Lessons in medical ethics from ancient Indian teachers

Lessons in medical ethics from ancient Indian teachers ISSN: 2394-0026 (P)Review Article ISSN: 2394-0034 (O)Lessons in medical ethics from ancient Indian teachersPragnesh Parmar1*, Gunvanti B. Rathod2, Sangita Rathod3, Ashish Parikh41Associate Professor, Forensic Medicine Department, SBKS MI & RC, Sumandeep Vidyapeeth, Vadodara, Gujarat, India2Assistant Professor, Pathology Department, SBKS MI & RC, Sumandeep Vidyapeeth, Vadodara, Gujarat, India3Assistant Professor, Department of Medicine, AMC MET Medical College, Ahmedabad, India 4Consultant Physician, Gayatri Hospital, Gandhinagar, Gujarat, India*Corresponding author email: [email protected] to cite this article: Pragnesh Parmar, Gunvanti B. Rathod, Sangita Rathod, Ashish Parikh.Lessons in medical ethics from ancient Indian teachers. IAIM, 2015; 2(2): 161-164.Available online at www.iaimjournal.comReceived on: 08-01-2015 Accepted on: 27-01-2015AbstractAge of medicine is as old as the age of human on the earth. The doctor today is a scientist,technologist and healer at the same time. The ethics germane to the medical profession can’t besimple and uniform. Nor is the ethics simply a matter between the doctor and the patient; thesociety with its entire economic and political dimension is involved in much bigger way. Certain basictraditional thoughts given by ancient Indian teachers like Hippocrates, Charaka, Sushrutha andVagbhata are still become relevant. Medical ethics in the medical curriculum, must be included notas a normative discipline but as a practical course with its own problems and considerations. As perIndian outlook, the role of ethics is certainly vast and varied, from treating a common cold, to thecontroversy on euthanasia, from the simple obligations of a family doctor, to the specialist servicesin the high cost, high technology five star nursing homes.Key wordsLessons, Medical ethics, Ancient Indian teachers, Traditional thoughts, Indian outlook.Introduction that “the physician must be friend, philosopher, well-wisher and guide of the patient and theAge of medicine is as old as the age of human on family under his care” [1]. In the currentthe earth. In the golden era, doctor was not only scenario, hunger of earning more money isa healer, but family counselor and the tribal deteriorating doctor from his ethical and moralpriest, all at the same time. Sir William Osler toldInternational Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 161Copy right © 2015, IAIM, All Rights Reserved.

Lessons in medical ethics from ancient Indian teachers ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)values but still golden words told by golden men These are some of the problems which pertainlike Charaka, Sushrutha, Vagbhata etc. are very to the medical profession now and whichmuch effective to impart in our daily life. involves ethical consideration in addition toAncient teachers of India had shown us a medical. We have moved far away from thelightened path to improve ourselves not only as Hippocratic context. The ethics germane to thedoctor but also as human. medical profession can’t be simple and uniform. Nor is the ethics simply a matter between theThe present context doctor and the patient; the society (with itsRapidly expanding science and technology has entire economic and political dimension) isbrought revolutionary improvements in involved in much bigger way. The doctor’sdiagnosis and treatment. The doctor is playing integrity is now related to the drugs, drugthree roles as scientist, technologist and healer manufacturers, medical representatives, law,at the same time and it’s difficult to cope up the patient’s family, organized medicarewith all at a time. Drug industry, hospitals and services, and the doctor’s own standard ofnursing homes with high technology tend to living.become business houses nowadays. How hollow The ethics of prolonging life applies to severalwould the words sound when we read the other issues in the field. The terminally ill needdeclaration of the tenth World Medical peace, comfort and dignity, but advancedAssembly in Havana during 1956: “The primary technology often deprives them of these things,obligation of the physician is his professional in the misdirected effort to prolong theduty; in performing his professional duty, the obfuscation of the border line between life andphysician’s supreme guide is his conscience” [2]. death. In the present scenario, sophisticatedDoes the medical education imparted today surgical and medical technology can be easilytouch the mysterious ‘conscience’ in any abused. This is a reflection which underlines thepalpable way? The talk of medical ethics should need for a fresh reappraisal of medical ethics,revolve around this ‘conscience’ which is independent of the technological advance in theincreasingly becoming the ‘grin of the Cheshire field of medicine.cat’.Unfortunately for the medical technology, there The enduring valuesare now several hurdles which the conscience