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Indian Journal of Medical Ethics

Jagdish Varma, Anusha Prabhakaran, Suman Singh
The Medical Council of India intends to implement an attitude, ethics, and communication training module for medical students. This study investigates undergraduate students' attitudes towards communication skills training (CST). Forms were distributed to 81 recently admitted undergraduates, of whom 76 responded, in an anonymous cross-sectional survey. Single questions assessed knowledge of communication skills (CS), need for formal curriculum, and importance of CST. Attitudes toward CS were measured using a modified Communication Skills Attitude Scale...
June 22, 2018: Indian Journal of Medical Ethics
Saurav Basu, Nandini Sharma
Ineffective diabetes management results in suboptimal glycaemic control and adverse health outcomes. In resource-poor settings, a combination of high burden of medication nonadherence in patients and therapeutic inertia amongst clinicians is largely attributed to the failure to achieve glycaemic targets in diabetic populations. The potential health risks from intensification of medical therapy for aggressive lowering of glucose levels in Type 2 diabetes patients represents an ethical dilemma between averting risk from overtreatment and preventing future harm from raised blood glucose levels...
June 16, 2018: Indian Journal of Medical Ethics
K Radhika, M Manjula, T S Jaisoorya
Although there have been numerous studies, especially in the last few decades, on the impact of child sexual abuse (CSA) on adult survivors, there is a dearth of studies focusing on the ethical aspects of research in this area. Against this background, we reviewed the literature published between January 2000 and December 2016 on the reporting of ethical guidelines followed in research on adult survivors of CSA. We conducted a PubMed (MEDLINE) and Google Scholar search to find published research, using the keywords: "child sexual abuse", "adult survivors", "research", "guidelines" and "ethics"...
June 8, 2018: Indian Journal of Medical Ethics
Md Mahbub Hossain, Abida Sultana, Arindam Das
On August 25, 2017, the military and paramilitary forces of Myanmar launched "clearance operations" against the Rohingya population in Rakhine state of Myanmar. In the resulting humanitarian crisis, a Médecins Sans Frontières (MSF) report estimated that the number of deaths crossed 9000 within the first 31 days of these "operations". In addition to mass murder, other atrocities including burning down of residences, torture, rape, kidnapping continued to be practised on the Rohingya living in Myanmar...
June 6, 2018: Indian Journal of Medical Ethics
Aju Mathew
Collaborative research is integral to medicine. Multi-national and multi-institutional research partnerships produce advances in medicine and public health that have a significant societal impact. Developing nations can gain from such collaborative partnerships in achieving progress in sustainable development goals. However, it is important that the research agenda is relevant to the region where studies are conducted. Funding of research by the national government and regional organisations will ensure that the research is appropriate for the region, and ethically rigorous...
June 2, 2018: Indian Journal of Medical Ethics
Madhu Gupta, Jaya Prasad Tripathy, Sanjay Verma
Audiovisual (AV) recording of the informed consent process in a clinical or vaccine trial to document the consent process of participants (especially from vulnerable populations), ensures preservation of their rights and well-being. This paper describes the AV consent process during a phase III rotavirus vaccine trial among healthy infants in Chandigarh and examines its effects. Out of 155 parents/guardians of participating infants who were contacted to be a part of the study, 50 were reluctant to participate in the study trial (not necessarily in the AV consenting process)...
May 28, 2018: Indian Journal of Medical Ethics
Noorin Bhimani
In a bid to encourage medical graduates to opt for postgraduation in pre- and paraclinical courses, the Odisha Government, in January 2018, hiked the stipend for students pursuing these courses in state-run medical colleges. The state government also announced additional financial assistance of Rs 18,000 per month for pre- and paraclinical postgraduate students, along with the stipend money. The state's Health and Family Welfare Minister, Pratap Jena, said this would be applicable to both in-service and direct postgraduate students...
May 23, 2018: Indian Journal of Medical Ethics
Gajanan Phutke, Timothy Laux, Priyank Jain, Yogesh Jain
The Pre-Conception and Pre-Natal Diagnostic Techniques Act was written to prevent societally unacceptable harms including intentional sex selection. The pragmatism required to enforce this law has profound effects on the ability of rural Indians to access diagnostic ultrasonography. In so doing, it may have inadvertently placed a heavier burden on the poorest and worsened health inequity in India, creating serious ethical and justice concerns. It is time to re-examine and update the law such that diagnostic ultrasonography is widely available in even the most peripheral primary health and community health centres...
May 18, 2018: Indian Journal of Medical Ethics
Himmatrao Saluba Bawaskar, Pramodini Himmatrao Bawaskar
We describe below the pressures of running a small private hospital in an underserved rural area, while providing emergency healthcare for victims of poisonous stings, accidents, and other acute health conditions. Both ethics and law demand that payment is not asked for upfront in emergency cases. Yet patients and their families often fail to pay normal dues for months or even years. It is disturbing to encounter such behaviour even in villages; and doctors in small communities are easy prey. In these conditions can one be true to ethical principles and ensure one's own survival?...
May 3, 2018: Indian Journal of Medical Ethics
Renju Ravi, Alhad Mulkalwar, Urmila M Thatte, Nithya J Gogtay
In 2013, an independent group of researchers developed the CARE guidelines, a checklist to standardise reporting of case reports. This study assesses adherence to CARE guidelines among PubMed-indexed Indian medical journals in 2015 and the extent of endorsement of these guidelines by the journals. Case reports published in 2015 in journals indexed by PubMed, belonging to the medical stream, currently active, and that had an impact factor were included for analysis. Case series and journals that were published from India but for another country were excluded...
