance coverage, insufficient public healthcare funding, and a fragmented healthcare system. India is grappling with a growing burden of non-communicable diseases, which poses a significant challenge to its healthcare system.

The Indian government has initiated multiple programs to improve the healthcare system. The National Health Mission improves the availability of medical equipment and supplies. This also promotes community participation and engagement in healthcare decision-making and service delivery. The Ayushman Bharat scheme is a health insurance program that provides coverage of up to INR 5 lakhs per family per year for secondary and tertiary care hospitalization.

The Indian healthcare system is also witnessing multiple healthcare innovations, ranging from low-cost medical devices to innovative healthcare delivery models. The country's healthcare regulatory system is evolving to ensure patient safety, promote high-quality care, and control costs.

Furthermore, India has emerged as a leading destination for medical tourism due to the relatively low cost of medical procedures, the availability of skilled doctors, and advanced technology. Factors such as cost-effective treatment, advanced technology, a wide range of specialities, alternative medicine, English language proficiency, and ease of travel have contributed to India's growing medical tourism industry.

The Indian healthcare system has made significant progress in recent years. The positive transformation of the Indian healthcare system involves a range of changes and initiatives. Despite challenges, the continued investment in healthcare and innovation provides reasons to be optimistic about the future of healthcare in India.

The structure and organization of healthcare systems vary widely across different countries and regions. Some countries have a predominantly public healthcare system, where the government is responsible for providing healthcare services to the population. Other countries have a predominantly private healthcare system where healthcare services are provided by private hospitals. A well-functioning healthcare system provides high-quality healthcare services to the people, and it should be accessible, affordable, and sustainable over the long term [ 1 ].

The Indian healthcare system is a complex and diverse network made up of the public and private sectors, which offer a range of medical services and infrastructure to the 1.4 billion people living in India. It has undergone significant transformations over the years but still faces several challenges. The public sector includes primary, secondary, and tertiary care facilities managed by the central and state governments. Primary healthcare services are the individual's first point of contact and are provided through primary health centers, community health centers, and sub-centers. Secondary care focuses on acute and specialist services provided by district hospitals. Tertiary care refers to advanced medical services, including specialty and super-specialty services provided by medical colleges. The private sector consists of individual practitioners, nursing homes, clinics, and corporate hospitals [ 2 ].

The Indian healthcare system faces several challenges that impact its ability to deliver quality healthcare services to its large and diverse population [ 3 ]. Some of the key challenges are:

Inadequate infrastructure

India has a shortage of healthcare facilities, especially in rural areas, where the majority of the population resides. Many primary health centers and sub-centers lack essential infrastructure, medical equipment, and resources, making it difficult to provide even basic healthcare services to the population. The insufficient number of healthcare facilities, poorly maintained facilities, inadequate medical equipment and resources, and limited access to advanced healthcare services exacerbate the existing challenges in providing quality healthcare services to the population [ 3 ].

Shortage of healthcare professionals 

India has a significant shortage of healthcare professionals, including doctors, nurses, and paramedical staff. This is a critical challenge facing the Indian healthcare system, affecting the quality and accessibility of healthcare services across the country. The scarcity of trained medical staff has consequences like inadequate patient care. This is particularly evident in rural areas, where the majority of the population resides but has limited access to trained medical professionals. The limited capacity of medical and nursing schools to train healthcare professionals is a contributing factor to the shortage of skilled staff.

Urban-rural disparities

There is a marked disparity in the quality and accessibility of healthcare services between urban and rural areas. Urban areas tend to have better infrastructure, access to skilled professionals, and availability of specialized care, while rural areas often struggle with inadequate facilities and limited human resources.

Financial constraints and health insurance

The high out-of-pocket expenses for healthcare services can be a major burden for many Indians. Health insurance in India is not as widespread as in some other countries. This can lead to delayed or avoided treatments, causing further complications and health issues.

Insufficient public healthcare funding

The Indian government's expenditure on healthcare has historically been low compared to other countries, which contributes to the inadequacy of public healthcare facilities and the high reliance on private healthcare services, which may not be affordable for all citizens.

Fragmented healthcare system and inequity in access to care

The Indian healthcare system is characterized by a complex mix of public and private providers with varying degrees of quality and regulation. Socioeconomic disparities and regional differences in access to healthcare services result in unequal healthcare outcomes for different population groups, with poorer communities and those living in remote areas often facing greater challenges in accessing quality healthcare.

Growing burden of non-communicable and communicable diseases

Non-communicable diseases, such as diabetes, cardiovascular diseases, and cancer, have been on the rise in India, putting additional strain on the healthcare system. Despite progress in recent years, India still faces challenges in controlling communicable diseases like tuberculosis, malaria, and HIV/AIDS, which continue to pose significant public health risks.

The positive transformation of the Indian healthcare system is a multifaceted and ongoing process that involves many different changes and initiatives. The statistical data shows that the average life expectancy at birth in India has increased by approximately three years in the last ten years. The government has been working to improve the healthcare system through various initiatives to strengthen primary, secondary, and tertiary healthcare services. The Indian government spent two percent of India's gross domestic product (GDP) on healthcare in financial year 2022 and is forecast to reach over 2.5% of the GDP by 2025. In the financial year 2022, the government of India allocated approximately 860 billion Indian rupees to the Ministry of Health and Family Welfare in the Union Budget. The health tech sector in India secured private equity and venture capital investments worth nearly 1,740 million U.S. dollars in 2021. India's healthcare sector was worth about 280 billion U.S. dollars in 2020, and it was estimated to reach up to 372 billion dollars by 2022. The country's healthcare market had become one of the largest sectors in terms of revenue and employment, and the industry was growing rapidly [ 2 ].

Indians spend approximately 20 percent of their health spending as an out-of-pocket expenditure. In 2019, Indians spent around 55 percent of their total health spending as an out-of-pocket expenditure. This was at 74 percent in 2001, showing a gradual decrease in the share of healthcare expenses that people pay directly to the providers [ 2 ].

Some of the key elements of this positive transformation of India's healthcare system are the National Health Mission, Ayushman Bharat, and medical tourism.

The National Health Mission (NHM) was launched in 2013 and comprises the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The NHM aims to strengthen primary healthcare infrastructure and services by upgrading existing facilities, building new ones, and improving the availability of medical equipment and supplies. This initiative also seeks to enhance human resources for health by training and recruiting more doctors, nurses, and paramedical staff, especially in rural areas. The NHM also aims to improve maternal, neonatal, and child health by expanding access to essential services such as antenatal care, skilled birth attendance, and immunization programs. Finally, it targets communicable and non-communicable diseases through targeted interventions and public health campaigns. The National Health Mission was allocated a budget of over 290 billion Indian rupees for the financial year 2024 [ 2 ].

Ayushman Bharat is another flagship healthcare initiative launched in 2018. This scheme provides financial protection and health coverage to India's vulnerable populations through Health and Wellness Centers (HWCs) and the Pradhan Mantri Jan Arogya Yojana (PMJAY). As of December 2022, there were about 117 thousand Ayushman Bharath Health and Wellness Centers (AB-HWCs) across India. AB-HWCs provide free essential medicine, diagnostic services, and teleconsultation. The HWCs aim to provide comprehensive primary healthcare services to rural and urban populations, including preventive, promotive, and curative care. The HWCs focus on maternal and child health, non-communicable diseases, communicable diseases, and palliative care while providing essential drugs and diagnostic services. The PMJAY is a health insurance scheme that provides coverage of up to INR 5 lakhs per family per year for secondary and tertiary care hospitalization. This initiative targets approximately 100 million economically disadvantaged families, covering around 500 million beneficiaries, and covers a range of medical procedures and treatments at empanelled hospitals. PMJAY aims to reduce out-of-pocket expenses and improve access to quality healthcare for India's poorest and most vulnerable populations. Over 217 thousand public health facilities were reported in India as of the financial year 2022. Over 1.4 billion services were performed by outpatient departments across India, a significant increase from the previous year's value of over 1.1 billion [ 2 ].

