Ethical principles such as autonomy, beneficence, and nonmalfeasance and double effect

REVIEW ARTICLES Year : 2005 Volume : 9 Issue : 2 Page : 81-85
End-of-life issues for a modern India - Lessons learnt in the West Puri Vinod K

St John Health System, Providence Hospital and Medical Centers, Southfield, MI, USA

Consideration of end-of-life issues is a relatively new phenomenon in the Indian context. It is difficult to assess the magnitude of the problem except the certainty that these issues will affect more patients and their families in the future. The approaches used in the West to prepare patients and public in general such as living will and durable power of attorney have not always been useful. The religious and social attitudes have an effect on facing end-of-life issues and yet these attitudes are in transition. The lack of education in bioethics and paucity of case law is reviewed. New approaches to the end-of-life issues in the light of experience gained in the West are suggested...

The essence of developing census on bioethical issues is to reconcile differing points of view, debate the ethics and logic of legal opinions and to adopt pragmatic but principled solutions. It is obvious that the justices need to reconcile the views they have expressed about article 21 of the Indian constitution. The differences between withdrawal of life support as distinct from suicide or murder appear to escape the sensibilities of some jurors.

It is not surprising that most of the articles Mani cites are US references for legal opinions. His excellent review discusses the ethical principles such as autonomy, beneficence, and nonmalfeasance and double effect. Many of these concepts have evolved from the Judeo-Christian ethos and from the work of European philosophers over many centuries.[3],[4] An equally vigorous effort to address bioethical issues raised by rapid advances in medicine has been joined by ethicists, physicians, and law people. [5],[6],[7],[8],[9] The medical students receive education in ethics. The residents and practicing physicians continue to receive instruction during their training and years of practice.

The principles of informed consent and autonomy are inter-related and are likely to be considered universal human values in the modern world. Therefore, the application of these ethical principles to Indian medical practices is inevitable in the future. And yet it is appropriate to enquire about the experience gained in the West. Puri Vinod K