What role does the ethical physician play in promoting human rights? Are physicians equipped for this job? Some may feel this topic is too abstract, far from the life of the average doctor. However, ethical medical practice is based on the understanding that all people – medical professionals and patients – have certain inalienable rights. Medical professionals must respect the rights of their patients, and also be conscious of the possibility that they can abet human rights violations. Discussions of this topic have usually taken as examples the hazards of human experimentation or the medical professional’s involvement in torture. However, health practitioners are confronted with the subject of human rights more often than this discussion would suggest. The world Health Organisation has been speaking of Health for All by 2000 as a human right. What meaning can this have when our people’s ill-health is a consequence of deep-rooted problems like poverty, corruption, exploitation and illiteracy?
The medical professional is often found in situations which explicitly or implicitly support serious human rights violations. Many physicians have seen under-trial prisoners with injuries suggesting torture – how many have reported the matter to the authorities who could follow up, protect the prisoner, and take action against the offending policeman? Many doctors have seen battered women in their outpatient departments. How many helped such women get support?
This point is well illustrated in Lalitha D’Souza’s article in this issue of the journal. Not only is the examination of rape victims shoddy, but there is no attempt to treat the victim.
These are situations in which physicians who witnessed human rights violations did not stand up and do their duty. What about the doctor who is called to treat hunger strikers, force-feeding them against their will? What should the doctor’s role be?
Still there are plenty of instances of physicians who didn’t seem to be bothered with questions of human rights and ethical practice : the ‘hysterectomy camp’ for mentally disabled women in Maharashtra (1), the virginity tests on nurses (2), the cervical cancer study in North India, in which researchers used poor women as guinea pigs, letting some of them die without treatment (3) and the xenotransplant case in Assam in which a doctor transplanted a pig’s heart into an unfortunate patient in blatant contravention of all ethical codes (4). A recent television programme had the last, Dr. Baruah, defending his decision.
These outrages were met with mild protest, and feeble action. Yet we can safely assume that many more such rights violations take place routinely, but remain unreported.
More than a decade ago, the British Medical Association (BMA) published a report on the medical profession and human rights violations. It cited many instances of the profession participating in police brutality, of attempts to change post-mortem reports after custody deaths, and so on. Our newspapers tell us that not much has changed since then. We have doctors who tie their patients up “to keep them from harming themselves; we have others who manufacture injuries on patients to help the police in their cases. This from a profession, which has been taught ‘Primum non nocere’!
It is to combat such behaviour that groups such as Physicians for Human Rights have been formed, and professional associations such as the BMA and the World Medical Association have made the subject one of their central activities. The BMA’s report on rights and medical ethics, Changing the culture of silence, is to be published shortly. In India, in Mumbai, the health research organisation, Centre for Enquiry into Research and Allied Themes, has conducted a course on human rights for post-graduate students in the University of Mumbai.
If one hopes to inculcate a respect for human rights among Indian physicians, the process must start during one’s medical education. Yet medical ethics is taught as a formal course in only one institution (St. John’s Medical College, Bangalore) in this country. The Indian Medical Council, the watchdog of the profession, usually maintains a deafening silence when it comes to critical issues (4, 5).
Clearly the medical profession’s involvement in human rights violations concerns all of us, whether physicians or patients. We urge our readers to follow news reports and debates on the topic, as they appear in the lay press, in medical journals such as The Lancet, as well as the many professional publications such as Issues in medical Ethics, which devote space to the subject.
I am grateful to Sandhya Srinivasan for her comments and suggestions.