Indian Journal of Medical Ethics

In low- and middle-income countries, caring for the elderly is a responsibility that is undertaken within households with minimal institutional support from the community or structural support from the state [1,2]. Usually, this responsibility is shared within the home, with the physical and emotional work of caring falling to the one who does not have too many extra-residential responsibilities. The gendered nature of caring responsibility is such that, usually it is women who are not in the formal or informal labour markets who share the responsibility [2,3]...

The present commentary reviews the goals and differing positions on the Movement for Global Mental Health (GMH), with a distinct emphasis on the cultural differences in the understanding of the aetiology of mental health issues. The proponents and advocates of GMH support its intentions and primary agenda of scaling up mental health services, especially in low-income and middle-income countries where the prevalence of mental health disorders is continually rising. However, many cultural psychologists and sociologists critique the movement for universalising psychiatric symptoms, as this universalisation could actually suppress local voices and might also undermine the significance of culture and political and psychosocial predictors which may contribute to mental health challenges...

Since the Delhi High Court judgement (2009), reading down IPC 377 that criminalised homosexuality, the Indian judiciary has been at the forefront of invoking constitutional morality to uphold LGBTQIA+ rights. In contrast, the mainstream mental health systems have failed to uphold human rights and protect LGBTQIA+ people ethically, except for a few position statements. Though the Supreme Court directed the mental health fraternity to exercise utmost sensitivity to LGBTQIA+ issues, they have not risen to the occasion...

An outbreak of the Covid-19 has led to substantial mortality globally. The entire world is carrying out studies to understand the pathophysiology, clinical features, diagnosis and treatment of Covid-19. We investigated the possible association of type of funding, corporate or academic, and conflict of interests on the outcomes reported in clinical trials on Covid-19.<br> Methods: Studies containing the keywords "clinical trial" AND "Covid 19" or "Corona" were located by a search on PubMed published between September 2019 to August 2021...

<p>Background: Medical ethics teaching has received little attention in India's undergraduate medical curriculum, so the National Medical Commission's formal inclusion of medical ethics in the new competency-based curriculum (CBME) is creditable. However, the policymakers have left out the most crucial stakeholders - the teachers. This study was conducted to find out how physiology educators in Delhi felt about the implementation of ethics teaching in physiology in the CBME.</p> <p>Methods: This was a pilot, cross-sectional, observational, feasibility study conducted using a questionnaire, involving faculty and senior residents (post-MD) in the departments of Physiology at nine medical colleges in Delhi, conducted over the period from February to October 2020...

BACKGROUND: There has been a gradual increase in disputes between doctors and patients in the healthcare system over the years. The aim of this review was to determine the speciality-wise prevalence of medical negligence in cases decided by the National Consumer Disputes Redressal Commission (NCDRC) and the factors responsible for it. METHODS: A total of 253 cases of medical negligence decided by the NCDRC from 2015 to 2019 were reviewed and categorised with respect to the number of cases compensated, the speciality involved, the compensation payout for the specialities involved, and the nature of the error leading to negligence...

There are gross inequities in access to non-communicable disease (NCD) care in India. The Indian state of Tamil Nadu recently launched the "Medicine at people's doorstep" (Makkalai Thedi Maruthuvam - MTM) scheme in which screening and medications for NCDs are delivered at people's doorsteps. This is likely to improve geographical access to NCD services in the community. The objective of this study is to analyse the MTM scheme and recommend policy interventions for improved and equitable access to NCD services in the community...

I read the editorial "Ethics regulation by National Medical Commission: No reason for hope" by Amar Jesani with keen interest [1]. The article raises many pertinent issues which need urgent policy attention. Institutions and governance for regulating medical education and practice in India carry a significant colonial legacy of British rule [2]. No major reform was carried out to change the status till 2019. The recent reform in apex medical regulatory institutions, replacing the erstwhile Medical Council of India (MCI) with National Medical Commission (NMC), was a result of long-term demand...

From the British era, regular medico-legal autopsies have never been done in India after sunset, except for those specially permitted by the law enforcement agencies. The Ministry of Health and Family Welfare, Government of India, issued a notification on November 15, 2021, regarding the "Conduct of post-mortem in hospitals after sunset". This has given rise to much debate on whether post-mortems can be conducted after sunset in an ethical manner. Here, we briefly discuss the various issues related to the carrying out of post-mortems after sunset in India...

When a patient loses decisional capacity, the responsibility to make treatment decisions often falls on a family member who becomes the surrogate decision-maker. This case study provides an example of a situation where the medical team and the surrogate decision-maker initially disagreed on the best course of action for the patient. The ethicist was called in to lead a guided conversation to help the team and the surrogate decision-maker reach a consensus. This case illustrates the importance of allowing the surrogate decision-maker to ask clarifying questions and process their emotions before making a decision...

