10. Traditional medicine systems
Just as customs and cultures have evolved over the last few centuries, so have healing systems. The desire of humans to treat themselves and their loved ones for infirmities has existed since time immemorial. When compared to traditional medical systems, modern medicine has a relatively short history.
Every community has many of these kinds of practices, like relying on spiritual healing or using medicinal herbs. The practitioner of modern medicine may come across as firm believers, and it can be a tough job to debate them out of their experience and convince them of our experience. It is a good idea to embrace diversity and build cultural sensitivity before getting into debates. The paradigm of cultural humility says that people should meet in the middle unless a practice is harmful and can cause a patient to suffer.
Studies on the effects of traditional practices could show that they are just as good as modern medicine. For example, traditional European medicine used elderberries to heal, and a meta-analysis done in 2019 found that using elderberries to treat respiratory infections had a large effect size.
Other instances include contemporary magical fixes that are less than plausible. Probably these are the ones earning blanket terms like "quackery" for everything connected to them: a typhoid-curing necklace (witnessed in Punjab) and the act of digging a pit to prevent and cure rabies (witnessed in Lucknow), to name a few. The fact that these practices keep on going is proof of how the placebo effect works and how powerful faith can be. If looked at closely, healing intent is the common denominator.
Instances include contemporary magical fixes that are less than plausible. Probably these are the ones earning blanket terms like "quackery" for everything connected to them: a typhoid-curing necklace (witnessed in Punjab) and the act of digging a pit to prevent and cure rabies (witnessed in Lucknow), to name a few.
9. Denying treatment based on cost considerations
Medical systems differ from country to country, yet inequity finds a place in all of them. The maximum health resources of a country are often utilized by those who need them the least. The debate over health inequities keeps reverberating in the conference halls of human rights and social rights activists. In our practice, we see situations where admitting a patient to a ward or leaving the cure to chance are only a few dollars apart.
Attending doctors cannot be expected to play the dual role of philanthropist and physician. Even though empathy is at the heart of both, there is only so much that can be done to make up for social flaws. The right to health cannot be blatantly translated into the right to utilize health resources. A country can have both helicopter ambulances and people who can't afford to buy basic medicines on their own. Facilities like primary health centers bridge this disparity to some extent. So do some legends like Padma Bhushan Dr. Sengamedu Srinivasa Badrinath.
8. Medical errors
A medical error is any deviation from the intended plan of medical care. Many scholars have given definitions to understand what best fits in this category and how to keep clear boundaries from negligence. Simply put, these errors are the result of just humans treating other humans without any malign subtext. Misdiagnosis, overtreatment, and undertreatment are examples of common medical errors. A simple example would be attempting to draw blood from a vein but failing two out of ten times on the first try.
For sensitive new doctors, it can be hard to accept that medical mistakes do happen. Even though textbooks make disease and cure look like math, the real process is not at all linear. The principles of the Helsinki Declaration and Hippocratic Oath empower us to practice medicine while minimizing harm. Yet, claiming perfection is nothing short of arrogance.
7. The role of pharmaceutical companies in the healthcare system
During our second year of medical school, we learned how to read drug advertisements and decide logically if a drug is worth the hype. In practice, we encounter the answer to why.
Modern medicine has advanced at a breakneck pace. From the synthesis of human insulin in laboratories to foreseeing precision medicine and artificial wombs, we have come a long way. Without a huge number of trials and just as many companies, this jump would not have been possible. The medical world is inextricably tied together with the pharmacy.
One must not forget the nature of this equilibrium, while the doctor is the healing hand, a pharmaceutical ambassador may just be a marketer. The extent of influence may not be quantifiable, yet it is not imperceptible.
6. Role of cultural beliefs in medical decision-making
A very obvious example comes to mind: abortion laws and heartbreaking stories of women seeking abortions being denied the same. The arguments on both sides are not comparable. Faith and religious laws are yet another expansion of brain functions, however, the law of medicine only cares about evading suffering.
On the other hand, the criminalization of medical procedures may also be relevant in certain social contexts and completely absurd in others. Another instance in this discussion is the criminalization of sex detection of unborn babies in India and many other nations.
The miracle of science bestowed us with the ability to look at the baby in the womb and its gender. However, the stereotypical evil side of the human mind decided to use it as an opportunity to selectively opt out. The number of cases of female foeticide rose, necessitating government to veto the prowess of medical technology, while the other half of the world enjoys the thrill of blue or pink-themed gender reveal parties.
5. Reproductive technologies
Artificial wombs will be the next technological marvel. The concept video released in December is as brilliant as it is shocking. It could be a huge step forward for public health in places like India, which has problems with infant mortality, low birth weights, premature births, and the complications that come with them. Infertile couples may have much better chances of having a baby.
On the other end of the spectrum of theories, however, is the idea that it could mess with the way people normally reproduce. Additionally, the idea that favorable genes can be chosen and phenotypes can be altered may ring bells of horror with flashbacks from the 1940s. As the world develops, lessons and perversions from the past cannot be forgotten.
When the news of the first test tube baby broke, it was met with mixed feelings. Patrick Steptoe and Robert Edwards came up with the idea for the first IVF baby. It was born on July 25, 1978. This first successful IVF birth took 102 IVF cycles to achieve. Lesley and Peter Brown became the parents of the world's first test-tube baby, a healthy girl named Louise Joy Brown. The evolution of NaPro technology soon afterward has tackled some ethical issues and religious concerns.
Patrick Steptoe and Robert Edwards came up with the idea for the first IVF baby. It was born on July 25, 1978. This first successful IVF birth took 102 IVF cycles to achieve.
