Hospital ethics committee

We have learnt of an hospital ethics committee that has been set up in our institute. I place my thoughts on this subject in the hope of stimulating discussion on the subject.

An ethics committee is easy to constitute but its functioning can appear very nebulous, especially in a multi-religious and multi-cultural institution such as ours. It is so much easier for such a committee to function in institutes run by religious organisations which already have clear-cut ethical principles which govern the thoughts and shape their actions. It is also relatively easy for it to function in the West where the Judaeo-Christian ethic has homogenised societal attitudes and behaviour.

Our own ethical norms in this country are confused. We have codified, or tried to codify, principles of ethical behaviour based, I believe, on Judaeo-Christian thought that was imbibed by Indians educated by Western minds and exposed to Western literature. I believe the time has come for our Medical Councils to face this issue head on and formulate ethical norms that will encourage practice in keeping with our traditional and modern Indian values.

Of course, there are underlying humane values that run like a common thread through all religious and cultural traditions, which should form the backbone of our code of ethics.

In spite of what I believe, I know that Medical Councils will not fulfil their legitimate role. It will be up to small groups (such as the ethics committee at Tata Memorial?) to show the way. This, I hope, will be a positive fallout of the exercise.

I also hope that the ethics committee will not be an exercise in cosmesis. (I am not so bothered by the witch-hunting problem. Far worse is to sweep evidence of malpractice under the ethics committee carpet.)

To this end I would suggest that the Committee be renamed the Ethics and Standards Committee. Members of all departments, including the staff from the nursing, administration, social service and other departments,constitute an extended group that could meet every alternate month to review existing non-technical patient care practices and suggest improvements that would contribute to overall healthy functioning of the institution.

The problem may be a small one (eg. dealing humanely with death in the hospital environment, including the nitty-gritty of handing over the body, reduction of bureaucratic procedures at this sensitive time etc.) or a major issue such as the lack of access that the general (non- paying) patients have to consultant level care on a day-to-day basis.

I feel that until there is a full-fledged quality management exercise instituted at the Tata Memorial Hospital which would include a formal medical audit, the Ethics and Standards Committee could fill this gap in keeping with their avowed objective of improving patient care in its technical aspects.

I think an ethics committee is a step in the right direction, but it will remain only a step if all it does is review projects and lay down codes of behaviour in a esoteric manner.

To be effective, ethics should not just be preached but practised. We live in a world where the motto seems to be, ‘Do what I say – don’t do what I do.)