Digital healthcare

The shift towards digital healthcare in India is transforming the way healthcare services are delivered, particularly in remote areas. Telemedicine, digital health records, and mobile health apps are all being used to improve healthcare service quality and efficiency [ 4 ].

Non-communicable disease prevention and management

India is facing a growing burden of non-communicable diseases, but there are efforts underway to prevent and manage these diseases. This includes initiatives to promote healthy lifestyles, increase awareness of disease prevention, and provide specialized care and treatment for those with chronic conditions.

The penetration of health insurance across India stood at around 35 percent as of the financial year 2018. This was a slight increase compared to the previous year, when penetration levels were about 33 percent. In the financial year 2021, nearly 514 million people across India were covered under health insurance schemes, and the value of premiums for the government-sponsored health insurance schemes across India aggregated to around 43 billion Indian rupees [ 2 ].

Healthcare innovation and regulation

There are many examples of healthcare innovation happening in India, from low-cost medical devices to innovative healthcare delivery models. These innovations have the potential to improve healthcare outcomes and reduce costs in the long term. India's healthcare regulatory system is evolving to ensure patient safety, promote high-quality care, and control costs. The government is taking steps to streamline the regulatory system and ensure that healthcare providers adhere to high standards of care [ 5 ].

The private healthcare sector in India plays a vital role in achieving universal health coverage, as recognized by the government. India offers healthcare services at comparatively low costs, attracting international patients seeking quality treatment at affordable prices. The private healthcare sector has made significant advancements in infrastructure, technology, specialized services, and healthcare access. Private healthcare providers have invested in modern hospitals, clinics, and diagnostic centers equipped with advanced medical technology. They have embraced digital innovations such as electronic medical records, telemedicine, health apps, and remote monitoring systems to improve patient care. Increased health insurance coverage has facilitated access to private healthcare services, with insurance companies collaborating with private hospitals and clinics. The government has encouraged public-private partnerships to enhance healthcare access and infrastructure, particularly in underserved areas. Collaborative efforts between the public and private sectors, along with targeted interventions, can help bridge gaps and create a more inclusive healthcare system.

Medical tourism

India has become a popular destination and thrived due to the availability of advanced treatments at relatively lower costs, the availability of skilled doctors and advanced technology in private hospitals contributing to foreign exchange earnings, and a positive reputation. India has emerged as a popular destination for medical tourism in recent years, attracting patients from around the world. The factors contributing to India's growing medical tourism industry include cost-effective treatment, skilled medical professionals, advanced technology, a wide range of specialties, alternative medicine, English language proficiency, and ease of travel.

Despite the challenges, the Indian healthcare system has made significant positive progress in recent years, particularly in terms of expanding access to healthcare services and improving health outcomes. These government initiatives, programs, and policies address the various challenges faced by the Indian healthcare system and improve access to quality healthcare services for all citizens. The positive transformation of India's healthcare system is ongoing and involves a range of changes and initiatives. While there are still significant challenges to overcome, such as healthcare access disparities and the burden of disease, the continued investment in healthcare and innovation in the sector are reasons to be optimistic about the future of healthcare in India. However, sustained efforts and investments are required to ensure that the benefits of these initiatives reach the intended beneficiaries and lead to lasting improvements in health outcomes.

The authors have declared that no competing interests exist.

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Role of Medical Ethics in India

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Published: Jan 21, 2020

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Theories of medical ethics, confidentiality, code of medical ethics, medical ethics under medical council act.

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Essay on Healthcare in India

Students are often asked to write an essay on Healthcare in India in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Healthcare in India

Introduction.

Healthcare in India is a critical sector. It includes public and private hospitals, clinics, and other medical facilities.

Public Healthcare

The government provides public healthcare. It’s often free or low-cost, making it accessible to many people.

Private Healthcare

Private healthcare, on the other hand, is usually more expensive. However, it tends to have better facilities and shorter wait times.

India faces challenges in healthcare, like inadequate facilities in rural areas and a shortage of trained medical professionals.

250 Words Essay on Healthcare in India

Healthcare in India is a multifaceted system, encompassing public and private sectors, traditional and modern medicine, and urban and rural disparities. This essay explores the current state of healthcare in India, its challenges, and potential solutions.

Current State of Healthcare

India’s healthcare sector has made significant strides, with increased life expectancy and decreased infant mortality. However, it is riddled with disparities. While urban areas enjoy better healthcare facilities, rural regions grapple with inadequate infrastructure and lack of trained medical personnel.

The challenges are manifold. Accessibility and affordability remain major concerns. A large portion of the population lacks access to quality healthcare, while high out-of-pocket expenses push many into poverty. Furthermore, there is a significant shortage of healthcare professionals, particularly in rural areas.

Public-Private Partnership

A public-private partnership (PPP) is seen as a viable solution. The private sector’s resources and efficiency can supplement the public sector’s reach and affordability. However, the implementation of PPPs requires stringent regulations to prevent exploitation.

Role of Technology

Technology can bridge the urban-rural divide. Telemedicine, AI, and mobile health technologies can facilitate remote consultations, predictive diagnostics, and health monitoring, making healthcare more accessible and affordable.

500 Words Essay on Healthcare in India

India’s healthcare sector is a study in contrasts, presenting a complex tapestry of cutting-edge advancements and systemic challenges. With an expansive population and diverse health needs, the healthcare system in India is a critical component of the nation’s development agenda.

The Landscape of Indian Healthcare

India’s healthcare infrastructure is a mix of public and private providers. The public system, under the aegis of the Ministry of Health and Family Welfare, provides primary, secondary, and tertiary care. However, it suffers from inadequate funding, lack of infrastructure, and a dearth of healthcare professionals. The private sector, on the other hand, is burgeoning. It is technologically advanced, offers high-quality services, but is often criticized for being expensive and inaccessible to the poor.

Healthcare Accessibility and Affordability

Government initiatives.

Recognizing these challenges, the Indian government has launched various initiatives. The National Health Mission aims to improve health outcomes, particularly for the rural population. The Ayushman Bharat scheme, launched in 2018, provides health insurance coverage to the underprivileged, aiming to make healthcare more affordable. These initiatives, while commendable, need effective implementation and monitoring to ensure their success.

Technological Innovations

Technological innovations have the potential to revolutionize India’s healthcare landscape. Telemedicine, artificial intelligence, and digital health records can address the issues of accessibility and affordability. Telemedicine can bridge the urban-rural divide by providing remote consultations. AI can assist in disease prediction and management, while digital health records can streamline patient data, improving efficiency and patient care.

Challenges and Future Prospects

The future of healthcare in India lies in adopting a holistic approach. This includes increasing public health expenditure, strengthening primary healthcare, improving health literacy, and leveraging technology.

India’s healthcare sector, while fraught with challenges, is teeming with potential. With the right mix of policy interventions, technology adoption, and a focus on equitable access, India can transform its healthcare landscape, ensuring a healthier future for its citizens. The journey is long and arduous, but with concerted efforts, a robust and inclusive healthcare system is achievable.

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• Legal Ethics

Conflict between Medical Laws and Ethics

This article has been written by Nishtha Jain , a fourth year student from Symbiosis Law School, NOIDA. She discusses the approaches taken by professionals to resolve conflicts between medical laws and ethics, position of medical laws and ethics in India along with landmark judgements.

