On Medical Ethics (1)

… I gladly fulfil your request of commenting on the copies of your newsletter. Asappears from several contributions, you have to cope with pressures on standards of professional morality due to commercialisation of health care services. From a theoretical point of view, this phenomenon – certainly not unfamiliar in Western countries – raises the question to what extent certain technological developments in modern medicine tend to undermine traditional morality in that they are linked with economic power and privilege. From a practical point of view several strategies are open to conquer this unwelcome development.

Protection of patients through legislation of patients’ rights is one option, but it might be a difficult one, given political inertia [although I noticed a reference to a Consumer Protection Act (1)]. Another option is to build networks with health care professionals that are firmly rooted in a moral tradition and community and address the relevant issues publicly, supported by such a moral ‘stronghold’ (it appears that this is what you are doing presently with your group). Yet another route, one that in Western society has proven very effective, is that of hospital ethics committees as an instrument for public audit of medical practices. It would be interesting to hear about developments in your society on this matter.

Given my own field of research, ethics and mental disability, I read with particular interest ‘Removing the uterus from mentally handicapped women (2) and guidelines for such procedures (3). The questions raised in the first article seemed to me quite_appropriate. The underlying issue is one that is very familiar in the field of institutional care for the mentally handicapped, namely the strong tendency of seeking technical solutions for what are basically attitudinal problems of giving proper care to incapacitated human beings. If you were interested, I would want to take some more time and comment on the second piece later this month… It raises the interesting philosophical point of the status of ethical principles in relation to ‘real-life’ situations (for example: the concession under ‘practical points’ 2 and 3 and the ‘rationale for hysterectomy’ lc, Note, might allow principle 5 to be overruled, which would provide the justification of the surgery on mentally handicapped women discussed in the first article). I would basically support the claims of the PARYAY group.

Generally the contents of your newsletter are very informative, although I would add that the style of the leading articles is somewhat ‘declaratory’ and could be improved by bringing in more ethical analysis. On the other hand, in many cases the malpractices that are criticised are just too obvious to require further analysis. They require changing attitudes, which is a hard and difficult task that analysis does very little to promote.

I wish you all the success you and your colleagues deserve and hope to hear from you.