Ethics in surgical practice: an Indian viewpoint.

It is a matter of concern that medicine all over the world is often practised without proper and strict ethical controls and monitoring. A survey of surgical opinions on ethics in Canada' revealed that even though a general sensitivity for clinical ethics was present amongst the members of the national association of surgeons, there was a lack of formal education and the existence of properly constituted ethics committees for the purposes of monitoring. A large number of hospitals did not appoint consultants for education in ethics and monitoring of ethical practices. The scenario in India is worse, with hardly any institution having functional and effective ethics committees. It is, therefore, time that greater attention is paid to this aspect of surgical practice in India. Although it may not be possible or even desirable to formulate a code of ethics that covers all eventualities, a beginning at least ought to be made. The Indian Council of Medical Research has recently conducted a nationwide survey of ethical practices as prevalent in India and has formulated guidelines for the practice of research on human studies. Ethics has an individualized or personal component and, in the case of professionals, also involves interaction with patients, their relatives and professional colleagues. This component is best defined by three Ds-discipline (a negative trait because it involves self-denial), development (positive trait) and dedication (a healthy trait). Unfortunately, not many professionals seem to possess these traits. Contrary to the philosophy of upholding departmental and larger institutional interests above oneself, a self-centered individualistic approach is prevalent. For the benefit of society, it is, therefore, mandatory that the ethics of sacrificing self-interest is learnt and practiced. Professional ethics and the judgements of a surgeon should not be influenced by secondary interests such as financial gains or personal prestige and should not lead to conflicts of interest in research, education and patient care.' The best strategy in dealing with such conflicts by institutions and administrators is a policy of disclosure and transparency of a review process which would minimize conflict-raising activities. Like personal ethics, the professional ethics of a surgeon also have three important components--conduct in surgical practice, surgical teaching and training, and surgical research.