LETTERS...

Thank you for sending me the first two numbers of Medical Ethics. Please accept our congratulations and the hope that it will flourish as it should. It comes at a time when ethics in all walks of life and certainly the practice of medicine could do with a much needed reappraisal. If there is any way that our Centre can help with such resources as we may possess, please do not hesitate to call upon me.

Dr. Eustace de SouzaExecutive Director, FIAMC Bio- Medical Ethics Centre, Bombay

(We are encouraged by the support so generously offered by Dr. Eustace de Souza who, with his team, has already done much to inculcate the principles of ethics into the medical profession. His note on the victims of AIDS appears elsewhere in this issue. He has also provided valuable insights on the Guidelines on page 2. -Editor)

Medical Ethics is particularly timely as both the political and intellectual leadership as well as the profession are taking more and more liberties with medical ethics. That this is a global issue is evident from the Round Table on ‘Is Machiavelli a better guide to physicians than Hippocrates? ’ in an issue of World Health Forum in 1993 Dr. Shethe’s observations on Batra Hospital (Medical Ethics Vol. 1, No. 3, page 11) can open up a vital area on this subject.

Dr. Debabar BaneProfessor Emeritus, Jawaharlal Nehru University, New Delhi

( Readers may wish to consult Dr. Banerji’s essay Combating AIDS as a public health problem in India published by the Voluntary Health Association of India (VHAI) and Nucleus for Health Policies & Programmes, New Delhi in 1992. Copies of the 23- page document ,are available from VHAI.)

Medical Ethics is enlightening and educative. I certainly wish to read more of it. ‘Caraka’s Oath of Initiation’ really calls for a doctor of Oliver Sacks’ sensitivity!

The only cautionary note for the future, if I may be allowed to say my piece in the interest of Medical Ethics, is to ensure that this newsletter does not have a crusading- call attitude. The facts presented are valuable by themselves and their surgical delivery will win broad support from a thinking public.

As regards removal of the uterus from mentally handicapped women (Medical Ethics, February- April 1994) Dr. Shirish Sheth and Ms. Vandana Khullar, the professional players associated with this tragedy come out in poor light. If these ‘thinking individuals’ (as against their ‘non- thinking’ patients) had taken a few minutes to reflect upon the realities they would have prevented the thoughtless dehumanisation of these women and salvaged a bit of their own reputations. These professionals could have asked themselves some basic questions:

a) Is menstrual fluid any extraordinary excretion from a woman’s body? Should its management be viewed differently from that of daily urine and faeces?

b) Is removal of the uterus from mentally handicapped women adequate safeguard from harassment from sexually charged/ mentally handicapped males?

c) Is the removal of the male organ of mentally handicapped males an equal consideration? Is it my responsibility to sanitise society? I am especially concerned that Ms. Khullar, an I. A. S officer and a senior functionary of the state, should attempt to deflect public attention from shortcomings in the provision of care by a Government institution, using a transparently illogical argument. It is the responsibility of the institution to care for the women entrusted to it. It is not the duty of activists or other concerned individuals to take over these functions.

For many doctors today the business of cutting up the human body to get rid of an organ termed a nuisance has become assembly- line stuff: The thoughtless exertion of the power of decision making over a helpless human being cannot but raise the hackles of any thinking human being.

I wonder whether Forum for Medical Ethics is restricted to the medical profession. If so, it would be a great shame for the topics concerning it are of considerably wider interest. Individuals and groups outside the medical profession can contribute a lot to the debate conducted by the Forum.

Asha Dutia

(Ms. Dutia has worked for Save the Children Fund and other organisations in India and in Sudan. We take this opportunity to assure her and other readers that the Forum actively seeks participation from anyone concerned about the current standards of medical ethics. We especially welcome those not connected with the medical profession as they will ensure objectivity in our dialogue.)

A wealthy Doctor, who can help a poor man and will not without a fee has less Sense of Humanity than a poor Ruffian who kills a rich Man to supply his Necessities. It is something monstrous to consider a Man of liberal Education tearing the Bowels of a poor Family by taking for a Visit what would keep them a Week.

Richard Steele (1672-1729) in The Tatler Volume II, no. 78.