How should medical practitioners react to laws that are directly interfering with their ability to do what is best for their patients? What is a physician ought to do when caught between his/her professional obligations to do her best for the patient and her legal obligation to obey the law?

One of the most controversial subjects is the interrelationship between laws and ethics. As a long standing convention, rules of professional ethics have been imposed by professionals upon themselves and the medical profession is no exception. These rules govern them in universal practice of their profession. It is often observed that the ethical standards of the professionals often exceed those required by law.

A physician charged with ill-conduct may be held guilty or innocent in a court of law, however, along with legal proceedings, disciplinary proceedings may also be initiated against him on the basis of unethical conduct. So, where does it leave the medical practitioners? Should they follow the law or do what is best for their patient? Is there a way to give a concrete answer to this question?

What are medical ethics?

There is no universal definition of medical ethics and more often than not, it is quite difficult to explain it. A broad interpretation could mean the moral and not legal obligations that a medical practitioner is supposed to abide by. However, there are a lot of times when some of the standards known as medical ethics have legal effect as well.

Medical law is made up of bits from a large number of different branches of law: Criminal Law, Human Rights Law, Tort Law, Contract Law, Family Law, etc and is undoubtedly very confusing. Medical Law is undergoing a massive change. Rapid scientific advances mean that lawyers and ethicists are constantly required to face new issues. There have been a lot of legislations and rules pertaining to Medical Laws like Policy of Family Planning, Surrogacy Bill, laws pertaining to abortion and sex determination test, etc.; but the challenge they pose is not merely a matter of liberal versus conservative perspectives.

It is undisputed that everyone has certain prima facie moral obligations to others that may conflict with the law. For instance – Everyone has obligations to not lie, to avoid harm, to not steal, etc. Medical professionals, however, have special moral obligations by virtue of their profession. These obligations are tied to their roles as doctors, therapists, nurses, and others.

These special obligations have been expressed through codes of professional ethics, principles of biomedical ethics, the concept of a fiduciary relationship, rich accounts of the virtues, and obligations inherent in the doctor-patient relationship.

What are the various approaches?

The principlist approach.

In Principles of Biomedical Ethics, Tom L. Beauchamp and James F. Childress elaborated four principles that are now often regarded as foundational for medical ethics.

The four principles are – Respect for autonomy, Non-maleficence, Beneficence and Justice. They believe that these four principles represent a common morality and have given various arguments in support.

Respect for autonomy –

• Respect patients as individuals (e.g., respecting their privacy by maintaining confidentiality and being truthful about their medical care). For example – A psychologist is not to disclose the private records of a patient, it he fails to abide by the same, legal as well as disciplinary action can be taken against him.
• Provide the information and opportunity for patients to make their own decisions regarding their care. For example – informed consent – practitioners can’t impose their will on the patients and administer whatever medicines/diagnosis they think is in favour of patient’s health. An informed consent is required to be taken.  However, if the patient is not in a condition to consent, then his family members can do so on his behalf. And if it is an emergency case, then the doctor can go ahead with what he thinks is right according to his experience and knowledge.
• Honor and respect patients’ decisions regarding their choice to accept or decline care. For instance – Jehovah’s witnesses believe that blood transfusion is unethical and never agree to that.
• In addition to having the right to refuse a diagnostic or therapeutic intervention, patients also has the right to refuse to receive information.

Beneficence – Act in the best interest of the patient and advocate for the patient. Misrepresentation of the facts or misleading the patient by giving false information or prescription is considered highly unethical.

Non maleficence – Avoid causing injury or suffering to patients. The healthcare professional should not harm the patient. All treatment involves some harm, even if minimal, but the harm should not be disproportionate to the benefits of treatment.

Justice – Treat patients fairly and equitably. Distributing benefits, risks and costs fairly; the notion that patients in similar positions should be treated in a similar manner.

However, laws force physicians to violate the above mentioned four principles in numerous ways, such as –

• When the physicians are required to tell lies, for example – about links between breast cancer and abortion, the principle of respect for patient’s autonomy is violated.
• The principle of respect for autonomy is also violated in cases wherein the physicians force a patient to listen to a fetal heartbeat or observe a fetal ultrasound before the abortion procedure is started with.
• Whenever patients are given less than full and truthful information, the principle of “do no harm” or “nonmaleficence” is violated as the decisions made on the basis of such information received are often not in patient’s best interests. For example – False information about a rise in risk of breast cancer can also result in women’s increased anxiety for the rest of their lives and lead to an increase in unnecessary cancer screening procedures such as mammography.
• The principle of beneficence is violated when physicians do less than they are capable of doing to promote patients’ welfare. For example, by not asking parents about gun ownership, they neglect a very important information that might help in the child’s well-being. The moral obligation to prevent avoidable harm to children is considered central to the ethics of pediatric medicine and if a physician fails to abide by it, there is definitely a violation of the principle.
• The principle of justice is violated if some patients, because of better education or better insurance, are able to navigate around legal restrictions on the doctor-patient relationship, while other patients are left severely limited.

The Covenantal Approach

Ethicists Edmund Pellegrino and William F. May are propounders of this approach. Taking their inspiration from Hippocrates, Maimonides, etc., they represent a philosophical return to the roots of the medical ethics. They introduced physicians and students of medical ethics to a “covenantal” understanding of the doctor-patient relationship and believed that a rights-based, autonomy-driven medical ethics are not that relevant anymore.

For Pellegrino, medicine is based on an “internal morality” derived from the nature of medicine itself, and it is oriented toward the twin goals of “excellence in healing” and “the good of the patient.” In simple terms, he emphasises on the importance of the internal goods of the medicine and firmly argues that internal goods should always take precedence over external goods such as social prestige, financial reward, self pleasure, etc. He urges the medical practitioners to focus on the well being of the patient and accept the responsibility.

Following the Biblical notions, he urges powerful practitioners to help the vulnerable and powerless. According to him, the services of the physicians should extend “beyond parochial boundaries” to the stranger and the person in need. He states that medicine is a vocation as well as a profession. Basically, the covenantal approach encompasses a virtue-based description of professional ethics.

Another available model for the doctor-patient relationship is that of the contract. This model assumes obligations on both sides, but the content of the contract may be decided by the parties itself. It can be as huge as a dictionary or as small as two pages.

Pellegrino criticizes the contractual model. According to him, such a contract makes an assumption that one party to the contract is lesser than the other party and hardly has parties on equal footing. Such a disparity may lead to one party acting only out of self interest which may be unethical in nature. However, even the contractual model obligates physicians to give patients the benefit of their best medical knowledge and to recommend procedures optimal for patients’ health.

The Fiduciary Approach

It is always observed in the society that some relationships although appear to be merely a species of business transaction or contract, require an increased ethical vigilance. And medicine is undoubtedly one of them.

A fiduciary relationship can be simply defined as a relationship based on trust. A fiduciary relationship describes a situation of heightened trust and confidence between the parties. Some of the common examples are of the relationship between a teacher and a student, the relationship between an attorney and a client.  

Physicians have strong fiduciary duties towards patients and it can not be neglected. Propounders of this approach propose that the interest of the patient is to be placed above any other competing factor. Since, the patients cannot access and evaluate medical information by themselves, this makes it much more important for the medical practitioners to be fully supportive and available to their patients and evolve a safe space for the patient to openly discuss his/her issues. It is thus of utmost important that a medical practitioner gives accurate, reliable and correct information to his/her patient and not mislead him/her.

What is the position of medical laws and ethics in India?

