Ethics in Paediatric Surgery. Editors P D Madhok, SJ Karmakar. 60 pp. Mumbai, 1997.

This collection of papers presented at a December 1996 seminar on the ethics of paediatric surgery provides food for thought in a profession where ethics is rarely mentioned, which does not see fit to include the subject in the education system. The collection does a good job of discussing the range of relevant issues:

S K Pandya and P Madhok highlight two organisations which could promote medical ethics: medical associations and statutory hospital ethics committees. I only disagree with Dr Pandya’s perception that an independent commission of doctors would render consumer protection courts superfluous. Doctors will be reluctant to speak out against their colleagues; it is easier to remedy lacunae in the CPA.,

Justice Suresh rightly refers to the Supreme Court judgement upholding a patient’s right to emergency medical care: that the right to life must include the right to medical care is well taken. How can we talk of medical ethics when primary health centres don’t even have essential drugs?

RK Gandhi responds well to doctors’ opposition to the Consumer Protection Act by pointing out that the profession need not fear frivolous litigation or resort to defensive medicine if they communicate with their patients, and keep proper-records.

Another point, brought up by a number of writers, was the need for multispecialist committees, and the inclusion of parents in the decision-making process, particularly in cases of prenatal diagnosis and therapy, and when dealing with children with multiple deformities. Other situations which create ethical dilemmas are intersex disorders, advanced malignancy and the use of passive euthanasia. In his discussion of ethics in research, Sanjay Oak raises the important question of sensitivity to animals.

Santosh Karmakar gives a good perspective on the management of children with neural tube disorders by including, in the decision-making structure, the question: would I do this for my child? However, the editor’s note here, that severe cases “are best prevented by foetal abortion”is simplistic. Reports can be wrong. And equally important, some parents may have strong views against abortion. It is essential in such situations to take the parents into confidence.

When talking about the ethics of scientific publishing, P Madhok ignores the central question of publishing research funded by the pharmaceutical industry, where there is always a possible bias. Many journals today require that the authors mention the funder as well as any possible conflicts of interest.

SHORT NOTES…

The May 1997 issue of Reproductive Health Matters covers a health service whose absence kills more than 100,000 women world-wide annually. ‘Abortion, unfinished business’ looks at changes in law and practice since the 1994 International Conference on Population and Development in Cairo acknowledged that unsafe abortion was a major public health problem, and the 1995 International Women’s Conference in Beijing agreed that something had to be done about it. Seventeen features report on specific local issues in law and health services. Three examine some issues in current research. The round-up carries reports on law and policy, service delivery and research, and a list of recent publications. All make the journal essential reference material on a complex issue.