Ethical issues in health care sector in India

The issue of ethics and economic efficiency in the provisioning and delivery of services becomes complex in the Indian context where health indicators are poor. In an attempt to explore this issue, this round table article first provides an overview of the field of ethics in health care, the health care sector in India and its facilities, the key institutional actors and finally, the key ethical issues concerning the different players in health care e the physician, the bio-pharmaceutical industry, and the chemist. In its second part, the article reports on a discussion of the issues with a panel of experts across geographic and organisa-tional settings. Health care institutions across the world are facing challenges in the delivery and provisioning of services with financial solvency. Patient care now competes with the financial solvency of the health care institutions (Silverman, 2000), and the issue of ethics has become more relevant than at any other point in time. Health care services have a special moral quality. The purposes of health care services include saving lives, preventing or relieving suffering, preventing and curing disease and disability, and ameliorating the consequences of disease when it cannot be prevented or cured. Few people can be morally comfortable with the idea that some people should be denied access to health care that might relieve their suffering or save their lives because they cannot pay for it (Enthoven, 1993). In the Indian context, where health indicators of the country are poor, the discourse on ethics assumes greater complexity and requires a more nuanced understanding and appreciation of the contextual elements. This note attempts to provide a brief overview of the field of ethics in health care, the status of the health care sector in India, the key institutional actors and finally, the key ethical issues arising out of the interactions across the various actors. The field of medical ethics has long existed, arising from the Hippocrates oath, and tenets of the early religious healing traditions of the West. Several Asian traditions have also had ethical tenets governing the physicianepatient relationship (Tsai, 1999; Desai, 1988). In the field of contemporary medical ethics, the doctors in the USA were the first to develop a modern code of ethics. At the first meeting of the American Medical Association (AMA) in 1846,