Ethics: April 2025 UPSC Current Affairs | UPSC Mains: Ethics, Integrity & Aptitude PDF Download

Compassion in Primary Health Care 

Why in News?

The World Health Organization (WHO) has released a report titled “Compassion and Primary Health Care (PHC),” emphasizing the importance of compassion in enhancing PHC and addressing the growing mental health challenges through patient-centered and dignified care.

What is the Significance of Compassion in PHC?

About: Compassion in PHC involves recognizing human suffering and taking action to alleviate it within the framework of essential health services. It is not merely a moral value but a practical factor that improves the quality, accessibility, and equity of care.

• Significance: Compassion is distinct from sympathy and empathy. Sympathy is passive and driven by pity, while empathy can lead to emotional exhaustion. Compassion, on the other hand, combines emotional connection with thoughtful action, making it a more sustainable and effective approach in healthcare.
• Role in Healthcare: In India, the lifetime prevalence of mental disorders is 13.7%, with 15% of the adult population experiencing mental health issues. The WHO estimates a burden of 2443 disability-adjusted life years (DALYs) per 10,000 population due to mental health problems. The economic loss from mental health conditions between 2012 and 2030 is projected at USD 1.03 trillion.
• Treatment Gap:. significant treatment gap exists, with 70% to 92% of individuals with mental disorders not receiving proper treatment due to factors like lack of awareness, stigma, and a shortage of professionals.
• Rising Mental Health Issues: With increasing cases of depression and anxiety, compassion in healthcare has become crucial. It fosters people-centered care by making services more responsive, respectful, and holistic.
• Continuum of Care: Compassion strengthens the entire health continuum, including prevention, health promotion, treatment, rehabilitation, and palliative care, ensuring effective and empathetic care delivery.
• Inclusive Care: Compassion promotes inclusive care for marginalized groups such as Dalits, Adivasis, LGBTQ+ individuals, persons with disabilities, and others.

Case Studies Related to Compassionate Healthcare

• ASHA Worker Responding to Domestic Violence: An ASHA worker, Praveena Ben, extended her role beyond maternal health to address domestic violence by ensuring private referrals and trauma-informed care, upholding the dignity and autonomy of survivors.
• Tamil Nadu’s Disaster-Ready PHCs: Tamil Nadu’s health system exemplifies ethical governance by training PHC staff for disaster response and ensuring swift, humane action during crises through interdepartmental coordination and ethical resource allocation.
• Clinical Courage in Tribal Areas: Dr. Vidith Panchal of Amrit Clinic (NGO: Basic Health Services) demonstrated ethical courage by treating a critically ill TB patient, Tukaram, locally despite poor infrastructure, prioritizing the patient’s dignity and comfort in end-of-life care.

What Can Be Done to Enhance Compassionate Healthcare in India?

• Institutionalise Compassion: Integrate compassion as a measurable dimension of Quality of Care (QoC) in healthcare provisioning, as emphasized by the National Health Policy, 2017.
• Mandate Compassion Checklists: Implement compassion checklists in Health and Wellness Centres (HWCs) under Ayushman Bharat to enhance patient-provider interactions.
• Enhance Capacity of HWCs: Train health workers in trauma-informed and culturally sensitive care, and equip Accredited Social Health Activists and Auxiliary Nurse Midwives with skills in compassionate communication, particularly in sensitive areas like domestic violence and mental distress.
• Integrate Compassion Metrics in Audits: Incorporate compassion scores from patient feedback systems into outcome-based health grants recommended by the 15th Finance Commission to incentivize compassionate healthcare.
• Reform Curriculum: Introduce educational modules on compassionate leadership, grief counselling, and end-of-life communication in relevant training programs.
• Mental Health Interventions: Embed empathy training modules for first-level responders in Tele MANAS, a mental health intervention operational in multiple languages, to enhance the empathetic response of service providers.
• Adopt Community Engagement Strategies: Promote home visits, maternal counselling, and community health dialogues to foster compassionate healthcare practices at the community level.

Case Study 1: Balancing Development and Environmental Justice

Questions:
(a) What are the ethical issues involved in this case?
(b) Who are the stakeholders, and what are their interests?
(c) What options are available to you, and which course of action would you adopt?
Ans:
(a) Ethical Issues Involved:

• Environmental Ethics vs. Developmental Ethics: The conflict between economic growth and the preservation of ecological balance and indigenous rights.
• Integrity and Transparency: The potential bias in the EIA report raises questions about the integrity of the approval process.
• Justice and Equity: The displacement of indigenous communities and the unequal distribution of project benefits violate principles of social justice.
• Duty vs. Pressure: Balancing your duty to uphold environmental laws and public welfare against pressure from higher authorities.

