Bridging the ethics gaps

“Sir, I have already collected 15 cases in my research project, and have not taken consent from any of the participants. What should I do now?” asked a postgraduate student in an ethics committee meeting that I happened to be attending, several years ago. Promptly came the reply from the head of the institution, who also happened to be the chairperson of the ethics committee there: “No problem, just go to any patient who is admitted in the ward and take his thumb print on the consent form.” This encounter rudely awakened me to the huge gap between knowledge and practice in medical ethics.

In keeping with the advances in medical technology, the world has moved forward in the area of bioethics, but in India we are still rooted in outdated concepts. In the four and a half year MBBS course, students cover a very limited ethics syllabus, inadequate in today’s context. The course content in ethics at the undergraduate level stresses deontological theories and lacks in applications or skill development. The focus is on the doctor-patient relationship, issues of negligence and the Consumer Protection Act. In other words, medical ethics is taught on the premise that the law is breathing down a medical practitioner’s neck and one should be careful not to cross the legal boundary.

The past decade has seen an astronomical rise in clinical research in India. The lure of money that has inevitably accompanied this has not only attracted human participants from vulnerable populations, as research participants, but also many graduates of medicine or related disciplines, who decide to engage in a career in clinical research. Many of them come from disciplines like homeopathy, and other Indian systems of medicine, besides allopathy. These youngsters lack the exposure to and competence in research ethics. Even principal investigators of clinical trials are not well grounded in the basic issues of research ethics. Often, ethics committees, which give ethical clearance to myriad clinical research protocols involving human subjects, lack qualified or even knowledgeable members.

The undergraduate curriculum should be covering areas of skill-building in ethics such as identifying ethical issues and violations, and focusing on remedies and ethical case resolutions. Currently, this is not being done. At the postgraduate level, ethical deliberations, end-of-life decisions, ethical conflicts resolution and clinical ethics consultation are not touched upon.

To bridge this gap, the Centre for Ethics was established by Yenepoya University, in Mangalore, Karnataka. The first programme launched by the Centre was the Postgraduate Diploma in Bioethics and Medical Ethics, a year-long course with six contact programmes, supplemented by projects, online assignments and group discussions, culminating in a summative written exam. The course exposes the student to the basics of ethics, morality, theology and philosophy and their inter-relatedness in healthcare, technology and research involving human subjects. The main objective is to train enough people in the basics of healthcare and research ethics issues so as to do justice to their positions on institutional ethics committees or as members of clinical research teams.

In 2011, the Centre signed a memorandum of understanding with the Department of History, Philosophy and Ethics in Medicine at the Johannes Gutenberg Medical University, Mainz, Germany, and another with the Duquesne University, Pittsburgh, USA. These collaborations promote staff and student exchange and take up joint research ventures in the field of trans-cultural clinical ethics. The six-month certificate course in clinical ethics consultation conducted by our centre utilises the services of the faculty members of both these universities. Two one-week long intensive contact programmes in each trimester are supplemented with online assignments and group discussions. This is designed to train participants in the basics of ethics, its applications in healthcare and how to conduct a clinical ethics consultation. The objective is to bring into India the concept of clinical ethics consultation that will have an impact on the ethics of healthcare practices in our country.

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