ofthe medical practitioner should cross or In the welter of all this confounding issues,circumvent, to maintain the so called certain basic considerations still becomeprofessional dignity; what his judgment would relevant. These were also touched bybe in cases like euthanasia, iatrogenic diseases, Hippocrates more than two thousand years ago,medico-legal responsibilities, pregnancy tests, as well as by the ancient Indian medical writersartificial insemination, organ transplantation, in- like Charaka [3], Sushrutha [4] and Vagbhata [5].vitro fertilization, embryo transfer technology, The Indian text books prescribe elaborately howgenetic engineering, use of cadaver or dying a physician must train himself to be an effectivepatients for their organ, and even blood healer, and how he must conduct himself intransfusion (which is objected by many religious society and with the patient.groups including Jehovah’s witnesses). These areissues which are ethical in character and import. The traditional Indian approach to the problem is indeed a simple one. But it deals with the core of the problem. That the approach does notInternational Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 162Copy right © 2015, IAIM, All Rights Reserved.

Lessons in medical ethics from ancient Indian teachers ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)envisage the technological advance of more The former remove the diseases and assure life,recent times or the population explosion, does while the later produces illness and remove thenot take away the merit of the approach, which life itself [3]. There were quacks and fakes evenconcerns itself with the essential values of the in the ancient times. They have been termedhealing art. ‘prathi-rupakas’ or ku-vaidyas. Even the law of the land laid a heavy hand on them. Manu, theIn the words of Charaka, the earliest Indian law-giver, enjoins that the fake physician mustmedical writer who lived centuries before the be severely punished [7]. Yajnyavalkya-smiritiChristian era, sickness prevents a person from lay down that a quack is to be fined heavily [8].pursuing his values of life which includesatisfying the normal desires and having the According to Charaka, the physician should be ausual pleasures of life, acquiring wealth and benefactor in as much as he facilitates people tosecuring financial comfort, leading a life of virtue attend to the three main objectives of life, viz.and social usefulness. This triad characterizes virtuous living, wealth and security, andnormal human life. The person who is sick is pleasures of life, for all the three depend onunable to lead a normal life, pursuing this triad, health. The physician in this sense is looked upand to this extent he threatens the society in on as a ‘donor’, for his gifts bodily health andwhich he lives and of which he is a part [3]. wellbeing. Yogarathnakara, a medieval work onValues of life are fulfilled only by a healthy medicinal preparations, said that the physician isperson. The physician who restores the health of most virtuous on this account and worthy of allthe person will indeed gift him with the values honor.of life. As we all know monetary considerations playFour are the gifts praised in the society: increasingly important and enormous role inproviding defense for the weak and helpless, modern society. A large number of young andfeeding the hungry, teaching those who want to brilliant aspirants take medical practice only forlearn, and treating the sick; and the best among the rich rewards that it entails. The social fabricthem is providing health to the sick. The Smriti has become so complicated and tangled thattexts are found to regard the physician in an one does not distinguish the competent and theexceptional light; the usual disabilities and honest doctor from the commercial mindedrestrictions of caste, status and so on, do not doctor who merely puts on airs. Ethics in thisapply to the physician, because what he does no context gets terribly out of gear. The old andone else in the society can do [6]. honored concepts of service, propriety, efficiency, integrity, honesty, commitment andMithkshara, the commentator of the famous sincerity do not seem to be applicable to thelaw-giver Manu said that the physician was modern times. The code of conduct, even whenalways pure and among the elite [6]. Charaka one has a notion of it, seems impracticable. It issaid that a physician is superior to a Brahmin, economics, and not ethics, that seem to rule thebecause if the Brahmin is twice born, once from roost.the mother and second time when threadingceremony is done, the physician is thrice born, Ideals to be pursuedwhen he completes his medical education [3].Charaka, however classified physicians into two Mahabharata, the great Indian epic, told us thatcategories: the right ones and the wrong ones. we must cultivate the physician who is wise,International Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 163Copy right © 2015, IAIM, All Rights Reserved.

