Thursday, 22 January 2015

Sterilization Menace an International Concern

Some concerns of World Medical Association, answered by Prof Dr K K Aggarwal, Padma Shri Awardee, Honorary Secretary General IMA

Q 1:      Some doctors would be offered compensation to do as many sterilizations as possible in the camp. Is this the case? if so, this would constitute a clear unethical inducement, not placing the health of their patients as their first consideration.

A:  Ministry has targets for the government doctors. Normally private doctors do not do such camps.   Central Council decision of IMA on 27th December: "IMA has asked for defined protocols for medical professionals for organizing medical and surgical camps. IMA is against any unrealistic targets given to government doctors.

As per IMA guidelines which are also consistent with Govt. guidelines, in one day, more than 30 such surgeries should not be done.   IMA wrote to Shri Lov Verma, Health Secretary, Deptt. of H&FW, in early January, to ensure that no unrealistic targets are given to any government doctor in any state.  

As per MCI ethics regulation 1.7 it is the duty of a doctor to expose the unethical acts of others.
MCI 1.7 Exposure of Unethical Conduct: A Physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession.      

Q 2: Women would undergo surgeries in very questionable hygienic conditions (on the ground, without sterilized medical instruments). Here again, by doing so, doctors would obviously not place the health of their patients as their primary consideration. In addition, this would clearly be contrary to the dignity of the women. Has the Indian Medical Association checked these facts?          

A:  IMA has written to the health ministry regarding this.  Hygienic conditions gets worse only if they surpass their targets. In the present Vilaspur case there were some cases of infections. IMA is in process of uploading its and governments guidelines regarding infection control in camps.  
As per MCI ethics regulation 2.4 the patients once taken charge must not be neglected.
MCUI 2.4 The Patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care.      

Q 3:  Some doctors would do as many sterilizations as possible under pressure by the State for fear of losing their position. Doctors would then be coerced, undermining their autonomy to carry out their mission according to medical ethics principles. Have you investigated such a potential coercive action by government authorities?                  

A: See answer to first column as the IMA response. Also only a doctors can put pressure under the junir one and here the MCI ethics regulation 1.7 apply.
q 4:   Women would be proposed sterilization as the only contraception method. Can you confirm these information? This would touch upon the right to information of the patients. How can women make a decision on such a key and intimate issue without other options offered?  Linked to this, the issue of consent of the patients should also be investigated: the women being sterilized would be living in poverty and be illiterate. In these conditions, are they not likely to be influenced (if not manipulated), potentially lacking the capacity to take the best decision for their health and well-being?  There is a clear scope to question the validity of the informed consent of the patients. Has the Indian Medical Association inquired about these facts?                    

A: Weather in government or in private sector in India no surgery can be done without informed consent.   As per MCI ethics regulations 7.16 Before performing an operation the physician should obtain in writing the consent from the husband or wife, parent or guardian in the case of minor, or the patient himself as the case may be. In an operation which may result in sterility the consent of both husband and wife is needed.   In the informed consent all women are given choices of all forms of contraception. Failed sterilization also has a compensation clause.

Q 5: All these factors would bring us to the conclusion of cases of forced and coerced sterilization condemned by the WMA  as well as by other health and human rights organisation. The recent inter agency statement (WHO, UNICEF, OHCHR, UN Women, UNAIDS, UNDP, UNFPA). Eliminating forced, coercive and otherwise involuntary sterilization goes along the same line.

A: IMA is against forced, coercive and otherwise involuntary sterilization  so is Indian government.          

Q 6: Therefore, the issue of the spurious drugs supplied by the Government in these camps that you mention in your response is just one amongst many other issues that are of very serious concerns to us. If the reports are correct, we see various reasons to raise our voice, given the severe violations of medical ethics and unprofessional behavior as potentially coercive action by government authorities.

A: The issue of spurious drugs is under criminal investigations.  Law will takes its own action. Soon in all government supply only government quality approved drugs are to be supplied.              

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