MEDICAL ETHICS AND INTERNATIONAL INSTRUMENTS: IMPLEMENTATION IN INDIA
INTRODUCTION
Ethics is about building or learning such rules and regulations by which people are compelled to live. Ethics tries to bind society through uniform opinions and considerations that help society judge what is correct and what is incorrect. Ethics are dynamic; what was considered ethics 100 years ago may not be considered ethics anymore. Ethics are involved in each and every profession; likewise, there are also medical ethics. Medical ethics plays an important role, as does the healthcare system. The Healthcare system should be updated and upgraded in every country; only then would it be possible for doctors to provide better facilities and services. There is a need in India for the implementation of international instruments in the healthcare system. The Healthcare system should have modern technologies.
MEDICAL ETHICS
Medical ethics are the rules and regulations by which doctors must conduct themselves. Everyone has to follow certain ethics, so the doctor has to. Doctors also need to follow some ethics, i.e., medical ethics. Ethics can’t be separated from any of the professions.
The four principles of Medical ethics are Beneficence, non-maleficence, Autonomy, and Justice.
The principle of beneficence states that it is the moral duty or obligation of the practitioner to act for the benefit of the patient. This basically implies that it is the moral duty of the practitioner to promote those courses of action that are in the best interest of their patients. Generally, it means practitioners must do good for their patients. For instance, a ten-year-old boy has been admitted to the hospital because of a fracture in his left leg, and due to the fracture, there is massive bleeding and the risk of infection. There are two options available for the practitioner to treat the patient: amputation, and using blood products to manage the bleeding, and orthopedic surgery. Using blood products to manage the bleeding and the orthopedic option would be the best option and the best course of action, rather than amputation. According to patients, The practitioner should consider every option and contemplate the best course of action for the particular patient. The practitioner should also focus on the course of action that should match up with the patient’s expectations.
Nonmaleficence means that it is the duty of the practitioner to do no harm to the patient. The Practitioner should not cause any harm to the patient due to neglect. There is a difference between Beneficence and non-maleficence. In nonmaleficence, if the treatment causes more harm than good, it may not be considered. In beneficence, all the treatment options are considered, and then they are ranked according to preference.
Autonomy is the other principle of medical ethics; it basically means the deciding power for the treatment is with the patient itself. Simply put, it means the practitioner cannot impose any treatment on the patient. The exception is there, like when the patient isn’t able to make any autonomous decisions. The patient should be actively involved in their treatment. For instance, a patient of twenty-six years of adulthood suffered a high-speed collision thanks to which he got an injury on his head. There was continuous bleeding from his head, but he didn’t lose consciousness. The patient refuses the treatment and makes the decision to depart the department. So in this case, the doctor can’t force the patient to undergo the surgery as he is an adult with learning ability; his autonomy must be respected, and he cannot prevent him from leaving the hospital. If the patient doesn’t give consent to the hospital authorities for action, then the practitioner cannot intervene, even if it results in the demise of the patient.
Justice is the fourth principle of medical ethics. Before taking any course of action, it must first be checked to see whether it’s ethical or not. We also have to look at its compatibility with the law. It must make sure that nobody is ignored for the advantage of accessing healthcare.
There is another medical ethics concept :
- Consequentialism
- Utilitarianism
- Deontology
INDIA: MEDICAL ETHICS
India lacks a worldwide healthcare system that’s essentially accepted by most countries. Countries like France, Italy, and the US are moving at a high pace within the healthcare system. France is one of those countries that has a good and efficient healthcare system. It’s ranked highest within the world healthcare system because of the great technologies adopted by France in the direction of the healthcare system. France has adopted technologies like ATIH, DMP, etc., and thanks to these technologies, France has been ready to achieve a fruitful end within the healthcare system. ATIH means technical agencies for information on hospitalization; its basic functions and responsibilities are to take care of the knowledge records of varied hospitals technically so proper coordination of the hospital could happen. It aims to replace the ineffective manual processing of data with better communication at a definite level, including among regional healthcare agencies. It helps in matching up the demands of the patient through timely diagnosis. The healthcare system of France is combined with IT through the utilization of smart health cards, first utilized in 1998, which simplify and speed up the medical reach of the people. The cardboard includes a digital special biometric photograph so that fraud may possibly be controlled. It also contains patient healthcare records, which help to establish the history of the patient’s health. DMP stands for Dossier Médical Personnel (DMP), or ‘personal medical file’, which has tried to form an electronic anamnesis for all French residents covered by insurance. Because of these techniques, the quality of healthcare facilities and timely access to medical procedures are improved. The French healthcare system has adopted a singular healthcare facility, i.e., a bottom-up approach. This approach also covers the regional area, which helps to strengthen and widen the E-health infrastructure. India lacks such techniques as ATIH, DMP, etc. India faces the challenge of information hesitancy, and this may be seen through this pandemic. During this pandemic, one of the foremost issues that India is currently facing is inaccurate and inadequate data collection. Inaccurate data collection is creating a wonderful problem for healthcare workers, i.e., doctors. Thanks to inadequate data, it’s totally difficult for scientists to evaluate the results of the vaccine, which is getting used to fighting the coronavirus pandemic. India needs to implement such international instruments as ATIH and DMP, which France has already adopted in the past and since which France is the only country that is functioning excellently within the health care system. If India adopts these instruments, it will be able to improve its healthcare system.
