Home
Current Issue
Past Issues
Support
About IJME
Jul-Sep2002-10(3)
LETTER FROM CHENNAI
Systematic subversion
George Thomas
The news that numerous unrelated donor renal
transplants are being permitted in Bangalore will surprise no one. It is near
axiomatic that whenever anything is in short supply, as kidneys are, and when a
few people are given discretion on the allotment of the scarce commodity, as the
authorisation committee is, the ground has been prepared for misuse of power. A
similar situation (and no less important) exists in the field of medical
education. The abandon with which different states are rushing to permit private
medical colleges, which charge exorbitant amounts for seats, is cause for
serious concern. Unfortunately, those who should be advising the government on
such matters are themselves using these avenues for their children and as
post-retirement sinecures.
Subverting systems
The harmful effects of this kind of subversion of
the system will be felt widely and deeply. In the field of renal
transplantation, the availability of cheap live donors (the amount paid in
Bangalore is reported to be around Rs.35,000) is likely to be one of the reasons
that cadaver transplantation has not taken off in India. When opinion-makers
have access to live donors, very few are altruistic enough to help in the tough
job of developing a cadaver transplant programme. Also, in the present scenario
of free availability of live donors, very few doctors involved in transplants
have the commitment to push the cadaver programme. Not many lay people realise
that this is a major impediment in transplanting other organs like the liver,
lungs and heart. The only cadaver transplant programme that is somewhat
successful in India is for the cornea, and the success in this field suggests
what is possible if commitment is available. The fact that so many people are
willing to donate their eyes gives the lie to the oft-repeated statement that
Indians are unwilling to donate their organs.
The rates that are being charged for medical
education are horrifying. One institution in Chennai is reported to be charging
Rs 25 lakh for an MBBS seat and amounts like Rs 45 lakh for a post-graduate seat
depending on the demand. This is unaccounted-for money, and the fact that the
regulators are turning a blind eye to this wholesale subversion of the rule of
law in India is a pointer to the depth of the rot. I do not hold the view that
all the doctors from these colleges are bad, or, conversely, that all the
products of the regular system are paragons of virtue. But the principle here is
that this method of admission lays the ground for all kinds of abuses. To take
but one example, the pressure to recover the investment in medical education on
these students must be immense. Will they not be tempted even more than others
to do unnecessary surgery, investigations, etc?
Built-in corruption
What all this illustrates is that the present
systems and institutions in India are so designed that the potential for
corruption is built into the system. It is true that any number of laws
cannot totally eradicate the problem. It is also true that corruption exists in
all societies. But the point here is that in India it is of such colossal
proportions that it is damaging the entire society. When a system of ethics is
not part of the accepted norms of society, the potential for dangerous
destabilisation exists. And this is what we are now witnessing in India. Never
before has it been so obvious that money can buy anything. The resultant
divisions between those who have money and those who do not, is becoming deeper
than ever before. Superficially, it appears that poverty has decreased, or at
least not increased in the last few years, but the difference in consumption has
definitely grown by leaps and bounds.
The moral effect of this difference should not be
underestimated. When you can buy anything, from a kidney to a medical degree,
the message is that you are living in a society where everything is a commodity,
available for sale; you only have to find the money. The next easy step is that
the method of acquiring money is unimportant; the only important thing is to
have it. We have then arrived at the situation where the very people who are
supposed to implement the law subvert it in order to get money.
Fighting corruption
It is now more important than ever to keep fighting
this canker. We must use every means available to us to re-establish the role of
ethics and morals in society. Although we may concentrate on the medical
profession because we belong to it, we must intervene in other areas too. If the
legislature, the judiciary and the executive are all corrupt, the possibility
that other areas of society will be corrupt too, increases. Amongst medical
professionals, we must seek to make ethical behaviour the norm. The efforts of
the Forum for Medical Ethics Society must be strengthened and
expanded.
Dr George Thomasis an orthopaedic surgeon working at Railway Hospital, Perambur. 114J, Rostrevor Garden, Railway Colony, Teynampet, Chennai 600018. Email:george@medicalethicsindia.org.