(b) Stakeholders and Their Interests:

• Multinational Company: Seeks project approval for profit and market expansion.
• Indigenous Community: Wants to protect their land, culture, and livelihood.
• Local NGOs: Advocate for environmental conservation and community rights.
• State Government: Prioritizes economic growth and infrastructure development.
• Local Population: Expects job opportunities but may face environmental consequences.
• Environment (Flora and Fauna): Non-human stakeholders affected by potential ecological damage.

(c) Options and Course of Action:

• Approve the Project Immediately: This aligns with government pressure but risks ecological damage and community displacement, violating ethical principles of justice and non-maleficence.
• Reject the Project Outright: This protects the environment and community but may lead to economic losses and political backlash, potentially harming your career.
• Conduct an Independent Review: Order a fresh, transparent EIA by a neutral agency and involve community stakeholders in the process. This balances development and environmental justice but may delay the project.
• Engage in Public Consultation: Hold public hearings to incorporate community and NGO inputs, ensuring transparency. This may prolong the decision-making process.

Recommended Course of Action:
Adopt a combination of options 3 and 4. Order an independent EIA to verify the claims of the original report, ensuring compliance with environmental norms. Simultaneously, conduct public consultations to involve the indigenous community and NGOs, fostering trust and transparency. Communicate the findings to senior officials with evidence to justify delays, emphasizing long-term sustainability over short-term gains. This approach upholds environmental ethics, ensures procedural justice, and mitigates career risks by demonstrating due diligence.

Case Study 2: Media Ethics and Public Safety

Questions:
(a) What are the ethical dilemmas in this case?
(b) What are the possible courses of action, and their implications?
(c) What would be your final course of action, and why?
Ans:
(a) Ethical Dilemmas:

• Media Ethics vs. Public Safety: Balancing the responsibility to inform the public with the potential harm of inciting communal violence.
• Personal Gain vs. Social Responsibility: The temptation to boost career prospects and channel ratings conflicts with the duty to prioritize societal harmony.
• Freedom of Expression vs. Harm Prevention: Allowing the leader’s views to be aired as free speech versus preventing statements that could disrupt law and order.

(b) Possible Courses of Action and Implications:

1. Present the Interview to the Editor-in-Chief: This could lead to airing the interview, boosting TRPs but risking communal unrest and legal consequences.
2. Suppress the Interview Entirely: This prevents potential harm but may be seen as censoring free speech and could lead to professional repercussions from the Editor-in-Chief.
3. Request a Re-Interview: Ask the political leader to rephrase inflammatory remarks in a way that expresses dissent without inciting violence. This mitigates harm but may not guarantee compliance.
4. Air Edited Content with Context: Edit the interview to remove provocative statements and provide context to promote constructive dialogue. This risks accusations of bias but reduces harm.

(c) Final Course of Action:
Choose option 3, requesting a re-interview with the political leader to reframe their statements in a way that respects public safety while expressing their viewpoint. If the leader refuses, opt for option 2 and withhold the interview from the Editor-in-Chief, citing ethical responsibilities under media codes of conduct. Simultaneously, engage with the reporter to develop alternative stories that maintain viewership without compromising societal harmony. This approach prioritizes non-maleficence and social responsibility while addressing professional pressures.

Case Study 3: Duty vs. Personal Values

Questions:
(a) Identify the ethical issues and stakeholders in this case.
(b) What options are available to you, and what are their pros and cons?
(c) What would be your course of action, and why?
Ans:
(a) Ethical Issues and Stakeholders:

Ethical Issues:

• Duty vs. Morality: The conflict between following official orders and adhering to personal values of non-discrimination and justice.
• Social Justice: Targeting a specific ethnic group risks perpetuating systemic discrimination and violating human rights.
• Integrity: Acting against your conscience could undermine your credibility as a public servant.

Stakeholders:

• Targeted Ethnic Group: Seeks protection from displacement and discrimination.
• Ruling Party: Wants to maintain political control and public order.
• Local Community: Divided, with some supporting relocation and others opposing it.
• Yourself: Faces career risks and a moral dilemma.
• Civil Society/NGOs: Advocate for the rights of the marginalized group.

(b) Options, Pros, and Cons:
Comply with the Order:

• Pros: Avoids career repercussions and aligns with official duties.
• Cons: Violates ethical principles, risks escalating tensions, and harms the targeted community.

Refuse the Order Outright:

• Pros: Upholds personal values and protects the community.
• Cons: Risks disciplinary action, transfer, or career stagnation.

Conduct an Investigation: Assess the ground situation to verify claims of unrest and engage community leaders to find alternative solutions.

• Pros: Evidence-based decision-making, promotes dialogue, and delays discriminatory action.
• Cons: May face resistance from superiors and prolong tensions.

Seek Legal Recourse: Escalate the matter to higher authorities or courts, citing violations of constitutional rights.

• Pros: Upholds rule of law and protects the community.
• Cons: Time-consuming and may escalate political tensions.

