Medical Ethics

SOCIAL ASPECTS OF MEDICAL fast cash loan australia ETHICS


It is Rousseau- the French philosopher who said, “It would take gods to give men laws”. He recognized the need to transcend the human level in establishing norms for behaviour and man’s inability to do so. Whereas a law dernands obedience, an ethic compels conformity. Ethics need to come from within. It is appropriate that Prof. Carlo Fonseka has with commendable foresight thought of inculcating an ethical ingredient in the new Medical entrant at the outset of his or her career.

It is an open secret that a patient in Sri Lanka can no longer go to the average doctor completely trusting him. The patient no longer accepts that all what the doctor does is for his or her best. If this kind of seminar helps to dispel that ugly blotch that has come on our noble profession and by ethical instruction restore the fiduciary relationship (faith and trust relationship) between patient and doctor, it would be a great service to the profession and our nation.

Let me commence with a general approach to a work ethic. In work we serve others. I for one believe that all men are created equal by a Benevolent Creator. This means in work we serve others. Work is an institution designed to bring the best of altruism (sacrifice and service to others) in man. While we should and could advance materially and socially, because of our chosen field, that however ought not to be the primary goal of work. Especially the work of a professional cannot be for profit nor is it a business. Webster’s dictionary defines a professional as one who does not engage in trade. If our countrymen have come to think of the medical profession as a lucrative trade, it indeed is a tragedy.

In work we ought to serve others. This should be the chief end of our work as doctors. “The joy of

comforting always., relieving often and curing whenever possible” is our noble and rewarding task.

There are three areas of medical ethics-namely:

(a). Doctor-patient ethics.

(b). Doctor-doctor ethics.

(c). Doctor and society ethics.

I would like to focus on a few common areas of present concern and some other areas of remote concern.


The medical student embarking on his\her career should not consider the 4 1/2 years in the medical faculty as the doorway to a lucrative business -a business more reliable and predictable than gemming. (after all gems are not found everyday but patients are). The financial difficulties that a medical student may encounter should not drive him in later life to mercenary (money making) attitudes. On the other hand those who have come from affluent backgrounds could want to preserve and even improve on what they already have and attempt to do so within a short space of time since passing out. Those of us who have felt the pangs of poverty should be the very ones who should be in the forefront of a movement amongst doctors for a more socially concerned orientation towards our patients. This is an important ethical consideration that we ought to bring to bear on our practice. If a poor patient who can ill-afford the money, is compelled to offer the D.M.O. his private practice fee (P.P.fee!) because he will be better treated, then we are indeed economic oppressors who use our priviledged profession-for which the country has paid-to fleece the sufferer. Even in consultation practice one needs to ask the question, “must I charge every patient I see? Is there anyway to ease the burden on the poorer patient?

A new generation of doctors needs to work together at all levels to prevent the financial drain on poorer patients in doing medical pilgrimages to the provincial capital-be it Colombo, Kandy, Galle or wherever.

1. Our peripheral units and district hospitals. should have caring, capable and confidence-building doctors. Drugs in the DH should not get into the DMO’s private dispensary. There is today a total breakdown of the once efficient CD; PU, DH system.

2. MOH should be active and conscientious in his\her M.C,H. (maternity and child health) and other preventive aspects of medicine. Often MOOH are occupied in private practice and have no time or concern for the improvement of primary health care. Each MOH and his team ought to be conversant with the preventable health problems of the area. In a village where we once had a free clinic the majority of the population was going blind with vit.A deficiency. We were able to. give them a month’s quota of vit.A (cost Rs. 3.60 per person). When we visited this community they were amazed no end that they were seeing better.

3. Such mobile clinics should be arranged into the many inaccessible areas of the area by the DMO and the MOH. This could be done even weekly if one is motivated. Undetected medical problems can be detected and referred to thee nearest General or Base Hospital . Vitamin or mineral deficiencies can be corrected. Since our country has given us a free education right upto the MBBS degree, we owe our people this much of altruism. The AMO, DMO and the MOH can become a source of comfort to the people of the area. A grateflil people will remember. you as their benefactor.

4. In arranging such clinics in your area you could .liaison with in any NGOO who will step in with other welfare schemes. What. the NGOO often lack is someone motivated and knowledgeable. It is unfortunate that knowledgeable people are often unmotivated and vice versa. Even free drugs are available through need 5000 loan NGOO, if one can honourably use the same for free clinics and not for PP! Many are the occasions when hospital drugs find their way into the DMO’s private dispensary and even into the PP of the Apothecary and the Attendant!! The old Sinhala adage- “when the teacher performs a certain function standing, will not the pupils do the same running” is so true.

