Medical Ethics

MEDICAL ETHICS

(Invited lecture at Yenepoya Medical college-Kodial Bail,Mangalore)

Dr Suvarna Nalapat
(Retd Professor &HOD Pathology Amritha Institute of medical sciences )

Format of the lecture/paper
.
1.Introducing the subject.
2. Gestalt.
3.How to decrease frustration?
4.Satisfaction in life
5.How do you work and learn?
6.conclusion /gurukulam as I envisage.

In 1925, “Young India “, a patriotic magazine of MahatmaGandhi mentioned seven social sins.These were
1.politics without principles
2.wealth without work
3.pleasure without conscience
4.knowledge without character
5.commerce without morality
6.science without humanity
7.worship without renunciation.of Ego.

We are witnessing all these social sins today.I restrict my views to general ethics for humanity with a capital E for medical ethics,as far as we doctors are concerned.Science without humanity is the social sin that we as doctors should try to eliminate first,from our professional sphere of activity.How can we do this?
1.we need examples/models among us for the younger generations to emulate.A Guru who is a rolemodel,and a professional Gurukula where students feel at ease to follow the profession ethically and efficiently.
2.we need a curriculum of medical ethics incorporated into all university programmes of medical education,and this should be a part of an institute of Human values in Healthcare.
Ethics is the energy behind all good actions.Is there a formula like E=MC2 ,for every doctor to follow regarding his professional ethical excellance?
E=e3-F would be an alternative .(E for efficiency ,three “e”s for enthusiasm,expertise and experience .and f for frustration) When there are frustrations in the environment(society)we live ,our enthusiasm is taken away from us and whatever is our expertise and experience in profession ,we cannot achieve 100%efficiency(E)..
Can we ever get out of the frustarating malpractices of our profession?Can our profession become beneficial to society by enforcing a medical ethics which can be of use to everyone in the society?
Gestalt
Based on Gestalt psychological studies I give an emphatic answer YES .Gestalt is a set of patterns.A dynamic system within a dynamic system acting upon each other.We learn from the world around.Thus we change our views and attitudes to life,we educate ourselves,and by our learning,wisdom and experience we can change the world around from which we have learnt.
As shown below in figure ,our environment gives us values,its good and bad aspects which we imbibe .Individual ,in turn,can contribute to the sociopolitical ,economical,spiritual,and cultural environment by actions,thoughts,speeches.(karma,manas,vaacha)Prophets and great personalities were doing this.Every individual has the potential to do this.If such a personality is amongst us,he/she is an asset to us,to the world,nation,state,to institutions,and to homes where they live and work.
FIG 1.gestalt.
E-economic environment
P-political
c-cultural
S-social


social contagion theory of Alport is worth mentioning in this context.A person with a strong ethical background is the real cream of society,not the one who has got into a particular profession.Such creams of society should be there in the healing art.
Medicine is not a mere science as the medical professionals(many of them!!!!)think,it is a science and art combined.It heals the wounds of the body and mind and the wounds inflicted by the environment on the human organism as a whole.It is a profession concerned with healing of body,mind,intellect and the soul.A purifying act .A noble profession ,indeed!!
Therefore ,the dire need to recognize our role in society .
Everyone knows that ethics should be part and parcel of human life to have a good social life.But many do not know how to apply that to daytoday life,especially in a corporate ,competitive world,where the morally strong and disciplined people are sidelined and marginalized by the clever and the immoral.It is here that we should understand the golden formula ,I mentioned earlier.E=e 3 –f.
How to decrease frustration?
1.By concentrating on your professional excellance,improving the quality of work done in profession.
2.By concentrating on a universal language through which you can communicate to all-(Music.) as a healing art.
3.By understanding and practicing the golden rule of all ethics(including medical ethics)is that nature and human life is a divine blessing –a sacred precious opportunity to love and serve others and thus to participate in a divine plan.
4.Reduce the desires which is the rootcause of all malpractices.

