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Oct-Dec2002-10(4)
CORRESPONDENCE
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article
This is with reference to your article on PVS (1).
I was touched by the entire story, but what touched me most is your reference to
nurses who care for such patients. Being a nurse myself, I appreciate the fact
that you have given thought to the caring aspects of PVS. I have often wondered
why many medical professionals admit terminally-ill patients with problems such
as multiple secondaries in the brain, or PVS, into intensive care units and
drain nurses' emotional strength. Having worked for over five years in intensive
care units, my colleagues and I have died many times over with every patient
(especially after caring for them for five days or more). A student of mine who
worked as a staff nurse once described to me her suffering when a patient who
was intubated for over seven days died in the ICU. She was quite sure that the
patient wanted to say something and was trying to communicate, but he died
without being able to do so. The death of that patient, without a loved one near
him, without being able to talk to anyone, killed a little of bit of the nurse
in her.
Reference:1.Nair K Rajashekharan. Clinical tales in neurology: a vegetative
existence. Issues in Medical Ethics 2002; 10: 55-57.
Ms
Shreedevi Balachandran,Manipal Hospital, Bangalore.
Charter on medical
professionalism
I must congratulate the editorial team for an
extremely readable April-June 2002 issue (1), relevant to the practice of
medicine in India today.
I was particularly interested in the comments of
Professor Ed Pellegrino on the Hippocratic Oath, because of a research project
by a group of physicians from America, Canada and nine countries in Europe.
Begun about three years ago, the aim of the project was to draft a charter on
medical professionalism, a document that is being hailed as a modern version of
the Hippocratic Oath.
As the charter acknowledges, the modern-day doctor
is 'confronted by an explosion of technology, changing market forces, problems
in health-care delivery, bioterrorism and globalisation'. One of the drafting
physicians, retired orthopaedic surgeon and former dean of the McGill medical
school, Richard Cruess, comments that the charter is designed to say: "Look,
times are really tough, but this is what we as physicians stand for, and we're
going to try." His wife of 48 years, endocrinologist Sylvia Cruess, who also
formed part of the drafting team, says, "Professionalism had not been in any way
referred to in the medical literature, which is rather appalling, seeing that we
think we're professionals."
Hence, high on the list are concerns of commitment
to integrity and honesty, reducing and reporting medical errors, avoiding
conflicts of interest with insurance companies and pharmaceutical firms and the
fair distribution of health care resources. Three fundamental principles and a
set of 10 commitments are outlined.
The charter appeared in print for the first time in
the February 5, 2002, Annals of Internal Medicine and simultaneously in The
Lancet and may be viewed by logging on to the following Web address:http://www.annals.org/issues/v136n3/full/200202050-00012.html,
under the title 'Medical Professionalism in the New Millennium: A Physician
Charter'.
Obviously, the word 'international' applies, as of
now, to the industrialised world from which the drafters come, but there is call
to 'physicians from every point on the globe to engage in dialogue about the
charter', to respond to the question: 'Does the document represent the
traditions of medicine in cultures other than those in the West, where the
authors of the charter have practiced medicine?' Some of the readers of IME may
be interested in responding from the Indian viewpoint.
Reference: 1. The future of general practice.
Issues in Medical Ethics 2002; 10.
Sr
Daphne Viveka Furtado,PhD, St John's Medical College,
Bangalore.
Not irrelevant
research
The letter from Bangalore by Dr. Sanjay Pai (1)
regarding research that 'cannot and should not be repeated' raised an important
and interesting point. I do agree that any research which has no benefits for
the people on which it is done should not be done. Moreover, in a broader sense,
it may be unethical to waste scarce resources on such matters. However, in his
letter, Dr Pai clubbed a study of the ICMR in the same category of research, ie
research which should not be done. This study was to measure the average length
of penis in Indian males. Dr Pai has solicited comments on his view. I disagree
with the author's views on this matter. I have not read the protocol of this
study. However, as a psychiatrist, I do feel that such a study is not
irrelevant. Such studies have been carried out in the past, and researchers have
disagreed on the results! (2)
There are many myths in the general population
about the size of the penis, and these myths in turn contribute to sexual
dysfunction. This research will help to dispel this myth. Moreover, it may help
manufacturers of condoms to make their product of the right size. I need not
mention the disastrous consequences, to the nation, of an ill-fitting
condom.
References:
1. Pai Sanjay. Letter from Bangalore. Issues in
Medical Ethics 2002; 10: 165.
2. Virginia Sadock. 'Normal Human Sexuality and
Dysfunctions.' In : Sadock & Sadock (Editors), 7th edition, Kaplan &
Sadocks Comprehensive Textbook of Psychiatry. Lippincott, Williams &
Wilkins, 2000; 1577-1608.
Dr
Nikhil Khisty,Lecturer in Psychiatry, B J Medical College, Pune 411
001.