Maimed Conscience and Maimed Beggars (Medical Ethics in India) – Part 1

The current report from CNN IBN and Channel 7 Indian Television network has raised many questions about the health of Indian healthcare field and the medical professionals. A cleaning up operation is long overdue to rejuvenate the sector. Forgotten are the ‘Declaration of Geneva by the World Medical Association in 1949 - I solemnly pledge myself to consecrate my life to the service of humanity …. I will practice my profession with conscience and dignity; The health of my patient will be my first consideration….. I will maintain the utmost respect for human life, from the time of conception… The sting operation conducted by the television network exposes the beggar mafia nexus being helped by unscrupulous surgeons in Delhi and the state of Uttar Pradesh. In a shocking revelation the network has captured the ‘doctors on camera’ being interviewed and accepting money to perform amputation surgeries on limbs of perfectly healthy children and adults - so that they can be made a cripple and become a high earning beggar. This apparently is being done at a cost of Rs.10,000 to Rs.40,000.

The money is paid to the surgeons by the beggar mafia and the doctors willfully perform these surgeries in various hospitals. The Indian medical profession and the public are infuriated by the news and the immediate statement from Dr Ajay Kumar, National President Elect of the Indian Medical Association was that doctors will be arrested immediately. ''If they are registered with the IMA then their medical license will be immediately suspended,'' he said.

One of doctors who is a founding member of National Organization of Bio-Medical Ethics and Law (NOBEL) said: ‘If this report is true it is as nauseating as the role of doctors who were involved in the mass extermination of Jews in the gas chambers of the ‘Nazi holocaust ’ during the second world war; there is no forgiveness here.’

This is not the first instance that the media has exposed the corrupt practice of some of the Indian doctors who are short on ethics and long on commerce. Another television channel (Sahara) not too long ago exposed the nexus of the commerce in the kidney donations and transplants in Punjab. Commerce of organs be it kidney or liver and the nexus between doctors, the middle man and sometimes the members of authorization committee of the Government (as in Amritsar case) has been a regular feature of news in India. Like the current case it causes a furor for a short time and the nauseating stink in the community settles with time till something else crops up.

Kickbacks for investigations to the doctors by laboratories and hospitals and the female feticide are other examples of corrupt practices that are rampant in the Indian medical profession.

In the last decade we have also seen how the power of advertising for services by the medical professional and hospitals (including in-flight magazines, hoardings and television) has been used effectively to drive and lure the gullible middle class Indian patient. The current boom in medical tourism may even make all this acceptable to the Governement. The current fashion is apparently doctors and hospitals actually paying huge amounts of money to the journalists and employing PR agencies to be written about regularly in the media.

The Medical Council of India and the State Medical Council - the apex bodies that decides the fate of doctors who are indulging in such forms of corrupt practices and bringing down the bastions of medical ethics in India; seldom react fast enough and the number of cases of doctors whose license is quashed are but few.

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It is one thing for the Council members to give an immediate statement to the press that is in line with the public sympathy and appear on the television media but another to fully investigate the case and impart justice. In most of the instances the doctors are let off with a warning by the council. What George Bernard Shaw said in 1913 may still be true in medical profession - ’No doctor dare accuse another of malpractice. He is not sure enough of his own opinion to ruin another man by it. He knows that if such conduct were tolerated in his profession no doctor's livelihood or reputation would be worth a year's purchase. I do not blame him: I should do the same myself. But the effect of this state of things is to make the medical profession a conspiracy to hide its own shortcomings.’

The current case has brought the issue of medical ethics in India in a glaring focus that doctors cannot hide from. What is likely to happen over the next few days is but predictable. Surely heated debates will take place on the media on the issue of erosion of ethics in the medical community. The health ministry and the Councils are likely to set up inquiry commissions to investigate this and similar cases. A few licenses of doctors may also be revoked; however the roots of commerce and corruption in the Indian Healthcare system are too deep rooted. The well knit system allows doctors to get kick-backs for referring the patient to a specialist or a diagnostic centres or surgeries. Even bigger tragedy that haunts this noble profession is that often these investigations and surgeries are unnecessary. All this will never truly come to light and cannot be eradicated.

The threats we face today in our society is not so much external but internal and there seems to be no long term solution or the will to fight this threat with any effectiveness. In any case in this nauseating instance of maiming of healthy adults and sometimes of the innocent children; demands a sentence that cannot be mere revoking of medical license to practice but should be as severely punitive as possible perhaps even hanging of the accused.

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The next time we look at a blind or a crawling beggar asking for alms, we will wonder if this was naturally fated or artificially created to win our sympathy to allow us to fish in our pockets and purses for a few coins. As an afterthought we may now stretch our imagination just a little and wonder which doctor or hospital helped these beggars to their current fate.

Having said all this, it is unlikely that the kingpins who run the ‘Beggar mafia’ will be nabbed. In all sincerity the Police is likely to release its usual statement like -‘they would spare no one …..’ The beggar mafia may have already by now shifted its base of operation and maybe inciting another set of greedy surgeons to perform the act... Only a maimed conscience of the doctors can maim a healthy human being; for a change the awakening has to be from within.

The most important contract that can be made, is that which takes place between a sick man and his doctor. The subject of it is human life. The breach of this contract, by willful negligence, when followed by death, is murder; and it is because our penal laws are imperfect, that the punishment of that crime is not inflicted upon physicians who are guilty of it. Benjamin Rush, 1801

References-
1. Shaw, George Bernard. The Doctor's Dilemma, preface. 1913 [Reprinted in Baltimore: Penguin Books; 1941, p. 15].

2. World Medical Association. World Medical Association Bulletin 1949; 1:15. [Cited in: Etziony MB. The physician's creed: and anthology of medical prayers, oaths and codes written and recited by medical practitioners through the ages. Springfield (IL): Charles C Thomas; 1973, p. 95.]

3. Rush, Benjamin. The vices and virtues of physicians. In Runes DD (ed). Selected Writings of Benjamin Rush. New York: Philosophical Library; 1947, p. 299.