The Medical Council Act, 1956 looks over the wrongdoings of medical practitioners in India. In 1933, the Indian Legislative Assembly passed the Indian Medical Council Act, 1933. This Act was highly criticised resulting in repealing of the entire Act. A new Act called the Indian Medical Council Act, 1956 was formed and passed which is the current law of the land.

In A.S. Mittal and Another v. State of U.P. and others, 1989 AIR 1570 , the Court had opined that there is a possibility of criminal convictions by criminal courts for offences including moral turpitude as it was very clearly observed by the Hon’ble Supreme Court that medicinal profession is one of the most established callings of the world and is the most philanthropic one in Poonam Varma v. Ashwin Patel, AIR 1996 SC 2111.

General Medical Council (acting at State level) is the apex body to manage the misconduct of the medical practitioners. Some additional powers to expel and suspend medical practitioners (if required) have been given to the State Medical Council. They are also empowered to enlist the medical practitioners who have faced disciplinary actions.

Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 (amended upto 8th October, 2016) indicates the duties and responsibilities of the registered medical practitioners.

These regulations enforce certain standards which medical practitioners are required to follow. If they fail to do so, legal action can be taken against them and they can be penalized as well. Some of the duties and responsibilities of the physician are –

• Maintaining good medical practice
• Maintenance of medical records
• Highest quality assurance in patient care
• Patience, delicacy and secrecy
• Patient should not be neglected
• Unnecessary consultations should be avoided
• Punctuality in Consultation
• Not to conduct sex determination test
• Advertising is not allowed
• Contravening cosmetics and drugs act are not allowed
• Reporting to call for emergency, military situations
• Reporting of suspected causes of death
• There should be informed consent of the patient
• Running an open medical shop is not allowed
• Ban on practice of euthanasia

Medical Practitioners are required to follow the standards set in the Code. The Code also states acts of commission or omission on the part of a physician which shall constitute misconduct rendering him liable for disciplinary action.

What are the specific laws governing the medical profession in India?

There are numerous legislations which have been formed and are currently in implementation in India. Following are the categories under which the legislations are grouped together –

• Laws Related to Governing the Commissioning of Hospital
• Laws Governing the Qualifications / Practice and Conduct of Professionals
• Laws Governing Storage / Sale of Drugs and Safe Medication
• Laws Governing Biomedical Research
• Laws Governing to Management of Patients
• Laws Governing Medico Legal Aspects
• Law Governing The Safety of Patients, Public and Staff within the Hospital Premises and Environmental Protection
• Laws Governing the Safety of Patients, Public and Staff within the Hospital Premises
• Laws Governing the Employment of Manpower
• Laws Governing to Professional Training and Research
• Regulations Governing the Business Aspects of Hospital

What are some landmark judgements concerning medical ethics in India?

Dr. kunal saha v. dr. sukumar mukherjee, amri (advanced medicare and research institute ltd.) and ors..

Popularly known as Anuradha Saha Case, this case was filed in 1998 against AMRI Hospital, namely three doctors – Dr. Sukumar Mukherjee, Dr. Baidyanath Halder and Dr. Balram Prasad. The petitioner had alleged medical negligence on the part of the doctors resulting in the death of the patient.

Facts of the case in brief – Petitioner’s wife was suffering from a drug allergy and the doctors were negligent in prescribing the medicines, which further aggravated the condition of the wife, resulting in her untimely death.

Supreme Court found the doctors guilty and awarded a compensation of around seven crores to the petitioner for the loss of his wife.

V. Kishan Rao v. Nikhil Super Speciality Hospital and Anr., (2010) 5 SCC 513

Krishan Rao had filed a case against the hospital alleging that his wife was wrongly diagnosed and treated which resulted in her death.

Facts of the case in brief – Petitioner’s wife was suffering from malaria fever whereas she was treated for typhoid fever. Due to the wrong medication and treatment given by the hospital, her condition worsened leading to her death.

Court found the Hospital at fault by applying the principle of “ ipsa loquitur ” (Latin for “the thing speaks for itself”) and the Petitioner was awarded a compensation of Rs. two lakhs.

Mrs. Arpana Dutta v. Apollo Hospital Enterprises Ltd. and Ors., AIR 2000 Mad 340

Facts of the case in brief – A woman had surgery for removal of cysts in her uterus. The doctors told her that the operation is successful. However, after a couple of days, the woman died complaining of severe pain in her lower abdomen. After her body was cremated, a pair of scissors was found in the ashes. It was later found out by the Court that during the operation for removal of cysts, one of the operators had negligently dropped the pair of scissors in the abdomen of the woman.

The principle of vicarious liability i.e. “ qui facit per alium facit per se ” (Latin for “He who acts through another does the act himself”) was applied in this case and the authorities of the Hospital were held guilty and a hefty compensation was awarded to the patient’s family.

Pravat Kumar Mukherjee v. Ruby General Hospital and Ors., 2005 CPJ 35 (NC)

The National Consumer Disputes Redressal Commission of India gave a landmark judgement on treating of accident victims.

Facts of the case in brief – A boy named Samanate Mukherjee, a second year student pursuing B. Tech from Netaji Subhas Chandra Bose Engineering College had met with an accident. The boy was hit by a Calcutta transport bus and rushed to the hospital which was one kilometer from the accident spot. He was in conscious state when he was being taken to the hospital and he showed his medical insurance card, which clearly indicated that he will be given a sum of Rs. 65,000 by the Insurance Company in case of an accident. Relying on it, the Hospital started his treatment. However, after initial treatment, the hospital demanded a sum of Rs 15,000 and on the non-payment of the demanded money, hospital discontinued his treatment. Afterwards, he was rushed to another hospital however, he died before reaching there.

National Commission held Ruby Hospital liable and a compensation of Rs. 10 lakhs was given to the grieving parents.

Above mentioned are some of the landmark cases which shows how negligence and unethical conduct on behalf of the medical practitioners can lead to serious consequences, even resulting in death of the patients. Hence, it is extremely important for physicians to follow the proper procedure along with code of conduct keeping in mind the basic morals.

Critical Analysis

Medical practitioners are often facing difficulties to choose between the following three, i.e.-

• Doing the best they can using the abilities they have for their patient,
• Abiding by the provisions of the law and being a law-abiding citizen of the country , and
• Safeguarding themselves from the consequences of not following the law (losing their licenses, for example).

They are also required to be highly sensitive to the actions they undertake. Actions of even one individual can lead to fatal consequences. One medical practitioner who only follows the law and doesn’t pay heed to the ethics of the profession may lead to corrosion of the profession’s integrity. Hence, it is necessary that a balance is maintained between following the law, keeping patient’s integrity intact and upholding the professional ethics.

Patients are now becoming more dependent on the medical practitioners as the medicine is getting more complex with each passing day. Even the internet sometimes isn’t able to give accurate information or tends to provide incorrect information which may lead to complications later on. A medical practitioner who deliberately gives wrong information to the patient disrespects the patient’s autonomy and also loses the patient’s trust. This mistrust in one physician may lead to mistrust in the entire profession.

A simplistic understanding of the principles and applying them in a naïve way can lead to unsophisticated lines of thought. Often it is seen that there is a clash between the principles and cases may arise wherein it is necessary to infringe one principle in order to abide by the other. For instance when a particular treatment is absolutely necessary to save the patient’s life and involves risk but he is unconscious and cannot agree to the same, then the clash between the principles is set up.

Critics of the fiduciary model says that the thrust that “doctor knows best” has now weakened over the years. Arguments presented for the same are that the doctors are now motivated by the money involved in the profession instead of taking care of the patient. For instance, in India it is a common practice that pregnant women are forced to get operated through a caesarian operation rather than having a normal/natural delivery of the baby.

