Indian Journal of Medical Ethics

This paper focuses on the ethical tensions seen in health systems research by researchers owing to their scientific obligations to their research, ethical obligations to study participants, and social obligations to the community. Health systems research differs from other public health research fields in terms of the participants selected, power relations within health systems and the socio-political environment. The study seeks to answer the following questions through experiences in health system research...

In response to the continuing high prevalence of anaemia recorded in the National Family Health Survey-5, the Indian government launched a policy for mandatory iron fortification of the rice provided through public nutrition programmes in India. This was done even though a rigorous evidence analysis had already concluded that rice fortification was not effective in preventing anaemia or iron deficiency at the population level. Fortification also poses a potential risk of iron toxicity over time, but there is no stated time period for the policy's implementation...

Over 200 health journals call on the United Nations, political leaders, and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. This overall environmental crisis is now so severe as to be a global health emergency.

With the proliferation of pharmaceuticals and advances in innovative medical technologies, use of animal-derived products is widespread in the healthcare industry. The use of these products sometimes conflicts with the religious beliefs of patients. I was involved in an ethical dilemma during reoperative abdominal hernia surgery. I engaged with the patient's next-of-kin via an intraoperative phone discussion regarding the possible use of a porcine-derived biological mesh implant. Here, I reflect on the experience to help clinicians who seek ethical competence alongside clinical competence...

Despite its ancient roots and prominence in India as an accepted alternative to modern medicine, Ayurveda's growth has been hampered by an inability to carry out clinical studies of its effectiveness and safety using modern scientific methods - while preserving the core of Ayurveda, which is personalised medicine. In this comment, we propose that the N-of-1 trial be used as a practical method to evaluate Ayurvedic treatments, which is simultaneously consistent with the canons of modern medicine and of Ayurveda...

Alzheimer's Disease is the most common form of dementia which affects 55 million people worldwide. Not surprisingly, it is a key focus of research involving huge funding. Scientific fraud has inevitably surfaced in this research area. This essay discusses a report of alleged fraud and its implications for the credibility of scientific research.

BACKGROUND: Professionalism has long been recognised as a core competency for clinical teachers as role models and educators. The present study aimed to evaluate the adherence to professionalism of clinical teachers from the perspectives of resident doctors and undergraduate medical students. METHODS: This is a descriptive and cross-sectional study. All learners, including undergraduate medical students and residents who were studying in the medical school and teaching hospitals affiliated with Shahid Sadoughi University, were entered into this study as evaluators (n = 311)...

This is a reflection on the nature of language used by psychologists in the contexts of referrals and assessments. Through an example of a brief referral, I attempt to unpack the "clinical" language that may dehumanise and pathologise individuals. Further, I attempt to reframe it through a language, that is not just a shift from "deficits" to "strengths", rather a discourse respecting personhood. With a brief emphasis on neurodiversity and feminism, I reflect on the importance of incorporating affirmative language whether it is neuro-affirmative, queer-affirmative, age- or caste-affirmative, within and outside mental health practice...

BACKGROUND: In recent years, there has been a big push to register trials, but there are a number of problems with the data in public clinical trial registries. Here, we describe a cross-sectional study of the classification of the primary sponsors of all Phase 2, Phase 2/3, and Phase 3 interventional trials registered with the Clinical Trials Registry-India between May 15, 2016 and May 14, 2021. METHODS: Data was scraped from the records of CTRI, various filters were applied, and the trials of interest identified...

The increase in the number of cases of antimicrobial resistance has gained attention worldwide. The main drivers of this situation are the misuse and overuse of antimicrobials for human and animal health. The imbalance between ensuring appropriate use of antimicrobials and providing equal access in the community makes this an ethical issue. The antimicrobial stewardship programme was initiated in response to this global crisis. Its framework includes interventions targeting the optimisation of antimicrobials in hospitals...

The landmark judgment in the case of Indian Medical Association v VP Shantha in 1995 brought the medical profession under the ambit of the Consumer Protection Act, 1986. The Consumer Protection Act, 1986, was later repealed and replaced by the Consumer Protection Act, 2019. This article delves into the implications of the 2019 Act, highlighting significant changes in its scope, including the expansion of the definition of "consumer" and the incorporation of telemarketing and e-commerce within its ambit. Moreover, the amendments affect pecuniary jurisdiction, grounds for litigation, and introduce mediation cells, and the Central Consumer Protection Authority (CCPA)...

