Corruption & decline of ethics in medical practice
The marketing practices of the drugs and devices industries have further contributed to compromises in ethical practices. Professionals with limited expertise are offered opportunities to increase their incomes by subtle and not-so-subtle means
RP Sapru
THE issue of corruption in medical practice is not new. It troubled Hippocrates, Charaka and many others since then. Several codes of ethics have been suggested from time to time. The International Code Of Medical Ethics adopted by the World Health Assembly in 1949 (subsequently revised in 1968, 1983 and 2006) is the overarching international guideline.
Most countries have formulated their own codes of conduct for medical professionals very similar to the International Code. However, in spite of the existence of regulatory bodies to ensure compliance with the prescribed standards of medical ethics, most countries have been periodically reporting concerns on the issue. Recent media concern, drawing attention to the scale of the problem in India is welcome; though any suggestion of a “discovery”seems misplaced since the practice is well within the knowledge of all stakeholders, including patients. No sting operations are necessary; the information is openly shared within the community; an open secret like none other. In addition, many formal publications in professional journals as well as the lay Press have referred to the issue from time to time building a substantial glossary by now. The Indian Journal Of Medical Ethics is specifically devoted to the subject. It is a pity though that the hallowed profession in the country is today precariously positioned, in danger of falling off the pedestal.
Transgressions galore
Unfortunately, the Medical Council of India (MCI) as the sole organisation mandated to ensure adherence to ethical standards in medical practice, as well as the quality of medical education, in the country. It has failed on both counts. Even when it did bare a tooth or two, the existing legal machinery failed to deliver. Consequently, occasional transgressions have coalesced over time to gain present scale of operations. Following developments have further contributed to the much-less-than-satisfactory scenario.
The model of a free market economy adopted by the country espouses only a single measure of success in life, that of financial prosperity. It would defy logic if medical professionals remained unaffected by that pervasive mood generated in society. That aspirational drive, coupled with absence of any quality audit, striving for professional excellence alone no longer remains an endearing proposition.
The notion that medical profession in India should be judged as a philanthropic profession is anachronistic considering that even social philanthropy is commercialised. Unrealistic constraints on earnings of medical professionals in the country have added fuel to the fire. The same argument applies to enforced rural service, when there is no such conscription for any other humanitarian activity in the country.
Policies adopted by successive governments to deal with the shortage of manpower in healthcare industry have not helped either. Allowing RMPs, ayurvedic and Unani practitioners to freely practise the allopathic stream of medicine, for which they have never been trained, has been utterly short-sighted, with serious consequences for patients as well as professionals. That observation is no reflection on the benefits of any particular system of medicine, but only on the undesirability of practitioners over-reaching their own expertise. As is well known, cross-fertilisation between different species has the potential to produce monsters. Mismatched skills in this instance have predictably led to the compounding of undesirable practices. Although consequences to patients from this practice have never been measured, there is a strong perception within professionals that the practice has in a substantial measure, triggered the downslide. The suggestion for an abridged course for rural practitioners, that is currently doing the rounds in the corridors of power, is similarly flawed, and likely to contribute to further spread corruption. It is hoped that better sense prevails and the suggestion is shelved. The proposal is doomed to failure even otherwise for the present-day rural population is sufficiently informed to see through the undesirability of trusting their health to less than fully trained professionals. That the MCI is stated to have given its approval to the course speaks volumes about the professional commitment of the organisation.
Marketing ploys & professional ethics
The marketing practices of the drugs and devices industries have further contributed to compromises in ethical practices. Professionals with limited expertise are offered opportunities to increase their incomes by subtle and not-so-subtle means. The modus operandi varies with the type of business in question. For the more knowledgeable professionals there are other offerings. Likewise, business centres offering specialised services like diagnostic facilities, nursing homes or hospitals, big and small, offer a share in profits or incentives for business generated. Spectacular advances in the field of medical sciences have opened up equally spectacular opportunities for professionals open to persuasion.
Having been personally witness to the steady deterioration in medical ethics over 50-odd years, the present slide is painful. There were chinks in the armour earlier also but the present slide is a sea change from the past. Failure of regulation, the scale of available opportunities together with mounting peer pressure, has led to more and more persons getting sucked into the “system.” We seem headed to a situation of institutionalised corruption such that a new graduate may well ask “Medical ethics! Whatever is that?” However, there are still many ethically alive professionals who have managed to keep professional ethics afloat in the country. Whether the situation is redeemed remains to be seen. There is still time, but the window of opportunity is slipping away. The problem is not as much of awareness as that of a will and the wherewithal to address the issues. Corruption in the medical profession is the symptom of a systemic social disorder calling for innovative management; mere changes in laws or any other coercive methods will not work.
Having been complicit in the present mess, the MCI route will not work either unless transformational changes are introduced in that body first. To begin with, a transparent system of accountability needs to be introduced wherein the MCI is held answerable for under-performance or non-performance. A strong system that monitors public feedback in real time needs to be put in place with the proviso that it remains insulated from vitiation by pressure groups within the profession or outside.
Fortunately, currently available technology is eminently suited to deliver such a mechanism. Although dramatic punitive interventions through the judicial route, notably in the USA, have aroused media interest these can only be a fall back option for a failed system; a better solution is to infuse correctives well before punitive measures become necessary.
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