Another concern in the discussion is the legitimacy of surrogate services. Commercial surrogacy is banned in many countries, including India, and some critics claim that it commodifies human life and lowers the value of motherhood. Others believe that it is simply unethical to pay another woman to carry and deliver a child for another person.
4. The use of animal testing in medical research
Animal testing is a contentious practice that is utilized to conduct research and create novel medications and therapies for a wide range of medical ailments. Ibn Zuhr (Avenzoar), an Arab doctor who worked in Moorish Spain in the 1100s, is said to have been the first person to test surgical treatments on animals as a way to learn more about them before using them on people. Also, there are some stories from the Neolithic period, Greek scholars like Aristotle from the 4th century B.C.E., and the famous Roman doctor Galen. These examples imply that the use of animals in research has an ancient history.
Animal testing is a contentious practice that is utilized to conduct research and create novel medications and therapies for a wide range of medical ailments.
Along the evolutionary course of modern medicine, animal experimentation found its way into physiology and pharmacology labs. Many famous experiments documented in history, despite their research value, touch on the grim side of things. Interestingly, animal testing has been the topic of ethical discussions since the 1600s, although our preceding generation of physicians had first-hand experience dissecting frogs, earthworms, and even rabbits.
My physiology textbook gave detailed steps for pithing a frog, so it does not feel any pain when its nerves are stimulated. The pursuit of advancement cannot undo the cruelty that has occurred as a result of it. The other side of the debate involves alternatives. How can we expose humans to potentially lethal chemicals directly?
3. Prenatal genetic testing and counseling
There are genetic diseases, including some that are extremely dreadful. The total count is around 6,000 which we know today. Out of these, only 600 are treatable as of now. Yet treatment success does not always translate into improved quality of life. The common and popular ones include Down syndrome.
The purpose of antenatal counseling and gene analysis, highly recommended in consanguineous cultures, is to decide whether or not to abort the embryo that has been conceived. The other counterpart is opting for genetic counseling when choosing partners. Shortly soon, matchmakers will branch out beyond astrological charts and into genetic charts.
Despite the conceptual rationale, the actual uptake of the practice is not well documented. The deep genetic analysis also runs the risk of disclosing "variants of uncertain significance." Right to the life of fetus, who gets to choose, reproductive autonomy, life stories of parents who chose to bear the baby
The actualization of rights and their documentation in the constitution usually occurs after a generation or two of struggle, resistance, and then being heard, and then the other way around. Cruelty occurs as the baseline; someone rises to assert the need for freedom from that cruelty to
Political theorist Hannah Arendt thought that the actions of Adolf Eichmann, a key figure in the Holocaust, showed the "banality of evil." Eichmann did not see himself as a monster but as a bureaucrat who was just following orders. She said that to prevent similar atrocities from happening in the future, it is important to understand the social and historical conditions that make people who seem "normal" do dreadful things.
2. Legalization of euthanasia
Euthanasia is a Greek word that translates as "good death." It is also popularized as "mercy killing," where another person completes the act of killing. Francis Bacon was the first person to use the word "euthanasia" in a medical context in the 17th century. He used it to describe an easy, painless, and happy death in which it was the "physician's duty to relieve the physical sufferings of the body."
In contrast to advocacy for fetal life and reproductive autonomy, "medically assisted suicide" or "euthanasia" raises a terrifying question. On the other hand, putting down pets on medical grounds is more common than one can imagine.
Determining the quality of life for another class in another order in the animal kingdom is okay, but not for yourself. The idea of euthanasia goes against all religious beliefs and all cultural norms. Despite our medical explanations for other tricky points in the ethical arena, this is where we draw the line. This may be the line that medical knowledge is afraid to cross when it comes to the sacredness of life.
Currently, euthanasia is legal in fewer than 10 countries. An analogous concept of physician-assisted suicide has been charted out. The understandable distinction remains the role of a physician. In the first, the physician administers the lethal substance; in the latter, the physician only approves and provides it.
Euthanasia is legal in fewer than 10 countries.
For physician-assisted suicide to be legal in most places, the patient must have a terminal illness, show that they are mentally stable, say they want to die on several occasions and give themselves the lethal dose.
1. End-of-life care decisions
The concept of passive euthanasia or pulling the plug or involuntary euthanasia means to turn off life support for a person who is in a persistent vegetative state or has a terminal illness. A person might have expressed in the past that they don't want to be kept alive by artificial means, or their health may be so bad that they can't make that choice. The decision should be made based on the person's wishes and religious values while respecting their dignity.
To solve this dilemma, many countries have made the provision of legal documentation possible. It is a complex ethical issue that raises many questions about the right to life, autonomy, and responsibilities of healthcare providers. In these situations, the decision to stop life support is usually made by close family members or a legal guardian, with help from medical professionals and ethicists.
However, in India, Advance Directives like Do Not Resuscitate (DNR) and Limited Aggressive Treatment Options (LATO) are not legal or offered as an option. Palliative care has recently gained some interest, yet a consultation service of this kind is rarely heard of.
A casual visit to emergency rooms in low-resource settings, despite the high death rate, will reveal the horrifying reality of dying there. Not only can the experience be traumatic for the family, but it can also be traumatic for the doctors and everyone else present. The counterargument may be a lack of time and resources in a typical emergency room, but an open dialogue about such issues may actually mitigate psychological trauma and even have some impact on incidents of violence against doctors.
Mortality is not a surprise, irrespective of the discomfort, only a discussion can help us navigate crucial situations ethically.