April 23, 2018: Indian Journal of Medical Ethics
George Thomas
The Cabinet chaired by the Prime Minister has accepted six amendments to the National Medical Commission Bill suggested by the Department-related Parliamentary Standing Committee (1). These amendments are: the proposed National Licentiate Examination has been replaced by a countrywide final MBBS examination called the National Exit Test (NEXT); the bridge course to train practitioners from AYUSH (Ayurveda, Unani, Siddha and Homeopathy) in modern medicine has been removed, and it has been left to individual states to take a decision about this; the percentage of seats in private medical training institutions under fee regulation has been increased from 40% to 50%; the number of nominees from the states and Union territories who are members of the Commission has been increased from three to six; the penalties for non-compliance with educational norms for colleges has been modified; and the punishment for practising modern medicine without qualification has been made imprisonment up to one year and a fine of Rs 5 lakh...
April 16, 2018: Indian Journal of Medical Ethics
Santosh Vijaykumar, Aravind Sesagiri Raamkumar
India's approach to disseminating information about the first three cases of the Zika virus was criticised nationally and internationally after the issue came to light in May 2017 through a World Health Organization news release. We analyse the incident from a risk communication perspective. This commentary recaps the events and synthesises key arguments put forth by the news media and public health stakeholders. We use Peter Sandman's risk = hazard + outrage framework - also adopted by India's risk communication planners - to analyse India's risk communication response and contextualise it against the mandate of the National Risk Communication Plan and Integrated Disease Surveillance Programme...
April 12, 2018: Indian Journal of Medical Ethics
Sunil K Pandya
I support wholeheartedly the argument of Drs Chisholm and Sheather (1) in their essay in IJME that silence is not an option in times of conflict; but suggest that there are other situations in which this principle applies.
April 2018: Indian Journal of Medical Ethics
Rakhi Ghoshal
In their case study Cash and Castro discuss a situation where a physician's duties to the laws of her land stand in conflict with her fiduciary duties to her patient. This present commentary is a response to the situation they describe, and it engages with the issue of conscientious objection in medicine, to argue that the ethical responsibility of the physician should be tilted in favour of the patient, especially when the laws of the land are regressive and harmful.
April 2018: Indian Journal of Medical Ethics
Richard A Cash, Marcia C Castro
The Zika virus (ZIKV) epidemic is spreading: 67 countries are now reporting transmission, and over 2,000 cases of congenital Zika syndrome (CZS) have been confirmed. The heaviest burden has been borne by those living where poverty, poor infrastructure, and lack of access to health services are common and the penetration of Aedes aegypti is high. Because most cases are asymptomatic, the most dramatic signs of the disease appear through the CZS cases. In spite of the need for disaggregated epidemiological data to understand transmission patterns and evaluate interventions in vulnerable populations, there is no reliable count of ZIKV cases by sex and ethnicity (1)...
April 2018: Indian Journal of Medical Ethics
Anindita Majumdar
The routinisation of assisted reproduction in India has led to its proliferation and the easy identification of infertility. However, clinical and popular discourse tends to focus primarily on age-related deficiencies in reproduction. Here, both the "dangers" of declining reproduction as well as the facilitation of delayed reproduction are areas of focus and eulogisation. Bringing together the diverse elements of the medico-social conversation, the aim of this commentary is to examine the ways in which the ARTs are used to make sense of declining reproduction...
April 2018: Indian Journal of Medical Ethics
Piyali Mitra
The recent spectacular progress in assisted reproductive technologies (ARTs) has resulted in new ethical dilemmas. Though women occupy a central role in the reproductive process, within the ART paradigm, the importance accorded to the embryo commonly surpasses that given to the mother. This commentary questions the increasing tendency to position the embryonic subject in an antagonistic relation with the mother. I examine how the mother's reproductive autonomy is compromised in relation to that of her embryo and argue in favour of doing away with the subject-object dyad between them, particularly in the contexts of surrogacy and abortion...
April 2018: Indian Journal of Medical Ethics
Rakhi Ghoshal
A few weeks ago, a leading multi-city IVF clinic published an advertisement in a leading news daily. The advertisement sounded ominous, "The longer you wait, the lower your chances" - it referred to one's chances of getting pregnant. The subtext was far too easy to decipher: the content was thoroughly gendered and directed solely at women, particularly at career-oriented women who delay their marriages and childbearing plans far too long, supposedly lowering their fertility in the process. It also sounded benevolent in its attempt to warn these "erring" women...
April 2018: Indian Journal of Medical Ethics
Sunita Vs Bandewar, Leni Chaudhuri, Lubna Duggal, Sanjay Nagral
On Friday, March 9, 2018 the five-judge Constitution Bench (CB) of the Supreme Court of India (SCI) chaired by Dipak Misra, the Chief Justice of India, pronounced its judgment (1) (henceforth CC judgment) granting, for the first time in India, legal recognition to "advanced medical directives" or "living wills", ie, a person's decision communicated in advance on withdrawal of life-saving treatment under certain conditions, which should be respected by the treating doctor/s and the hospital...
April 2018: Indian Journal of Medical Ethics
Sanjay Nagral
I met Jonathan Fine for the first time in 2011. He was to travel back to Boston through Mumbai after a stint in Chattisgarh, where he had volunteered with Jan Swasthya Sahayog, the well-known rural hospital near Bilaspur. A friend suggested that since he was a doctor who had done pioneering work by setting up the renowned organisation Physicians for Human Rights, we should arrange a talk by him for medical students. A lecture was thus organised at my alma mater, the GS Medical College and KEM Hospital, where Jonathan spoke on "Why should doctors engage with human rights?" In his characteristic blunt style, rather than talk about his past, he exhorted the audience to visit Chattisgarh and see the severe inequities he had witnessed...
April 2018: Indian Journal of Medical Ethics
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