Chikitsa Dharma (Medical Ethics): Insights from Ancient Indian Tradition

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The Vivekananda International Foundation held an online discussion on 10th August 2020, on the subject of “Chikitsa Dharma (Medical Ethics): Insights from Ancient Indian Tradition”. The main aim of the discussion was to understand medical ethics in the historical, modern and general context so that India-specific issues such as current perceptions of doctor-patient relationship, approach to treatment of patients, issues faced by both doctors and patients during the pandemic, lack of faith in the medical institutions, the concept of holistic healthcare etc., can be addressed. The panel consisted of the two main speakers, Dr Arun Agarwal, Former President, Delhi Medical Council and current President, Delhi Council of Physiotherapy and Occupational Therapy, and Ms. Gunjan Pradhan, independent researcher and author of the book, Dharma in Governance: Towards a Welfare State and numerous research papers on public policy in the Indian context.

Dr Arvind Gupta, Director VIF initiated the discussion and gave the opening remarks, emphasising on the need for addressal and formation of medical ethics in India based on historical and general context and the present situation. He also highlighted the importance of doctor-patient relationship and the element of trust especially during the time of an ongoing pandemic.

On that note, the discussion started with Dr Arun Agarwal giving a clear and concise explanation of the basics of medical ethics. He began with an explanation of medical ethics from a modern point of view, which looks at morals, values, principles and the laws as guiding factors for proper and professional conduct. The key features of modern medical ethics were noted to be: Autonomy (freedom to the patient for thought, fully informed decision making, intention, action etc), Beneficence (Patients welfare), Confidentiality (of patients personal treatments and medical records), Do-no-harm (attempt to make sure that a medical procedure does not harm the patient or the society and if there is some risk then the patient is aware of the harm that may be caused due to treatment) , Equity/Justice (Fair and equal distribution of scarce health resources, and the decision of who gets what treatment). This was followed by a look at the ancient medical ethics and its comparison with modern medical ethics. It was observed that the Charaka Samhita gave an on-point description of the ideal doctor who should possess certain qualities, like should be unbiased, liberal, honest, patient etc. Here, it was also noted that ancient medical systems, unlike modern medical systems, focused on holistic treatment of patients. Basic ethics of Ayurveda for instance revolves around preservation of good health and ability to fight a disease.

Keeping the historical context in mind Dr Arun Agarwal pointed out that there are certain factors that have led to loss of faith towards modern medicine. This can be seen by a positive shift of people towards alternative medical treatments such as Ayurvedic treatments, homeopathy etc. A major weakness observed in the modern medical systems was the complete separation of doctors from the patient's situation as a part of their medical training leading to lack of empathy and a weak doctor-patient relationship. As far as quality of education is concerned, an increasing dependence of doctors on technology has led to fossilisation of the basic clinical skills of a doctor. There is also a perception of government hospitals being less effective as compared to private ones and most people want to go to the reputed hospitals only. The ability of people to go to the most specialised doctor in a field of medicine without proper referral or screening for common health issues is also a matter of concern. Overall, Dr Agarwal concluded that the main cause for people losing faith in today’s medical system was the lack of communication and realistic expectations when it comes to treatment both on the part of the patient as well as the doctors.

The next aspect of the discussion was addressed by Ms. Gunjan Pradhan Sinha who shared her insights on the importance of adopting the ancient systems of medical ethics and the ancient approach to treatment of individuals. She pointed out that modern medicine only deals with the mind and the body but the ancient system focused on the mind, the body and the soul. A lot of the issues faced by modern health care systems are solvable using the understandings of Charaka and Sushruta which emphasize prevention and cure of disease as well as promotion of good health. Good health in our ancient text refers to attainment of sukha and moksha, which means freedom from illness and suffering. Here, the speaker pointed out that pain and suffering are two different concepts that can exist in a mutually exclusive manner. For example, you can have a stomach ache but that would not be considered as suffering and during the pandemic while you might not have any illness or pain, you may still be suffering. Considering the above she concluded that medical ethics should also include a diverse and holistic approach to treatment of the patient.

Points pertaining to more expenditure on cure and less on prevention in India, lack of recognition of alternative medicine, a potential for India-centric medical ethic code based on our ancient systems and community health were addressed by Dr Agarwal. At the government level work is currently being done to create primary health care systems and centres for common health disease to reduce the load on the current medical system. The Ministry of AYUSH has also created a good perception of prevention. More awareness however is still required at community level especially regarding the chronic symptoms, their implications and the need to treat them. While the government is coming out with various awareness and medical programs, their effects ondiverse parts of India are different. Some programs are therefore effective throughout the nation, while others are more area and situation specific.

In the present situation for the betterment of the welfare of the people, it is important to bring all the medical systems together under one panel so that they can address each other's weaknesses and we can have a holistic healthcare system. However, when it comes to the inclusion of alternative medical systems for a holistic approach to treatment, a major issue is the competition between the various systems of medicine in today's time. For this, the modern and ancient systems should be brought together in India to form a comprehensive evidence based medical ethics system. There is also a requirement for more research in the sphere of alternative medicine so as to provide evidence of their effectiveness.

Lastly, Ms. Sinha addressed the way forward for the various medical systems to come together. Firstly, the need for communication and interdisciplinary research between the various medical systems to assess compatibility between their treatments so that the patients can be fully informed about the same was highlighted. Secondly, it was pointed out that in India the alternative medicine system is at a disadvantage for processing research patents as compared to foreign institutions due to excessive formalities and paperwork that slow down the processes of patenting research findings in India. Due to this, Indian research work done in the field of alternative medicine are often plagiarised, not to mention, the financial disadvantage that the alternative medicine research faces due to a comparative lack of funding.

It was finally concluded that there was a need to bring the various medical systems together to provide people with holistic treatment and to address the lack of faith people have started to develop when it comes to the allopathy based medical system. Ancient ethical principles must be added to the modern code of ethics to make an India-centric code of medical ethics. This would be useful in rebuilding trust in the doctor-patient relationship in India. Lastly, proper interdisciplinary research and communication is required between the various medical systems.