There are various well-known models of healthcare that are widely accepted by different countries that have strong health structures. A number of those healthcare systems are given below, which are accepted by many global powers to strengthen their health infrastructure, and there lies the requirement for the adoption of those models in India to make it worthy and powerful enough to tackle catastrophes like COVID.
One of the well-known models of the healthcare system is the Beveridge model. This model was developed in 1948 by Sir William Beveridge in the United Kingdom. This model is basically centralized, as there is a national health service. In this sort of model, the government acts as the largest player because it is the single-payer of all the health expenditures within the country, removing the competition from the private players. During this system, nobody must pay the medical bills on his own, as it’s a bit like the investment or insurance of health through taxes. because the citizens who pay taxes to the government belong to the present category, or we’ll say that this model of health care is funded through taxes only. It’s utilized by the United Kingdom, Spain, New Zealand, Cuba, and Hong Kong. This model isn’t applied by India in its healthcare system; this might be the rationale for the inefficiency within India’s healthcare system.
The other prominent model is the Bismarck model. This model was founded by Ottoman statesmen in about the 19th century, and it is a more decentralized style of healthcare. This model works like insurance created by employers and employees who are responsible for funding their health from their salary or payroll reduction, thus finally creating “sickness funds” for their future. The plans in these aren’t profit-based. It’s basically employed by Germany, Belgium, Japan, Switzerland, and the European nation of France. There’s an urgent need for India to use these models to boost its healthcare system. If these international instruments are implemented in India, then India will be ready to fight pandemics easily in the future.
Another model that may be held suitable within the context of India is the national insurance model, if we discover a blind of both the above two models, i.e., the Bismarck model and the Beveridge model. During this, rather like the Beveridge model, the government acts as the largest player and plays a centralized role because it is the single-payer of all the health expenditure within the country, removing the competition from the private players and working for the betterment of medical procedures. However, similar to the Bismarck model, the model contains features like the requirement that private players act as providers of the services.
The main health providers are private players or hospitals, but expenditure on health is completed by national healthcare agencies and the government, i.e., the payments come from a government-run insurance program that every citizen pays in a similar way to taxes. In this, there isn’t any profit or loss condition as a motive, which doesn’t include financial measures to be taken or denied for claims, making accessing health care far easier. This balance between private and public gives hospitals and providers more freedom without the frustrating complexity of insurance plans and policies. It’s employed by Canada, Taiwan, and other Asian nations.
There is a requirement for the adoption of these models like Bismarck, Beveridge, and national insurance in India to ameliorate its health care system. Implementation of these models will increase the efficiency and effectiveness of the Indian healthcare system.
India may additionally adopt a variety of healthcare techniques from India to spice up its healthcare system. The healthcare system of India relies on national healthcare services. Thus, it helps to supply universal health coverage to any or all of its citizens, which is free of charge. The general public’s healthcare hospitals are well-maintained and quite decent. A variety of the treatments that are provided by the general public healthcare system require a small co-payment, including tests, medications, surgeries during hospitalization, doctor visits, and medical assistance provided by pediatricians and other specialists. The expats who are employed in Itlay must qualify for the government’s healthcare network. To test their eligibility for the program, foreign nationals should pay a visit to the closest local health authority, the Azienda Sanitaria Locale (ASL), and register with a doctor. Once registered, a health card and a health number are issued. These will function as tickets for free visits to the chosen doctor. Alternatively, World Organization citizens moving to Italy can make reciprocal healthcare agreements with their home country. A minimum of three weeks before traveling to Italy, expats must apply for Form E111, the certificate of entitlement to treatment. If moving to Italy as a non-European Union citizen, travelers are required to have private insurance coverage. Upon arrival, there’s an eight-day window to go to the local station and present a health policy that’s valid throughout the duration of one’s stay. India should also work on similar lines as Itlay is functioning in its healthcare system. India should also provide these facilities to the ex-pats who are employed in India; this could also increase India’s GDP and cause an upgrade of India’s healthcare system.
CONCLUSION
There is an urgent need in India for the adoption of International instruments, which have already been adopted by countries like France, Italy, Canada, Taiwan, South Korea, Germany, Belgium, Japan, Switzerland, European countries, the UK, Spain, New Zealand, Cuba, and metropolises. If there’s the implementation of techniques like ATIH and DMC in India, it’ll help to resolve the matter of information hesitancy. This technique will also help with data integration. India’s healthcare system should ponder various models like Beveridge, Bismarck, and the national health insurance model. The Healthcare system of India should also derive some international instruments from Itlay. Implementation of this international instrument in India will lead to improvements in the healthcare system. Secondly, it would also help in enhancing healthcare facilities, which may help the citizens of India. Thirdly, the implementation of some of these instruments may also help India reach the highest rank in a good world healthcare system. Fourthly, the implementation of this instrument will make the healthcare system of India more effective and efficient.
The doctor must conduct himself according to medical ethics. Practitioners have the choice to switch approaches (consequentialism, utilitarianism, and deontology) according to the demands of the situations. Four principles of medical ethics must be used: beneficence, Nonmaleficence, Autonomy, and Justice. Beneficence means doing good; nonmaleficence means doing no harm; autonomy means giving the patient the freedom to freely choose; and justice means ensuring fairness. It should ensure that doctors work according to medical ethics, and the government must implement the international instrument in the health care system.