(c) Course of Action:
Adopt option 3, conducting a firsthand investigation to assess the situation objectively. Engage community leaders, NGOs, and local police to verify claims of unrest and explore non-discriminatory solutions, such as dialogue forums to reduce ethnic tensions. Document findings and communicate them to superiors, recommending evidence-based measures over relocation. If pressure persists, consider option 4 by seeking guidance from higher authorities or legal bodies to protect constitutional rights. This approach balances duty, morality, and social justice while minimizing career risks.

Case Study 4: Integrity in Public Procurement

Questions:
(a) What are the ethical dilemmas and stakeholders involved?
(b) Evaluate the options available to you.
(c) What course of action would you adopt, and why?
Ans:
(a) Ethical Dilemmas and Stakeholders:
Ethical Dilemmas:

• Public Safety vs. Project Timelines: Ensuring project quality and safety conflicts with the pressure to meet deadlines.
• Integrity vs. Political Pressure: Taking action against the contractor risks political backlash, while ignoring the issue compromises public trust.
• Accountability: Addressing the bribery scandal involves holding subordinates accountable while maintaining departmental credibility.

Stakeholders:

• Public: Expects safe and reliable infrastructure.
• Contractor: Seeks profit and project continuation.
• Junior Official: Involved in the bribery, faces disciplinary action.
• Senior Officials: Prioritize political stability and project completion.
• Your Department: Risks reputational damage if the scandal is exposed.

(b) Options Available:

Ignore the Issue: Allow the contractor to continue, ensuring timely completion.

• Pros: Avoids delays and political conflict.
• Cons: Compromises safety, violates integrity, and risks future accountability.

Terminate the Contract: Cancel the contract and blacklist the contractor.

• Pros: Upholds safety and integrity.
• Cons: Causes delays, legal disputes, and political pressure.

Impose Penalties and Monitor: Fine the contractor, replace substandard materials, and enforce strict quality checks.

• Pros: Balances safety and progress, holds contractor accountable.
• Cons: Requires robust oversight and may face resistance.

Expose the Scandal Publicly: Report the bribery to anti-corruption authorities and media.

• Pros: Promotes transparency and deters future corruption.
• Cons: Risks career repercussions and project disruption.

(c) Course of Action:
Choose option 3, imposing heavy penalties on the contractor and mandating the replacement of substandard materials under strict supervision. Initiate disciplinary action against the junior official as per service rules. Strengthen quality control mechanisms by involving independent auditors to prevent future lapses. Inform senior officials of the actions taken, emphasizing public safety and legal compliance. If political pressure intensifies, consider option 4 by escalating the matter to anti-corruption bodies discreetly. This approach ensures accountability, prioritizes public welfare, and mitigates risks to the project and your career.

Case Study 5: Emotional Intelligence in Workplace Conflict

Questions:
(a) What are the ethical and emotional intelligence issues in this case?
(b) Who are the stakeholders, and what are their interests?
(c) What steps would you take to resolve the conflict, and why?
Ans:
(a) Ethical and Emotional Intelligence Issues:
Ethical Issues:

• Workplace Harmony: The conflict disrupts team cohesion, violating the principle of fostering a positive work environment.
• Fairness: Allegations of favoritism and authority undermining raise questions about impartiality and respect.
• Leadership Responsibility: As the head, failing to address the conflict compromises your duty to ensure organizational efficiency.

Emotional Intelligence Issues:

• Self-Awareness: Anil and Priya lack awareness of how their actions affect others.
• Empathy: Both officers fail to understand each other’s perspectives, escalating the conflict.
• Relationship Management: Their inability to communicate constructively harms team dynamics.

(b) Stakeholders and Their Interests:

• Anil and Priya: Seek respect, authority, and recognition for their contributions.
• Subordinates: Want a harmonious workplace and clear leadership.
• Department: Needs efficient project delivery and high morale.
• Yourself: Responsible for resolving the conflict and maintaining departmental performance.
• Public: Expects timely delivery of public services.

(c) Steps to Resolve the Conflict:
Private Meetings with Anil and Priya: Meet each officer individually to understand their grievances, using active listening to build trust. Emphasize the impact of their conflict on the department.

• Why: Demonstrates empathy and allows them to express concerns without confrontation.

Mediation Session: Facilitate a joint meeting to encourage open dialogue, setting ground rules for respectful communication. Help them identify common goals, such as project success.

• Why: Promotes mutual understanding and collaboration, addressing emotional intelligence gaps.

Clarify Roles and Responsibilities: Issue a formal memo defining their roles, task assignments, and decision-making protocols to prevent future disputes.

• Why: Ensures fairness and reduces ambiguity, addressing allegations of favoritism.

Team-Building Initiatives: Organize workshops on emotional intelligence and workplace ethics to foster a positive work culture.

• Why: Strengthens team cohesion and prevents similar conflicts.

Monitor Progress: Set up regular check-ins to ensure compliance with new protocols and assess team morale.

• Why: Ensures sustained improvement and accountability.

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