LETTERS TO THE EDITOR

We have been actively engaged in the Medical Audit of patient care in our hospital for the last 6 years. Our problems of medical ethics vary from lack of human emotional approach to greed for money; over treatment and over investigation; multiple consultations and visits; gross negligence and taking shelter under medical diagnoses in which multiple disciplines overlap.

Absence of definite guidelines from Universities or Medical Councils in defining the limits of the field of a discipline - whether it be a generalist or internist or subspecialist; absence of guidelines regarding the charges for laboratory tests, operations, consultations and visits cause much distress to patients, management and professionals

Dr. D. H. Shete,Director, Batra Hospital & Medical Research Centre, New Delhi 110062.

(Dr. Shete raises important issues. The Forum for Medical Ethics volunteers to help in the formulation of guidelines as proposed by him. We welcome suggestions from readers. Editor)

We were happy to see the first issue of Medical Ethics

and have some suggestions to offer: What is the chief role you envisage for this newsletter? Is it information, education, a commentary on current practices or a forum for discussion? It may be best to define this and orient it accordingly.

Will you consider establishing standard sections such as Ethics and Society, Ethics of Medical Research, Ethics and Malpractice, Medical Ethics and Public Health Policy, Clinical Competence, Medical Ethics and the Law, Medical Ethics and Human Rights

Another approach would be to focus on a single aspect of medical ethics in each issue and invite multiple views. When inviting responses, include one from a renowned ethicist.

The instance of the pregnant mother referred to in the first issue highlights the importance of general principles governing medical ethics. (In this instance the principle is that the life of the mother takes precedence over that of the fetus.) How did such general principles evolve? How are they modified? What is the role of religious beliefs?

Dr. Bashir Mamdani, Professor of Medicine, Cook County Hospital, Chicago.

(Dr. Mamdani offers several stimulating options. We invite opinions from other readers. At present we are dealing with current issues in medical ethics and are providing an authoritative review (as on the patient’s right to know in this issue).

We wish this newsletter could serve all the functions mentioned by Dr. Mamdani in his first paragraph! Editor)

The problem of fault compensation referred to in the first issue of Medical Ethics is a continuing one. It is certainly one that I am interested in myself and... think that no fault damage incurred in non- therapeutic research should be compensated without the need to prove medical negligence. However it seems to me that the harms meted out by ‘nature’ and also by the hazards of medical intervention, when carried out in good faith... cannot realistically be compensated in money terms. This would simply be too expensive for almost all countries, let alone the developing countries. The compensation that is available is treatment and that can be provided free

Dr. Ranlon Gillon Editor,Journal of Medical Ethics, London.

(From Dr. Gillon’s letter to Dr. H. S. Wyatt. - by permission of Drs. Gillon and Wyatt.)