The covenantal approach fails to acknowledge the fact that sometimes the patient may fail to provide the accurate knowledge which will in turn lead to improper treatment by the doctor. Most significant medical treatments involve causing of harm, even be it just a prick of a needle. So to tell a doctor to do no harm would be counterproductive. Also, the understanding of benefit may change according to the perspective analyzed. At best, this approach can be deemed as good in hypothetical situations but when applied in practical life, there are a lot of complications as humans inherently are not virtuous all the time.

The above mentioned theories fail to capture the basic principles of respect and purity. Many aspects of religious beliefs, communitarian ethics, virtue ethics, etc are left unaddressed and are often contested in debates relating to medical laws and ethics. It is not clear that until we have developed a firm theory of human dignity acceptable by all from which the values used in principles flows, it will be hard to arrive on a conclusion in ethical debates.

Medial law is undoubtedly an ever – evolving field with new advances making it difficult as well as simplifying a medical practitioner’s job. For instance the new gene altering technique found by scientists that help parents alter the genes of their child and produce a desired offspring. How far is it ethical to play with nature’s forces? Some may argue that it will help cure the diseases and increase mortality rate.

Even the dynamics of doctor-patient relationships are changing and it is often seen that guidance on how to behave ethically demands more of doctors than compliance with law. Although there may be tensions and discrepancies, as well as similarities between a doctor’s legal duties and his ethical responsibilities, his duty is to comply with both the law and with professional ethical guidance. Even where a doctor finds compliance with the law difficult, perhaps because it appears to him to be at odds with his ethical beliefs, compliance is not optional.

Accordingly, many doctors now follow pragmatism as it seeks to develop a methodology which starts from the actual experiences and develops approaches that are rooted in real life. There is no interest among pragmatists for grand ethical theories but rather for the problems that patients and medical professionals face in real life. The emphasis is on exploring how they see, understand, and interpret the issues, rather than engage in the fine language of the philosophers.

All said and done, it can be seen that the realm of medical laws and ethics is indeed a complex and difficult concept to understand and formulate for everyone as people have different beliefs, notions and interests attached to their lives. However, it is expected of experts and thinkers that in future, a better approach which is acceptable by all may come in force but till then, we need to be careful of what the practices are around the world as the lives of human beings are at stake.

• Burton, A W (I97I). Medical Ethics and the Law Sydney, Australian Medical Publishing Co, p 13.
• E. D. Pellegrino, “The Internal Morality of Clinical Medicine: A Paradigm for the Ethics of the Helping and Healing Professions,” Journal of Medicine & Philosophy 26 (2001): 559-79.
• Menon N R Madhava. “Medicine, ethics and the law.” Indian Journal of Medical Ethics [Online], 5. 1 (2008): 31. Web. 10 Jun. 2019.
• T. L. Beauchamp and J. F. Childress, Principles of Biomedical Ethics, 7th ed. (New York: Oxford University Press, 2012).
• W. F. May, The Physician’s Covenant: Images of the Healer in Medical Ethics (Philadelphia, PA: Westminster Press, 1983).

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dc.contributor.author: Hehir,patrick dc.date.accessioned: 2015-07-01T15:12:24Z dc.date.available: 2015-07-01T15:12:24Z dc.date.digitalpublicationdate: 2011-03-22 dc.date.citation: 1923 dc.identifier: V B Librarian dc.identifier.barcode: 4990010051527 dc.identifier.origpath: /data8/upload/0248/810 dc.identifier.copyno: 1 dc.identifier.uri: http://www.new.dli.ernet.in/handle/2015/95916 dc.description.scanningcentre: C-DAK, Kolkata dc.description.main: 1 dc.description.tagged: 0 dc.description.totalpages: 152 dc.format.mimetype: application/pdf dc.language.iso: English dc.publisher.digitalrepublisher: Digital Library Of India dc.publisher: Henry Frowde And Hodder And Stoughton,london dc.rights: In Public Domain dc.source.library: Central Library, Visva-bharati dc.subject.classification: Technology dc.subject.classification: Medical Sciences dc.subject.classification: Medicine dc.subject.keywords: Medical Education dc.subject.keywords: Indian Medical Service dc.subject.keywords: Ayurvedic dc.subject.keywords: Unani Systems dc.subject.keywords: Public Health Work dc.title: The Medical Profession In India

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The History of Medical Ethics in India

