After 22 years of the Indian Journal of Medical Ethics (IJME) and 10 years of National Bioethics Conferences (NBCs), it is time for some reflection on our achievements and the challenges ahead.

We launched the NBC in 2005 as an independent platform for bioethics, for the participation of individuals, organisations and institutions concerned with this subject in India. We expected about 100 participants and were delighted when over 300 participants from more than 100 institutions turned up. This number has grown with every meet since, and in December 2014 the Fifth NBC attracted over 700 participants across disciplines, from over 100 institutions in 15 Indian states and nine countries. The meetings are modestly organised and provide just a few partial fellowships. The rest of the participants came at their own expense, or with institutional support. It would be false modesty to deny that these numbers are also indicative of the contribution of IJME towards establishing bioethics in India.

The achievements of the bioethics movement

Still, we must ask: what has the impact been of a quarter century of publishing, conferences and activism around bioethics? Has the healthcare system become more ethical and sensitive to the needs of the vulnerable?

It sometimes seems that the situation has worsened, not improved. There are more reports today than ever before of unethical practices and outright corruption. Our medical colleges still do not have systematic teaching in ethics. Despite the concerted efforts of many, we still do not have a single full-time interdisciplinary master’s programme in India.

It is true that, like human rights, ethical principles become more prominent and get reported when they are violated. The increased reporting we see today may be because there are more violations. Or it may be that with the increasing public awareness and debate on the issues, the silent majority is no more ready to suffer in silence. The social acceptance of unethical practices and corruption is questioned more than ever now. And that is a big change.

IJME’s efforts to build this awareness may be the reason for the constant support it has received from its readers, institutions, NGOs and charitable organisations. It may also explain why the NBC has attracted increasing numbers of participants over the years.

Why we face a crisis

Yet, we must reflect on why IJME and the NBC are facing a crisis of such proportions that it threatens their very existence.

Two characteristics of IJME and the NBC demand extraordinary efforts to keep them going. They also make the real active support of readers and participants vital.

Unlike most medical journals published in India, IJME is not merely an academic journal. It is also actively involved in promoting good research, reflection and all efforts to nurture the discipline of bioethics in various institutions. And it is also committed to activism against unethical practices, to creating a space for all those who are committed to ethics, and, above all, to ensuring that our institutions and hospitals provide an environment to nurture and reward ethical healthcare.

The second characteristic of IJME and the NBC is their independence. This independence needs to be preserved even though it may endanger their very survival. With the all-pervasive influence, in India, of for-profit industry and corporates it is difficult to resist the easy solution of getting sponsorship from the pharmaceutical, hospital, or insurance industries. Many other journals, institutions and conferences with equally laudable objectives have gone this way.

On the eve of the fifth NBC in December 2014, we contemplated closing down the print issue of the journal and becoming a “web-only” journal. We would have done this in January 2015 were it not for the timely support from many individuals. But this has only postponed the crisis, as we are still not financially stable. For this stability, the journal and its publisher, the Forum for Medical Ethics Society, need annual support from individuals and institutions to undertake its core function of publishing. IJME also needs grant support for its further development, increasing the size of each issue, more frequent publication, and so on.

There is no doubt that both IJME and the NBC are unique institutions in India that have made an invaluable contribution to bioethics in this country, as well as to activism which can effect change. Their independence must be preserved. So, even as we celebrate our contribution to the movement for ethical practice, IJME and the NBC need your support more than ever.