Remembering that all of us are children of God,will alter our relationships and make our works better,and we feel that we are serving the divine sparks of nature by our karma/profession.By this feeling we ourselves are manifesting our divine nature.
Naturally it follows that a doctor practicing profession with a feeling that all are children of God cannot discriminate them on the basis of caste,creed,sex,or social status.They are needy,approaching to be served ,and he/she the healer of pains,(bodily,mentally or intellectually.)They are the less fortunate children,and she/he the more fortunate one to have had a chance to serve them.The daasa or daasi of God,who heal the children of God.
The daasa in Arabic is translated as the Abdul of God,who heal with love,compassion,(medical) knowledge.In Budhist and Hindu traditions the mahaabhishak (great doctor)with a bhinnachakshu(different view).Through the spirit of service and love we keep alive the spirit of God .We eliminate hatred,jealousy,quarrels,classwars and religious persecutions,(the opposing qualities which spring from our ego,known as Kaama in Budhist and Indian traditions ,satan in semitic traditions) from society.Thus reduce the pains of society.By removing the opposing or negative qualities in oneself,we can eliminate them from society.
Our selfishness makes us think that we need everything best.We want every luxury.And every profession has become just a means to get them.When we don’t get what we need ,we become disturbed,angry,jealous,frustrated.When we get it,we become vain,selfglorious,proud snobs.Acquisition of wealth is not a sin if done with fair means.It improves the economy of our society.We have to curb only malpractice,not practice of profession.
Satisfaction in life
We should feel happy for what we are.We are doctors ,well educated,fortunate to have the opportunity of the noble profession of Healing art.We know that all the differences in status –castes,religions,creeds and language differences –are human constructs.Look beyond the human constructs of differences ,to see the eternal truth.The cell functions in the same way in all humans,the biological,morphological ,physiological,pathological phenomena follow the same rules in all humans.Is there difference in a squamous carcinoma cell of a Hindu ,Muslim,or Christian?All look alike under microscope.
A teacher has a divine wick in his/her student to be kindled .Kindle it with knowledge,enthusiasm,and goodness.The pay and the economic benefits will naturally come when you practice the profession.
How do you work and learn?There are four different ways depending upon individuals.
1.with sradha (concentration)doing work and learning profession
2.Practicing profession without knowledge or sradha.
3.without knowledge but with sradha
4.without sradha but with knowledge.It goes without saying that the first is the best way.A doctor having this method,having compassion to all living things,is the Mahabhishak(the great doctor)in Indian tradition,both Budhist and Hindu.

To restore values to the society we have to keep values ourselves.We find unhealthy competition everywhere.Observe the world around and find out the fields where there is erosion of values.You will be surprised.It applies to our medical field too.But don’t get frustrated over the scenario.Don’t get entangled in the grievous practices and keep away from them .Cultivate efficiency ,gain experience and expertise and keep up the enthusiasm throughout your life.Create an atmosphere of positive values around you.Initially people will laugh at you for being impractical in a competitive moneyoriented world.But ,later on your life and ideals will be appreciated .You will get the satisfaction of having infused values into a society where you lived and learnt,by words,deeds and thoughts.Build up a new world around you ,healthy ,in every aspect,without separatisms ,or negative thoughts,with love and harmony and universal brotherhood.Health is not mere physical health,it is mental ,intellectual and spiritual health,.Be steadfast in your decision to achieve this golden state of health for all .
There is no shortcuts to medical ethics.Practice ethics rigourously throughout life and you wil l reach a stage when your example will spread light into the lives and minds of many.
Music ,the universal language of peace on earth.
Music is a universal language,enjoyed by all ,including birds,animals and plants.The cosmic music of the spheres and stars is in each and every one of us.Reducing stress inflicted by the worldly life of day to day existence through harmonious music is an ageold custom and practice of human race.The use of raagaa as therapy is a key to achieve the universal brotherhood,love and international harmony and peace,at the same time giving physical ,mental,intellectual,and spiritual health to all of us.
The efficiency of human beings is increased by soft melodious divine music which brings down frustrations,increase power of concentration and cognition and memory and thereby our performance in the worldstage.