The government healthcare system unintentionally excludes the destitute in several ways. In this article, a "slum's-eye" perspective on the public healthcare system is offered through reflections on stories of tuberculosis patients in urban poor neighbourhoods. We hope these stories contribute to discourse on how to strengthen the public healthcare system and make it more accessible for all, especially the poor.

The provision of government-funded public health services in India is grossly inadequate and 48.2% of "total health expenditure" for India is paid "out of pocket" [1]. When the total health expenditure in a household exceeds 10% of the annual income, it is considered catastrophic health expenditure (CHE) [2].

Kishor Patwardhan's 'confession' in this journal [1] has initiated the expected debate, which I hope leads to some good developments for the teaching and practice of Ayurveda. Before, commenting on this issue, I should myself confess that I am neither formally trained in Ayurveda nor practising it. A basic research interest in Ayurvedic biology [2] led me to learn about the "fundamental principles" of Ayurveda and to experimentally examine effects of some Ayurvedic formulations using animal models like Drosophila and mouse at organismic, cellular, and molecular levels...

Emergency care is largely seen as synonymous with resuscitation and saving lives. In most of the developing world where Emergency Medicine (EM) is still evolving, the concept of EM palliative care is alien. Provision of palliative care in such settings poses its own challenges in terms of knowledge gaps, socio-cultural barriers, dismal doctor-to-patient ratio with limited time for communication with patients, and lack of established pathways to provide EM palliative care. Integrating the concept of palliative medicine is crucial for expanding the dimension of holistic, value-based, quality emergency care...

Ayurveda is based largely upon two classics - Charaka-Samhita, representing the school of medicine, and Sushruta-Samhita representing that of surgery. These two texts mark the historic switch in the Indian medical tradition, from faith-based therapeutics to its reason-based variant [1]. The Charaka-Samhita, which acquired its present form in circa 1st century CE, uses two remarkable terms to designate the distinctness of these approaches: daiva-vyapashraya (literally, dependence on the unobservable) and yukti-vyapashraya (dependence on reason) [2]...

BACKGROUND: The sensitivity and skill of care providers, especially physicians, while communicating bad news to patients can improve patients' acceptance of treatment and their emotional adjustment. We aimed to determine how to break bad news to cancer patients and consider their preferences in this regard. METHODS: This is a cross-sectional study in which 249 patients participated. The Poisson sampling method was used. Data were collected using the Measure of Patient Preferences (MPP) and patient demographic profile forms...

This is in response to Dr. Harish Gupta's letter [1] commenting on my editorial titled "Police investigation and unethical 'scientific interrogation'" [2] in the January-March 2023 issue of the Indian Journal of Medical Ethics. I had written in light of the resurgence in the use of narcoanalysis (truth serums) ─ especially in the Shraddha Walkar murder case, against the accused, Aaftab [2]. I appreciate the author's engagement with the editorial and his acknowledgement of the challenges within the Indian criminal justice system, including the large numbers of undertrials jailed for years together, and the many documented instances of police torture during investigation that go unpunished...

In the twenty-first century, there is still a taboo on frank discussion of menstruation in Indian society, particularly with men. This inadvertently widens the gender/equity gap in families and in society. Even men in the healthcare sector are uncomfortable talking about this because the societal norms often overpower professional knowledge. Indian society needs to move forward and normalise menstruation in the perceptions of boys and men in all settings. We highlight below some salient points on the orientation of men regarding menstruation...

Researchers often neglect adolescents' willingness to participate in research. The granting of permission by parents is sometimes not in accordance with the unwillingness of adolescents. Relational ethics is the right approach to overcome inconsistencies between legal and ethical agreements in granting parental permission and adolescent's assent. This is because relational ethics is based on building relationships among many parties. The focus of this case study is to improve understanding of the assent of adolescents through intensive study of research conflict, reinforced using existing research and to understand how relational ethics can be used as an approach in decision-making, especially in conflicts between parental permission and assent from adolescents...

In January, 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90 seconds before midnight, reflecting the growing risk of nuclear war [1]. In August, 2022, the UN Secretary-General António Guterres warned that the world is now in "a time of nuclear danger not seen since the height of the Cold War" [2]. The danger has been underlined by growing tensions between many nuclear armed states [1,3]. As editors of health and medical journals worldwide, we call on health professionals to alert the public and our leaders to this major danger to public health and the essential life support systems of the planet - and urge action to prevent it...