5. Our infant mortality rate is rising and the birth weight is dropping, indicating a downward trend in our health services.

The Quality of Life Index of Sri Lanka which was the highest for countries with a low GNP in the seventy’s, (Prof. Carlo Fonseka; Towards a Peaceftil Sri Lanka;WIDER Research) may not long remain that impressive. While we spent 0.7% for defence and 5% of GNP for welfare in 1978, in 1988 we spent 5% GNP for defence and 0.7% GNP for welfare (Prof. Carlo Fonseka,. ibid.). The doctor closest to the grass-root level ought to be concerned about this decline.

6. The municipality Medical Officers of the large cities see the worst effects of poverty on health-especially maternal and child health. A caring MO in the municipality can do much for the teeming multitudes that come to her.

7. The GP, DMO, AMO can do much to offset the adverse effects poverty has on health. Vit.A and iron deficiency which contributes significantly to maternal and infant morbidity and mortality are easily corrected. Vitamin and iron supplements should be routinely prescribed. There are recent reports of decreased child and infant morbidity and mortality with vit.A supplementation. (BMJ vol.304: 25, Jan1992-207). Will it not weigh on our hearts that we as medical officers stand between poverty and death of our poorer patients? Should it not be a paramount ethical concern that we should do all in our power to prevent our patient’s poverty resulting in increased morbidity and mortality when the cause is preventable or correctable?

Can we merely blame lack of government resources? A tablet of iron costs 5-10 cents; vit.A and D

tab. costs 15-20 cents. Would a GP or DMO become poorer if they give a packet of 10 tabs. free to the mother who comes to them.

8. The consultants ought to discourage their patients coming from far away places when they can ill -afford such expenses. Name-building and “channel Antics” leave patients poorer. Every ethically concerned Consultant attached to Base and General Hospitals should assure the poorer patients who come to them for channelled consultations, that the same care and treatment will be accorded them if they follow the government clinic of the same Consultant.. He should ensure that the follow up clinic cares for the patients and that the routine referrals from GPP., AMOO, DM00 should be honoured at the Clinic without pecuniary benefit. This was standard practice 15 years ago.

9. Reduce the number of visits a patient has to make to you to the barest minimum. A bread-winner of a family (an accountant) went to four different specialists once in two weeks for three years, each time paying the fee. The disease was incurable and the drugs which could have been prescribed at a govt. clinic did not control the symptoms. Over the three years the patient was not given a diagnosis card, nor referred to a govt. clinic though all the four specialists were attached to govt. hospitals. The patient cannot work and his wife supports the family working as a stenographer Until I discontinued the habit they were paying the fortnightly fee. Incredible?

10. Prescribe the least number of drugs at the cheapest price. Iron is available at 10 cents per tab. and at Rs. 4 a cap. prescribe thee least costly, appropriate antibiotic, at the minimum needed dosage, for the period required. Do not get taken in by the attractively designed documents with impressive clinical trials. Please remember that the Companies paid for the clinical. trial with all the fringe benefits available to the researchers who fiddle the trial to achieve the desired end. Know your Pharmacology better than the drug rep.

11. Ask only for the most essential investigations. Simple viral or bacterial bronchitis needs no investigation. In fact viral bronchitis should not be treated with antibiotics. Kotthamalli is adequate! WBC/DC or ESR will cost a patient Rs. 20 or more. Dysuria and fever can be treated without a urine FR; go for a culture and ABS if your first line treatment with a cheap antibiotic, such as Nitrofurantoin fails. Accusations are afloat that doctors have shares in firms that offer investigations. The temptation is very real for the GP or DM0 who has his own lab. The patient should. not be treated as a goose that lays the golden egg.

12. There is a tendency to recommend admission to private hospitals because the doctor can earn more from the hospital visit or the operation. The patient is often made to feel that he may not get the best unless he is admitted to a private hospital. In an emergency govt. hospitals still offer the best care.

13. The patient needs to come to a doctor for the least number of visits. The old family doctor of would not charge a patient for the second visit for the same ailment.

14. Preferential treatment to channelled patients, quicker operations for them. Seeing only the channelled patients, are accusations often levelled at the profession.

15. Many interns are tempted to do “locum”. This is illegal.

16. Money for beds, quick operations, for bottle of saline, for false medical certificates are among other modes of illegal solicitation (bribery).

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