CONCLUSION
GURUKULAM AS I ENVISAGE
To become an educationist and to plan for the coming generations of people a way of life and education is no easy task to be done by people who never have thought about the problems of the society and of education and its goals.For this activity one may have to learn many arts and sciences ,should have a loving mind and a sharp extraordinarily receptive intellect and a love for nature and nurture.And one should have lead a life of purity as a model for the students to emulate.But ,these things are of the past,and not practical, ,some people argue.And others think that a gurukula is the function of celibate nuns and sphincters or of swamins and sanyasins.Both hese arguments are false and dangerous to society.If parents and householders do not set examples for children ,who else can set example?If ethics is impractical,we have to question the people who say so.And decide whether they are fit to be in the posts they hold to lead children and the nation.
In ancient India every gurukula had a guru and a gurupathni,and both lead an exemplary life of studies and austerities and a fruitful and honest domestic life so that the students learnt the ways of a good householder along with scriptures and sciences and professional skills...A Gurukula style of education which I envisage for the 21st century teachers and students is not one run by sanyasins and celibates but by human beings living a householder’s life ,fulfilling all duties of the householder and achieving excellance in learning,and in duties at the same time free from desires for money,power and professional rivalries. .A place where the good citizens of the world and of the nation are created ,useful to society ,nation and world and above all to themselves ,to their family and to the institutions they work for.
Bharath is the cradle of civilizations and in this ancient land of rishis Guru is equivalent to God.Guru and shishya makes a meaningful whole in generating vidya and upholding the traditions.Before they start a learning process they chant together.
Sahanou yasa:sahanou Brahmavarchasam(let us aquire fame and divine energy together).In the generation of Guruparampara for creation of knowledge ,Guru is the poorvaroopa,shishya is the uthararoopa and their sandhi is vidya and their offspring is prediction (pravachana).Medicine being a predictive science the teachers and students have to chant together “let me be filled with intellect(medha)and by that nectar of intelligence let us develop dhaarana(understanding).My body and mind are healthy.My words are sweet as honey.Let all the ears hear that sweet voice of love.God is hidden in the cells of my medha .Let my knowledge be preserved for posterity and propagated by the coming generations (of shishyaas).”

Then the Guru continues to pray alone:”Let there be more and more students in my care.Let them come even from distant places .Let them be happy ,intelligent,disciplined and thirsty of knowledge.”
Whenever an educational institution is trying to draw more students to it,apart from the curriculum and the syllabus,a feeling of oneness between the teachers and students and a bond of love between them is essential.The student ,after leaving the institution nostalgically remembers the people who have given them love and a feeling of security.A good educational institution should be a home away from home,and good teachers should be giving parental(motherly/fatherly)affection ,love and care and advice (councelling)and should not be policemen and women making life difficult for them.Children are always good.The only thing that they need is proper love and care,not to turn to bad things and company.They are not criminals who needs constant vigil from the teachers.
We have to revive the old gurukula system of India where the guru is a father/mother figure and the student is the son/daughter and in such a situation only one can give security and a feeling of belonging to the students and by sharing their happiness and sorrows the teacher becomes part of his/her training programme and of life.
Only by creating such an atmosphere in the campus (and in the houses and nation and the world )we can make it a happy place to live in and study and work.The happiness(aananda)or bliss is always associated with sath,chith (truth and energy of intelligence).Happy environment is the best for intellectual and physical work.Each and every faculty member should be able to understand this and create such an atmosphere in the college campus and each and every student should be able to respond to it by their natural instinct.For this the gurukula should have good and happy teachers,intelligent and free individuals leading a dutiful and pure domestic life.(This is applicable to homes as well)

India is a country rich in culture and its traditional ways of healthcare including ayurveda,yoga and Raagachikitsa.These are the ways of life to promote health and are preventive measures as well as curative.The villages in India at present lack proper healthcare and this is mainly due to lack of willing doctors to work in the villages,due to lack of proper watersupply ,lack of nutritious food and the environmental pollution and lack of awareness.The economically backward rural population do not get access to proper prevention ,therapy and information about diseases and healthrelated topics.The changing economic sociopolitical and civil structures and use of new drugs ,insecticides,pesticides and other chemicals also have contributed to spread of various types of diseases in rural population ,in tropical underdeveloped and developing countries.A better identification of such problems at a regional level and providing solutions to the problems for future needs is essential.
Let us become physically,mentally,intellectually and spiritually healthy world citizens and make a new nation and a new world of love and peace for the coming generations . .The gestalt field theory of educational psychology is defining human beings as dynamic systems within dynamic systems growing by the environment in the field in which they live,and stimulating the growth and development of the field they live in.Let us not be mere products of the environment we live in ,but also the creators of a healthy environment for the coming generations to live in and enjoy a fruitful life..