The whole episode of Ebola outbreak in East African countries brought the issue of medical ethics in a public health emergency to forefront of public discourse. Lack of availability of treatment and high mortality associated with disease led to initial panic, but subsequently matured response emerged from different stakeholders. Some of ethical issues associated with “ethics in public health emergency” in this context are:
- Who should get the first treatment? Whether the health care worker be first treated or people suffering in field be treated?
- Where the new medicine should be tested – whether it should be tested in developed world or in virus host countries of East Africa?
- Is it justified to give a medicine which has not yet passed the clinical trial and has not proved its therapeutic efficacy, possible also having side effects?
- Can large scale vaccination and production of medicine be allowed for treatment which has not proven its effectiveness and safety?
- Should fast-track trial be allowed considering the urgency of matter? If yes, can this act as precedent for future situations?
Overall the medical fraternity, WHO and other stakeholders acted very responsibly. They allowed fast-track approval process while simultaneously collecting data for further validation. The informed consent of people, to whom medicine was administered, was obtained and issue of racial & class division was also tackled in sensitive manner.
What do you understand by “mitochondrial replacement‟ or “three parent baby‟? Critically comment on various ethical concerns raised on this technique in the West. (200 Words)
Mitochondria, the powerhouse of the cell, has its own set of generic material called mitochondrial DNA or mtDNA. It is inherited maternally. Various mitochondrial disorders exist due to mutations in these DNA and result in visual losses, diabetes, hearing impairment, stunted growth etc. and finally pre-mature death.
Mitochondrial replacement technique is used to avoid defective mtDNA from passing down to the next generation. Here the nuclear DNA of patient mother issued to replace that in the donor mother’s eggs and the latter already had healthy mitochondria. Then In-Vitro Fertilization is done with partner’s sperm. Thus, the baby is effectively 3-parent and has healthy mitochondria. Only UK has legalised thus practice.
Various ethical issues have been raised in this technique:
- Church has opposed this move saying it would lead to Frankenstein babies who will not recognise their parents and alter human race. This may be the first step towards a market of designer babies.
- Opponents believe this method would cause a loss of sense of identity and cause emotional and psychological suffering to the child.
- Opponents say that this technique to tantamount to playing with God and will alter the human germline. These modifications will be passed to subsequent generations.
- The efficacy and safety of this technique is yet to be demonstrated.
- Some argue that it is better to have pre-natal diagnosis and if fetus is found defective, terminate pregnancy.
- Certain organizations believe that this technique will deter parents from going for adoption. No population control incentive exists in this technique.
- Opponents also argue that a child has right to fully inherit all genetic material from parents with all its deficiencies as well.
- Research on In Vitro Embryos is a controversial issue as well.
So there are a lot of issues to be sorted out before commercialization starts. Mostly, this technique is still not fully safe. But if proved to be safe, it represents a way for defective mitochondrial mothers to have a healthy baby.
Some see that the growing commercialisation of medical care, ranging from general practitioners to super specialists, in corporate hospitals is unethical. Do you think treating patient with profit motive is unethical? Critically comment why. (150 Words)
Physician (Doctor) is considered noble profession in India. In Vedas, Doctor is described as Narayan Vaidya means a form of God to remove ailments from patient. But, with rising commercialisation and spreading consumerism has led to many unethical practices conducted by doctors.
Earning more in right way is not wrong and unethical, If a world class hospital is providing facilities to patients then it‘s always correct to charge high, but falsification of reports, prescribing costlier medicines and unnecessary surgery is unethical on various grounds.
As education in medicine in India is a costlier affair because of shortage of seats and colleges. In economic term of ―return on investment, if doctor is charging high cost for treatment, it is not unethical. But disguising the real issue and exaggerating the ailment to scare patient is unethical. Patient trust on doctor is important, but that trust is breached. It should be left to patient to choose if they want to undergo surgery rather than pressing him for future issue. Hence, it is unethical.