Prabakar, Angel

Photo by Naveed Ahmed on Unsplash ABSTRACT India has had a solid standard for medical ethics since the birth of Ayurvedic holistic science over 5000 years ago. The country’s views on healthcare policy, counsel on how to deal with patients, and what constitutes good behavior within the profession stem from ancient outlines for medical practice. These “codes of conduct” were heavily influenced by religious and spiritual practices, emphasizing the sanctity of life and transcending the needs of the body. With time, however, medical care evolved through shifting priorities in education and governmental pressures. These once-cherished “codes of conduct” were referred to less often, while malpractice issues have steadily increased. There is a need for an open discussion of why this spike in medical malpractice is happening in a country that used to condemn it and how improving ethics, limiting the role of profits, and returning traditional philosophies to the medical ethics curricula could help. INTRODUCTION Currently, India has the largest number of bioethics units of any country, reflecting the importance of ethical behavior in Indian society. These centers do not affiliate with schools, yet they serve as spaces for bioethical discourse. The Indian Psychiatric Society (IPS) was the first to address escalating malpractice cases. Other major medical organizations (e.g., the Indian Medical Association and the Medical Council of India) followed, stressing the importance of standardized ethics. Some have formed symposiums and organized conferences to address these concerns.[1] There have been several calls to revisit the classic “codes of conduct” and their focus on the spiritual concept of life-death-rebirth. Toward this end, modern Indian doctors were reminded that physicians existed not for fortune or status but for the welfare of their patients. These altruistic teachings came from the seminal Ayurvedic texts, the cornerstone of India’s modern medicine. Happiness for the “healer” was to come out of showing compassion for all living beings and prolonging the precious gift of life.[2] In contrast, Indian novelist, Shashi Tharoor, speaking on the current state of medical practice, recently remarked: “India is not an underdeveloped country, but a highly developed one in an advanced state of decay.”[3] Taking a closer look at what caused the core values of an ancient healthcare system to change so drastically involves evaluating how the Indian medical education system evolved. This paper examines the development of medical principles, their influence across the subcontinent, commercialization, and the government’s role in India’s healthcare instability. This paper then lists some of the measures taken by bioethical units to counteract some of the issues brought on by corruption. l.     Western Influence Western influence on medical practices came when the French, Portuguese, and British arrived in India. They almost completely reinvented India’s healthcare system. Medical ethics based on the values of spirituality were almost completely stripped away and replaced by Western concepts.[4] Established traditional ethical standards were no longer taught, resulting in less deference to traditional moral beliefs. Coupled with an increase in medical misconduct, the general population lost trust in their healthcare leaders.[5] Before the influence of Western medicine, the Carakha Sumhita, a millennia-old Sanskrit text detailing Ayurveda, helped establish healthcare guidelines. A passage from the text sums up the ethics of that time: “He who practices medicine out of compassion for all creatures, rather than for gain or for gratification of the senses, surpasses all.”[6]  The Carakha Sumhita’s focus on medical ethics was ahead of its time, centuries before bioethics became a subject in its own right. Healthcare was predicated on aphorisms that all medical students internalized rather than on business models, as in many developed nations. India’s caste system, established generations ago, permeated every aspect of South Asian society except for when it came to medicine. Healers tended to ignore the conventions of adhering to an individual’s caste. Instead, they treated patients as if they were family and incorporated elements of spirituality when dealing with patients, making ethical misconduct a rare phenomenon. This was the case for almost two centuries.[7] To become practicing physicians, doctors committed to a consecration ceremony to prove their good moral standing to the people they were to serve.[8] Their schooling prepared them for a profession designed to “give back,” not for monetary gain. The core values taught in medical school affect the mentality doctors carry with them.  The lack of ethics training may have been at fault for the underlying corruption levels that now plague the healthcare space in India.  There is a 110 percent increase in the rise of medical negligence cases in India every year.[9]  To pinpoint why this occurred, we must look at current medical training practices and how they influence doctors of our time period. After colonization, many established core values were stripped from the medical curriculum.[10] In fact, by 1998, only one medical college in India, St. John’s in Bangalore, even addressed medical ethics in its curriculum.[11] Graduates across the country were left ill-equipped to deal with the ethical issues that cropped up once they made it into the field. As a result, they were not prepared to think through consequences pertaining to patients and their families. Some suggest that the curriculum changes were linked to rising malpractice cases. “When society at large is corrupt and unethical, how can you expect doctors to be honest?”[12] This topic arises regularly in bioethics discussions and the answer lies in education. Reverting to a system of medicine that encourages students to recognize ethical consequences can solve many of the ethical problems in contemporary society. ll.     Privatization and Tuition Some argue that the global increase in capitalism caused the subcontinent’s ethical problems, that the Indian medical education system began its descent into corruption and nepotism, and its loss in prestige, with the privatization of their colleges.[13] In India, just over 50 percent of medical schools are public, and just under 50 percent are private.[14] Through changing policies, private medical schools became increasingly for-profit like other businesses.[15] Despite having more medical schools than any other country, India has a shortage of doctors, primarily due to low enrollment rates and high university fees. While there are 202 medical schools in India, its large population means there are 5 million people per medical school.[16] Christian Medical College, a top-ranked university in Vellore, once had an acceptance rate of 0.25 percent, with only 100 seats for medical students.[17] Now its acceptance rate hovers around 5 percent. There has been minimal progress in making it easier to get a medical school acceptance; there is still a long way to go in equalizing access to education. India’s system for training doctors is now rife with corruption, with bribes accepted under the guise of “donations” and new curricula completely devoid of traditional Indian training methods.[18] Nepotism in the industry has made qualifications even less significant. In 2010, 69 hospitals and medical colleges were reported for selling exam papers to students, and most employed staff lied about their clinical experience.[19] In a cheating scandal in 2013 involving several Indian universities, students purchased falsified entrance exam results. Not only are these students unqualified for the placements they secured, but legal action by the government did not materialize.[20] Dr. Anand Rai, a physician who had to go into protective hiding following death threats for being a whistleblower in the 2013 scandal subsequently remarked: “...the next generation of doctors is being taught to cheat and deceive before they even enter the classroom.”[21] The effects of this scandal can be felt far beyond its borders - India also happens to be the world’s largest exporter of doctors, with about 47,000 currently practicing in the United States.[22] lll.     Hospital Privatization With the privatization of major hospitals and the shift to a “United States” business focus, another serious problem emerged. In the recent past, patients hailing from rural villages and often living in poverty could access quality health care from public hospitals. They had access to highly trained doctors, and all costs were usually fully subsidized.[23] This was in keeping with the old tradition that believed in aid no matter the circumstance. As the focus shifted towards maximizing profitability, these opportunities for poor patients vanished. Chains of private hospitals are rapidly replacing public ones. Their purchasing model is to consolidate through a centralized subsidiary.[24] This usually results in significant savings. Instead of passing on some savings to patients through reduced pricing, any savings are used to fulfill a key objective of privatized businesses: maximize profitability. The poor now contend with inflated prices and are being turned away from facilities that once treated them at no cost, all while levels of trust in the healthcare system have plummeted. This distrust can discourage people who cannot afford care from seeking medical aid when they need it. The healthcare system has devolved to the point whereby remaining public hospitals are overrun by huge numbers of patients unable to afford the hugely inflated prices at private institutions. This, coupled with healthcare workers that often have substandard training, has created deplorable public health conditions. lV.     Corruption This deplorable public health condition reflects a failing healthcare system. To make matters worse, hospitals hire unqualified graduates untrained in medical ethics to meet India's urgent need for large numbers of qualified doctors. Many hospitals have even resorted to employing corrupt doctors to counteract the physician shortage. According to the Indian Medical Association (IMA), about 45 percent of those who practice medicine in India have no formal training.[25] IMA also reported that close to 700,000 doctors employed at some of the biggest hospitals, who are currently diagnosing, treating, and operating, have neither the training nor experience to do so. A large-scale forgery ring, broken up in 2011, revealed that buyers could pay as little as 100 US dollars for a medical degree from a non-existent college. This “cleared” them for practice.