Disregard for medical ethics despite protest

Let me share two depressing experiences about the disregard for medical ethics shown by doctors despite my protest against unethical practices.

1. Ms. Medha Patkar was on indefinite fast three years back along with a local Adivasi activist, to oppose the Sardar Sarovar dam on the Narmada river. Volunteer-doctors were doing their duty in a relay to monitor the health of these two activists. I took over this task on 16th June, the 14th day of the fast. The health of both activists caused no alarm, yet the government decided to arrest them and forcibly give them intravenous glucose. The police swooped in past midnight on 16th June and forcibly arrested them and their followers. I was allowed to accompany them to the Bombay Hospital. In the hospital, I argued with the resident doctor that it is unethical to forcibly administer intravenous glucose to those on fast. The doctor did not seem to know this simple fact. He later defended his attempt at forcibly feeding Ms. Medha Patkar by saying that her life was in danger from increased concentration of serum potassium. I argued that the serum potassium must first be shown to be abnormally high. This was not done for 12 hours.

As per the guidelines of the World Medical Association, forceful feeding can be justified only when the person on fast is not in a state of consciousness to give consent or otherwise for medical intervention to save his /her life. Here, the persons on fast were fully conscious and there was no medical emergency. Yet the doctors chose to oblige the government by providing medical justification for forcibly injecting glucose into the protesters even though I pointed out that this act violated professional ethics.

2. The Pune branch of the Indian Medical Association organises annual refresher programmes for its members. In the course of such a programme i n 1995, during the talk on obesity in childhood, a number of slides of fully naked children suffering from obesity, were shown by the lecturer, a renowned endocrinologist from Bombay, without masking the identity of these children. Some of them were grown-up, preadolescents. While it was necessary to show the naked physique to demonstrate obesity in these children, the identity of these unfortunate children should have been concealed by masking their faces. This was not done. None of the 300 or more doctors in the audience protested in any way, then or later. After the programme, I met one of the office-bearers and pointed out the violation of the elementary ethical principles by such a display of photographs of patients. The response was not encouraging. I wrote a letter of protest to the endocrinologist and also a similar letter for publication – to the monthly newsletter of the IMA, Pune. I asked : ‘Would we have liked our own children to be shown on the screen thus without concealing their identities ? . . . The organisers were of course, helpless in this case. But in future, can all researchers bc requested to follow the basic ethical norms in the display of photographs of patients ?‘ The editor of the newsletter did not publish this letter. What disturbed me most was the unwillingness to improve, even when the unethical practice was pointed out.