The Medical Termination of Pregnancy (MTP) Amendment Act, 2021, contains some progressive changes. However, survivors of rape will continue to go through mental as well as physical trauma to secure an abortion. We argue that the MTP Amendment Act, 2021, fails to address the rights of rape survivors adequately.

The 22nd Law Commission of India (henceforth, the Commission) [1], in its recent 283rd report, offered its recommendation on the question of age of consent (AoC) to sexual activity. Two High Courts which have seen several cases of non-exploitative consensual sex involving adolescent girls, filed by the police under "sexual assault", had referred this issue to the Commission. The substantive matter before the Commission was whether to lower the AoC to prevent unnecessary prosecutions and resolve the contradictions in sexual violence laws...

The law ought to ensure that reproductive health services are accessible to all persons - married or unmarried - without subjecting them to heightened scrutiny or procedural requirements. However, the intersection of various laws and their impact on the willingness of medical professionals to offer abortion and reproductive health services to adolescents makes timely, safe, and affordable abortions difficult for adolescents to obtain. This challenge is exacerbated by a lack of public healthcare facilities, particularly in rural areas, and the overall restricted access to healthcare services during the Covid-19 pandemic...

To address the under reporting of sexual offences against children, the Protection of Children from Sexual Offences (POCSO) Act, 2012, makes reporting of such offences mandatory. The duty to report such offences has been extended to healthcare professionals. The inclusion of healthcare professionals within mandatory reporting, however, strikes at the very foundation of the doctor- patient relationship based on trust and confidentiality and conflicts with the patient confidentiality safeguards of the Mental Healthcare Act, 2017...

BACKGROUND: Mobile phone-based interventions are being increasingly used in community health work in India. The extensive use of mobile phones in community health work is associated with several ethical issues. This review was conducted to identify the ethical issues related to mHealth applications in community health work in India. METHODS: We performed a scoping review of literature in PubMed and Google Scholar using a search strategy that we developed. We included studies that mentioned ethical issues in mHealth applications that involved community health work and community health workers in India, published in peer reviewed English language journals between 2011 and 2021...

This article recounts a poignant interaction between the author and a mother of a child with cerebral palsy. The mother's remarkable strength and optimism in the face of adversity deeply moved the author, leading to a tearful moment which prompted a comforting response from the mother. The ongoing debate regarding whether doctors are allowed to display emotions in their professional lives centers around the challenge of balancing professionalism with the emotional impact of providing healthcare to patients...

The conventional sharing of information and education between doctor and patient is no longer what it used to be prior to Dr. Google's entry into the mix with voluminous data, not only transforming but often threatening the patient-doctor relationship. While patients no longer seek basic information from their physicians since they've already consulted Dr. Google, the wise physician accepts that patients are now more aware, more involved in their own care, and more empowered with information. The good old doctor who knew everything is now more a myth that exists largely in folklore...

I have been blind in the left eye after a childhood accident, and fall into the category of 'Divyāngjan' (people with divine body parts), but that is not a term I like being described by. I prefer to be known by a handicap that restricts my activity, without any attempt to patronise with pity rather than empathy. This also goes for the several politically correct terms being used to describe people with disabilities these days. Most of these reflect a patronising attitude and serve no purpose. If people sincerely mean well, they need to engage practically with the obstacles faced by those dealing with disabilities...

Numerous challenges have crippled the Afghan healthcare system. The nearly half-a-century-long war - that continues to this day - has had profound effects on all aspects of Afghans' lives, medical education being no exception. However, Afghans have partially revived their healthcare and medical education systems recently, and updated medical curricula and teaching methods, with international support [1]. The quality of medical education has, however, been a growing concern in the country [2]. We outline the Ministry of Higher Education (MoHE) perspective on Afghan medical education policy, envisioning the rapid scaling-up of medical education facilities, describe the evolving challenges faced in the current economic and political collapse, and put forward some recommendations...