[26] It has been estimated that over 50,000 fraudulent medical degrees have been purchased in the past decade. Government level corruption is widespread, as one can gain placement into medical school, “graduate” with fake degrees, and sell fake practicing licenses. V.     Solutions These topics, raised by bioethics centers, are now being taken more seriously by healthcare professionals taking steps to address medical misconduct. As many as five million people in India die each year due to medical negligence.[27] By requiring each physician to complete a new comprehensive Acute Critical Care Course (ACCC), specialists estimate that physicians can reduce the rate of malpractice deaths by as much as 50 percent in rural areas.[28] This intensive two-year course contains detailed training methods built off of current knowledge and walks healthcare professionals through crucial steps designed to reduce errors. Even small errors, such as a poorly inserted IV for fluid or a minor surgery mishap, can be life threatening. The course thoroughly covers these as mandated.[29]  The ACCC is unfortunately not a widely spread concept in a lot of rural areas. For now, while many major hospitals continue to ignore the high rates of avoidable deaths, implementation of the ACCC program seems slow. The current Medical Council of India needs to be more effective at addressing malpractice cases, as there are so many of them.[30] One possible solution to the growth of unethical business practices in medicine is to offer physicians incentives to make ethically sound decisions. This can start by increasing the number of slots available for medical students at government-run medical schools. Less student debt would lead more doctors away from overbilling their patients. This is a strategy currently being employed in the state of Tamil Nadu, where a centrally sponsored scheme has approved the induction of an additional 3,496 MBBS seats in government colleges.[31] More students studying at subsidized costs with less competition lowers the inclination toward deceit and profiteering. Another incentive for ethical practice can come from accountability and transparency. The background of every doctor operating should be public information, including the rate of successful surgeries versus unsuccessful ones resulting from personal negligence. This would encourage doctors to keep a clean record and, in turn, encourage hospitals to hire and train those who will preserve or improve their reputation. This information is kept in a medical record monitored in most parts of India through a traditional paper method.[32] While eliminating paper in medical recording and reverting to digital use is the ultimate aim, it will take time to implement a system that takes into account e-signatures and verifiable witnesses. CONCLUSION India’s history of leadership in medical ethics has undergone some major changes. A relatively recent privatization of the education system has caused a shift in values and decimated the medical industry on many levels. The moral principles of doctors have come into question. While industry and government leaders are trying to solve the multi-faceted issues facing the medical industry, it is obvious that this is an undertaking requiring inventive solutions. Prioritizing ethics in medical education, de-privatizing medical schools and hospitals, offering affordable options, and limiting corruption would improve India’s ability to offer high-quality medical care. Adding traditional Indian medical ethics back into the curricula would foster a workforce dedicated to serving patients over profiteering. - [1] Deshpande, SmitaN. 2016. “The UNESCO Movement for Bioethics in Medical Education and the Indian Scenario.” Indian Journal of Psychiatry 58 (4): 359. https://doi.org/10.4103/0019-5545.196722 . [2] Mukherjee, Ambarish, Mousumi Banerjee, Vivekananda Mandal, Amritesh C. Shukla, and Subhash C. Mandal. 2014. “Modernization of Ayurveda: A Brief Overview of Indian Initiatives.” Natural Product Communications 9 (2): 1934578X1400900. https://doi.org/10.1177/1934578x1400900239 . [3] 2020. Eubios.info. 2020. https://www.eubios.info/EJ102/EJ102E.htm . [4] Arnold, David, ed. 2000. “Western Medicine in an Indian Environment.” Cambridge University Press. Cambridge: Cambridge University Press. 2000. https://www.cambridge.org/core/books/abs/science-technology-and-medicine-in-colonial-india/western-medicine-in-an-indian-environment/28BAB761BE205B06D32BC3DC972E9384 . [5] Kulkarni, Vani, Veena Kulkarni, and Raghav Gaiha. 2019. “Trust in Hospitals-Evidence from India.” https://repository.upenn.edu/cgi/viewcontent.cgi?article=1026&context=psc_publications . [6] Bhasin, Dr Sanjay K. 2005 “What Ails Medical Profession.” Www.academia.edu . Accessed September 17, 2022. https://www.academia.edu/7631547/What_Ails_Medical_Profession . [7] Shapiro, Natasha, and Urmila Patel. (2006) “Asian Indian Culture: Influences and Implications for Health Care.” https://www.molinahealthcare.com/~/media/Molina/PublicWebsite/PDF/providers/fl/medicaid/resource_fl_asianindianculture_influencesandimplicationsforhealthcare.pdf . [8] Swihart, Diana L, and Romaine L Martin. 2021. “Cultural Religious Competence in Clinical Practice.” Nih.gov. StatPearls Publishing. 2021. https://www.ncbi.nlm.nih.gov/books/NBK493216/ . [9] “India’s Mighty Medical Education Mess.” 2022. Education World. July 11, 2022. https://www.educationworld.in/indias-mighty-medical-education-mess/ . [10] Pandya, Sunil. 2020. “Medical Education in India: Past, Present, and Future Perspectives. in Sun Kim, ed. Medical Schools Nova Science Publishers, Inc. (= [11] Ravindran, G. D., T. Kalam, S. Lewin, and P. Pais. 1997. “Teaching Medical Ethics in a Medical College in India.” The National Medical Journal of India 10 (6): 288–89. https://pubmed.ncbi.nlm.nih.gov/9481103/ . [12] “Chapter 9: Opinions on Professional Self-Regulation”(2016) https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-9.pdf . [13]Sanjiv Das. 2020. “The Pill for India’s Ailing Medical Education System.” Express Healthcare. February 3, 2020. https://www.expresshealthcare.in/education/the-pill-for-indias-ailing-medical-education-system/416711/ . [14] https://www.marketresearch.com/Netscribes-India-Pvt-Ltd-v3676/Private-Medical-Colleges-India-30399614/."There are ~50.89% government medical colleges and ~49.11% private medical colleges in the country.”; NPR.org. (2021) “When Students in India Can’t Earn College Admission on Merit, They Buy Their Way In.” Accessed September 19, 2022. https://www.npr.org/2019/08/04/745182272/when-students-in-india-cant-earn-college-admission-on-merit-they-buy-their-way-i .  [15] https://timesofindia.indiatimes.com/india/how-medical-colleges-in-india-became-a-business-one-policy-change-at-a-time/articleshow/69707594.cms [16] Muula A. S. (2006). Every country or state needs two medical schools. Croatian medical journal, 47(4), 669–672. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080437/ [17] Miglani, Andrew MacAskill, Steve Stecklow, Sanjeev. 2015. “Why India’s Medical Schools Are Plagued with Fraud.” Mint. June 17, 2015. https://www.livemint.com/Politics/BDGOx3SApU3QbsRMjZUK9M/Why-Indias-medical-schools-are-plagued-with-fraud.html . [18] Clark, J. 2015. “Indian Medical Education System Is Broken, Reuters Investigation Finds.” BMJ 350 (jun18 3): h3324–24. https://doi.org/10.1136/bmj.h3324 .  [19] Reuters. 2015. “Special Report - Why India’s Medical Schools Are Plagued with Fraud,” June 16, 2015, sec. Special Reports. https://www.reuters.com/article/uk-india-medicine-education-specialrepor/special-report-why-indias-medical-schools-are-plagued-with-fraud-idINKBN0OW1N520150616 . [20] Andrew Emett. (2015) “Over Two Dozen Witnesses and Suspects Mysteriously Die in Indian Cheating Scandal | NationofChange.” Accessed September 19, 2022. https://www.nationofchange.org/2015/07/08/over-two-dozen-witnesses-and-suspects-mysteriously-die-in-indian-cheating-scandal/ . [21] (Reuters 2015) [22] Clark, J. 2015. “Indian Medical Education System Is Broken, Reuters Investigation Finds.” BMJ 350 (jun18 3): h3324–24. https://doi.org/10.1136/bmj.h3324 . [23] Barik, Debasis, and Amit Thorat. 2015. “Issues of Unequal Access to Public Health in India.” Frontiers in Public Health 3 (October). https://doi.org/10.3389/fpubh.2015.00245 . [24] “Investment Opportunities in India’s Healthcare Sector.” (2021) https://www.niti.gov.in/sites/default/files/2021-03/InvestmentOpportunities_HealthcareSector_0.pdf . [25] Clark, J. 2015. “Indian Medical Education System Is Broken, Reuters Investigation Finds.” BMJ 350 (jun18 3): h3324–24. https://doi.org/10.1136/bmj.h3324 . [26] “Are We Importing Fake Doctors?” (2015) Www.workerscompensation.com . Accessed September 19, 2022. https://www.workerscompensation.com/news_read.php?id=21672&forgot=yes . [27] Boston, 677 Huntington Avenue, and Ma 02115 +1495‑1000. 2013. “Millions Harmed Each Year from Unsafe Medical Care.” News. September 19, 2013. https://www.hsph.harvard.edu/news/press-releases/millions-harmed-each-year-from-unsafe-medical-care/ . [28] “Specialised Course for Doctors Can Help Cut the Deaths due to Medical Errors; Experts.” 2018. DailyRounds. October 29, 2018. https://www.dailyrounds.org/blog/specialised-course-for-doctors-can-help-cut-the-deaths-due-to-medical-errors-experts/ . [29] Sokhal, Navdeep, Akshay Kumar, Richa Aggarwal, Keshav Goyal, Kapil Dev Soni, Rakesh Garg, Ashok Deorari, and Ajay Sharma. 2021. “Acute Critical Care Course for Interns to Develop Competence.” The National Medical Journal of India 34 (3): 167–70. https://doi.org/10.25259/NMJI_103_19 . [30] Singhania, Meghna A. 2020. “How Much Punishment?- MCI Formulates Sentencing Guidelines for Cases of Medical Negligence.” Medicaldialogues.in. February 13, 2020. https://medicaldialogues.in/news/health/mci/how-much-punishment-mci-formulates-sentencing-guidelines-for-cases-of-medical-negligence-62645 . [31] “Health Ministry Reports 30% Increase in Number of Functional Medical Colleges in Five Years.” (2022) Www.pharmabiz.com . Accessed September 19, 2022. http://www.pharmabiz.com/NewsDetails.aspx?aid=152299&sid=1 . [32] Honavar, Santosh G. 2020. “Electronic Medical Records – the Good, the Bad and the Ugly.” Indian Journal of Ophthalmology 68 (3): 417. https://doi.org/10.4103/ijo.ijo_278_20 .