Lessons in medical ethics from ancient Indian teachers ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)virtuous, pleasant, friendly, honest, and Referencescompassionate [9]. Adequate medical education 1. Shankar P.S. Values in health care. Theis no doubt ‘a light’ that will extend the horizon Journal of Postgraduate Medicalof one’s vision and refine ones native talent. The Education, Training and Research, 2007;education according to Charaka should enable 2(3): 1-2.the student of medicine to hold this light andenter in to the inner life of the patient, so that 2. World Medical Association, Regulationshe can treat him effectively; otherwise the in Time of Armed Conflict (1956; 1983),education is wasted [3]. Human right library, University of Minnesota.Medical ethics in the medical curriculum, must http://www1.umn.edu/humanrts/instrebe included not as a normative discipline but as e/armedconflict.html. Accessed on 26-a practical course with its own problems and 12-2013.considerations. The role of ethics is certainly 3. Sharma P.V. Charaka Samhita.vast and varied, from treating a common cold, Chaukhambha Orientalia, Varanasi,to the controversy on euthanasia, from the 2008.simple obligations of a family doctor, to the 4. Shrikantha Murthy K.R. Illustratedspecialist services in the high cost, high Susruta Samhita. Chaukhambhatechnology five star nursing homes. Vagbhata’s Orientalia, Varanasi, 2012.Ashtanga samagraha indicated that an efficient 5. Shrikantha Murthy K.R. Astangadoctor is friendly towards all, compassionate to Samgraha of Vagbhata, Parimalthe patients, happy when he sees healthy Publication, 2006.people, and composed when he finds that his 6. Rai Bahadur Srisa Chandra Vidyarnava.patient is unlikely to be saved; his good conduct Yajnavalkya Smriti with the commentaryis what distinguishes him [5]. of Vijnanevara called the Mitaksara and notes from the gloss of Balambhatta. Indian press, Allahabad, 1918.Finally the advice given by Charaka, may be Digitalised by University of Torrontopertinent for the doctors even today: ‘He whopractices not for money nor for caprice, but out press, 2010.of compassion for the living beings is bestamong all physicians. The physicians who set out http://www.archive.org/details/yajnavalto sell their skill like merchandise only lose sightof the gold and acquire heaps of dirt. Hard is to kyasnnritOOyj/ Accessed on 26-12-2013.find a conferrer of spiritual blessings comparableto the physicians who snaps the snares of death 7. Sharma R.N. (edi.). Manusmriti –for his patients and proffers renewed lease oflife for them’ [3]. At the end, we all should Sanskrit text with English translation ofaccept the quoting of Charaka that may allbeings be happy, may all beings be free from M.N. Dutt, Index of slokas and criticalailments, may all good occur to all people, mayno one be troubled with misery [3]. notes. Star Publishers’ Distributors, 1998. 8. Joshi K.L. (edi.). Yajnavalkya Smriti. 1st edition. Parimal Publications, 2006. 9. Dutta M.N. Mahabharata. Sharama and Bimali (edi). Chitrashala Press, Pune, 2010.Source of support: Nil Conflict of interest: None declared.International Archives of Integrated Medicine, Vol. 2, Issue 2, February, 2015. Page 164Copy right © 2015, IAIM, All Rights Reserved.