It is still a mystery
that since when we inhabited this planet and from where did the human race
evolve. But we now believe that our
species has a history of more than ten thousand years based on various dating
techniques and material decay studies. Human life has always been valued and
caring of the sick by other members of the community is practised. From the
time when different herbs were used empirically to treat ailments before the
Chriatian era to today where we witness heart, lung and liver transplants, Lobotomy,
Septal myectomy, Sex Reassignment Surgery (SRS) and many more, numerous advancements
in the field of health and medicine can be acknowledged. Since the Hippocratic
time, many breakthroughs were made at different points of time. After training
of physicians began in early 13th century in Italy, healthcare was systematized.
The invention of microscope in the 17th century , postulation of ‘The Germ
Thoery of Disease’ in the 19th century, discovery of antibiotics, invention of
X-rays and use of ultrasonography in medicine, all these accelerated the
medical field towards its ‘post-modern’ era.
Analyzing the rapid development of the science and technology and its
consequences in medicine, a German philosopher and educator, Fritz Jahr
presaged the controversial situations relating health care and ethics that
might arise in the future due to the exponential growth of such inventions that
once seemed impossible, and coined the term ‘Bioethics’ in 1926 which refers to the study of typically controversial ethical
issues emerging from new situations and possibilities brought about by advances
in biology and medicine. Some of the controversial issues in this topic are stem cell research,
cloning, gene therapy, life extension, fetal gender identification, abortion,
euthanasia, surrogacy, doctor-patient confidentiality, and many more. It is not
possible to prepare an exhaustive list of the issues that might relate to
bioethics and every medical professional faces such controversial issues every day.
Due to the increased abortion rate of female fetus in India and other
countries of South Asia, laws have been made to illegalise abortion after
identifying the gender of the fetus. Would you perform the abortion if a three month pregnant female approached to
you stating that her husband threatened to kill her if she didn’t abort the
female fetus she had ? Would you change your decision if she revealed that she
already had six daughters? Though determining the sex of fetus is illegal
in Nepal, the rate of abortion of female fetuses has not declined over years
due to poor implementation of laws. Opponents of abortion debate that abortion
should be illegal whatever may be the reasons. When do we assume that life
starts exactly ? Does the legalised provision of terminating pregnancy upto 12
weeks voluntarily give us the authority to kill the fetus which has the
potential to grow into a full human ? Is it justified to terminate life of a
being if that is helpless and doesn’t retaliate ? We must ponder about these things before
taking any action. Similarly, Euthanasia, the practice of intentionally ending a life in order to
relieve pain and suffering, more commonly known as mercy-killing, has brought
upon the conflict that upto what point should the efforts to restore the health
of the patient be continued and when should it be opted to terminate life. We
feel sorry for the dead and go to the funeral because we value human lives. The
day we feel dispassionate about death, we depreciate our lives.
A physician should never disclose the personal information of the patient
to others, even after the death of the patient. This ethical principle of
doctor-patient confidentiality may put a psychologist in such a dilemma
sometimes that he cannot decide whether or not should he report to the
authority that his depressed patient revealed that he felt like killing his
wife many times. Does he have to confide to the patients’ privacy or should he
report to prevent an impending crime?
Should the general physician refer the patient to another specialist for
a particular treatment or should he continue using empirical methods for the management
of symptoms ? The treatment plan what is best generally may not be the best for
that particular patient. Are there any special conditions where exceptions can
be made about the latin phrase ‘primum non nocere’ , meaning ‘first do no harm’
? Does it have an asterisk at the end and a footnote where it states that exceptions
can be made in any special circumstances ? A physician must always keep his
mind clear about these ethical controversies and prioritize the patients’ needs
as the utmost important.
Human embryonic stem cell research has great prospects in future of
medicine and surgery. Those pluripotent stem cells could be used to regenerate
any body parts and restore any devitalised tissue. However, the harvesting of
stem cells from human embryos involving their destruction is again
controversial. Adult stem cells, amniotic stem cells and induced pluripotent
stem cells could be used as alternative possibilities which do not involve
human embryos and consequently are not questioned for bioethics. Could we be
assured that it doesn’t have the potential to be misused in such a world where
we have already faced problems like nuclear attacks and bioterrorism ? Would we
feel more accomplished if we are successful to attain immortality or would we
add more problems on the top of the existing problems?
Ascertaining the necessity of spreading the essence of ‘Bioethics’ among
all the health professionals and to the general public, the UNESCO Chair in
Bioethics (Haifa) has started celebrating World Bioethics Day on 19th
October every year from 2016 which is celebrated by 106 UNESCO Chair in
Bioethics International Units in 57 different countries over the world
including Nepal.
Human
rights are inalienable fundamental rights to which a person is inherently entitled simply because he or
she is a human being regardless of their nation, language, religion, or any
other status. Every health
care provider must keep in mind that he is not just treating a physical body
with ailments, he is treating someone’s son, father, husband, brother and many
others’ somebody who has a special value in their lives. Would he have done the same
treatment to his son if he were the patient ? The patient must be respected and treated with
dignity whether he be a child, a bankrupt, a mentally ill, a differently able,
an ally or an adversary. We should never forget our limitations over nature and
should always confide to the bioethical principles. The ethical dilemma is the
most difficult dilemma to get over with. And that is when knowledge, morality,
conscience, emotions , ethics, justice and promptness all have to be integrated to reach
a conclusive decision for not compromising the patient’s life, dignity and human rights. So, all patients should be
treated irrespective of their race, religion and riches respecting their Human
Rights.