• Medical ethics
• Bioethics--Philosophy

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India, Bioethics, Malpractice, Government, Medical Ethics, Education, Healthcare Policy, Religion, Moral Beliefs, Ayurvedic Code, Modern Medicine, Public Health, Privatization, Equal Access

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Preamble: As member of Indian medical Association and as qualified physician, the conduct of a registered Medical Graduate is governed by the Ethics and the regulations pronounced by Indian medical Council Act 1956.

As very important part of society and nation building:

1.      I have read & agreed to abide by regulations under Indian Medical Council act, especially Professional, Etiquette & Ethics) Regulations 2002 and its subsequent amendments.

2.      I solemnly pledge myself to consecrate my life to the service of humanity & maintain utmost respect for human life from the time of its conception.

3.      I shall practice my profession with utmost conscience & dignity.

4.      I shall extend my teachers & fellow colleagues respect and gratitude legitimately due to them.

5.      I shall respect the privacy & secrets of my patients that are confided in me for professional reasons.

6.      I shall honour the autonomy of my patients to make decisions.

7.      I shall uphold both beneficence & non-malfeasance in treating my patients.

8.      I shall respect human dignity, esteem, prestige, rights & fundamental freedom of all my patients

9.      I shall take both informed consent & inform refusal from my patient towards any medical or surgical treatment.

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14.  I shall not accept any gifts, pecuniary benefits or gratification from the pharmaceutical companies, equipment suppliers and diagnostic centers or similar agencies.

15.  I shall not indulge in any activities that are immoral, unethical or illegal in the eyes of the applicable governing laws and also the prudence.

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Healthcare Sector in India

• 08 Sep 2022
• GS Paper - 2
• Government Policies & Interventions
• GS Paper - 3
• Government Budgeting

For Prelims: Government Policies & Interventions, Healthcare Sector in India and related Initiatives.

For Mains : Healthcare Sector in India, Challenges and Potential.

Why in News?

Healthcare has become more focused on innovation and technology over the past two years and 80% of healthcare systems are aiming to increase their investment in digital healthcare tools in the coming five years.

What is the Scenario of the Healthcare Sector in India?

• Healthcare industry comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment.
• The government (public healthcare system), comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of Primary Healthcare Centres (PHCs) in rural areas.
• The private sector provides a majority of secondary, tertiary, and quaternary care institutions with major concentration in metros, tier-I and tier-II cities.
• The Indian healthcare sector is expected to record a three-fold rise, growing at a CAGR (Compound Annual Growth Rate) of 22% between 2016–22 to reach USD 372 billion in 2022 from USD 110 billion in 2016.
• In the Economic Survey of 2022, India’s public expenditure on healthcare stood at 2.1% of GDP in 2021-22 against 1.8% in 2020-21 and 1.3% in 2019-20.
• In FY21, gross direct premium income underwritten by health insurance companies grew 13.3% YoY to Rs. 58,572.46 crore (USD 7.9 billion).
• The Indian medical tourism market was valued at USD 2.89 billion in 2020 and is expected to reach USD 13.42 billion by 2026.
• Telemedicine is also expected to reach USD 5.5 billion by 2025.

What are the Challenges with the Health Sector?

• Inadequate access to basic healthcare services such as shortage of medical professionals, a lack of quality assurance, insufficient health spending, and, most significantly, insufficient research funding.
• One of the major concerns is the administrations' insufficient financial allocation.
• Even neighbouring countries like Bangladesh and Pakistan have over 3% of their GDP going towards the public healthcare system.
• Preventive care is undervalued in India, despite the fact that it has been shown to be quite beneficial in alleviating a variety of difficulties for patients in terms of unhappiness and financial losses.
• In India, R&D and cutting-edge technology-led new projects receive little attention.
• Policymaking is undoubtedly crucial in providing effective and efficient healthcare services. In India, the issue is one of supply rather than demand, and policymaking can help.
• In India, there is a shortage of doctors, nurses, and other healthcare professionals.
• According to a study presented in Parliament by a minister, India is short 600,000 doctors.
• Doctors work in extreme conditions ranging from overcrowded out-patient departments, inadequate staff, medicines and infrastructure.

What is the Potential of the Indian Health Sector?

• India's competitive advantage lies in its large pool of well-trained medical professionals . India is also cost competitive compared to its peers in Asia and western countries. The cost of surgery in India is about one-tenth of that in the US or Western Europe.
• India has all the essential ingredients for the exponential growth in this sector, including a large population, a robust pharma and medical supply chain, 750 million plus smartphone users, 3 rd largest start-up pool globally with easy access to VC (Venture Capital Fund) funding and innovative tech entrepreneurs looking to solve global healthcare problems.
• India will have about 50 clusters for faster clinical testing of medical devices to boost product development and innovation.
• The sector will be driven by life expectancy, shift in disease burden, changes in preferences, growing middle class, increase in health insurance, medical support, infrastructure development and policy support and incentives.
• As of 2021, the Indian healthcare sector is one of India’s largest employers as it employs a total of 4.7 million people. The sector has generated 2.7 million additional jobs in India between 2017-22 -- over 500,000 new jobs per year

What are the Initiatives for the Health Care Sector?

• National Health Mission
• Ayushman Bharat.
• Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) .
• National Medical Commission
• PM National Dialysis Programme.
• Janani Shishu Suraksha Karyakram (JSSK).
• Rashtriya Bal Swasthya Karyakram (RBSK).

Way Forward

• There is an urgent need to improve the infrastructure of public hospitals, which are overburdened as a result of India's large population.
• The government should encourage private hospitals because they make a significant contribution.
• Because the difficulties are severe and cannot be tackled just by the government, the private sector must also engage.
• To improve the sector's capabilities and efficiency, more medical personnel must be inducted.
• Medical gadgets in hospitals and clinics, mobile health apps, wearables, and sensors are only a few examples of technology that should be included in this area.

UPSC Civil Services Examination, Previous Year Questions (PYQs)

Q. Which of the following are the objectives of ‘National Nutrition Mission’? (2017)

• To create awareness relating to malnutrition among pregnant women and lactating mothers.
• To reduce the incidence of anaemia among young children, adolescent girls and women.
• To promote the consumption of millets, coarse cereals and unpolished rice.
• To promote the consumption of poultry eggs.

Select the correct answer using the code given below:

(a) 1 and 2 only (b) 1, 2 and 3 only (c) 1, 2 and 4 only (d) 3 and 4 only

• National Nutrition Mission (POSHAN Abhiyaan) is a flagship programme of the Ministry of Women and Child Development, GoI, which ensures convergence with various programmes like Anganwadi services, National Health Mission, Pradhan Mantri Matru Vandana Yojana, Swachh-Bharat Mission, etc.
• The goals of National Nutrition Mission (NNM) are to achieve improvement in nutritional status of children from 0-6 years, adolescent girls, pregnant women and lactating mothers in a time bound manner during the next three years beginning 2017- 18. Hence, 1 is correct.
• NNM targets to reduce stunting, under-nutrition, anaemia (among young children, women and adolescent girls) and reduce low birth weight of babies. Hence, 2 is correct.
• There is no such provision relating to consumption of millets, unpolished rice, coarse cereals and eggs under NNM. Hence, 3 and 4 are not correct.
• Therefore, option (a) is the correct answer.

Q. “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (2021)

Source: PIB

Consumer Protection Act, 2019 and Its Implications for the Medical Profession & Health Care Services in India

• December 2019
• Journal of Indian Academy of Forensic Medicine 41(4):282-285
• 41(4):282-285

• Aligarh Muslim University

• Jamia Millia Islamia

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