Medical and Biotechnology Ethics | UPSC Mains: Ethics, Integrity & Aptitude PDF Download

Medical Ethics

Medical Ethics is the applied branch of ethics that defines the moral principles guiding the conduct of medical practitioners.
The four pillars of medical ethics are:

• Beneficence: The principle that medical intervention should aim to benefit the patient and promote their well-being.
• Non-maleficence: The duty to avoid causing harm to patients, ensuring that medical actions do not lead to injury or suffering. This principle is part of the Hippocratic Oath that doctors take.
• Autonomy: The right of patients to make their own decisions regarding their treatment, based on their personal values and preferences.
• Justice: The principle of fair distribution of healthcare resources, ensuring that everyone has equal access to necessary medical care.

Ethical Issues Involved in the Medical Field

• Issue of medical negligence: Medical negligence occurs when healthcare professionals fail to provide the expected standard of care, leading to harm or injury to the patient. This can include errors in diagnosis, treatment, or patient care that result in preventable damage.
• Collusive termination of pregnancy: This refers to unethical practices where medical professionals, in collaboration with other parties, perform abortions under false pretenses, such as falsifying medical records or misleading the patient about the necessity of the procedure for financial or other reasons.
• Medical fraud for monetary benefits: This involves healthcare providers engaging in deceptive practices for financial gain, such as overcharging for treatments, falsifying medical records, or prescribing unnecessary procedures to increase profits.
• Vadodara hospital shows kidney patients as HIV positive in medical reports, organ trade, higher bills for minor diseases: In this case, the hospital falsely labels kidney patients as HIV-positive in their medical reports, likely to manipulate them into selling their organs, thereby engaging in illegal organ trade. Additionally, the hospital inflates medical bills for minor diseases to increase their revenue, further exploiting patients for financial gain.

To deal with medical issues Code of medical ethics provides for the following provisions:

• Character of a Physician: A physician must uphold the dignity and honor of the medical profession, with the primary goal of serving humanity. Physicians should be knowledgeable in healing, maintain purity of character, and be diligent in their care for the sick. They must act with modesty, patience, and promptness, without anxiety, and behave with propriety in both their professional and personal lives.
• Maintaining Good Medical Practice: Physicians should constantly improve their medical knowledge and skills, sharing their expertise with patients and colleagues. They should use scientifically based healing methods and avoid collaborating with anyone who does not adhere to these principles.
• Maintenance of Medical Records: Physicians are required to keep medical records of their indoor patients for a period of three years from the start of treatment.
• Use of Generic Names of Drugs: Physicians should, whenever possible, prescribe drugs by their generic names, ensuring rational prescriptions and appropriate drug use.
• Exposure of Unethical Conduct: Physicians have an obligation to expose any unethical behavior, such as incompetence, corruption, or dishonesty, within the profession.
• Obligations to the Sick: While a physician is not obliged to treat every individual who requests their services, they must advise a patient to seek another physician if necessary. However, in an emergency, the physician must provide treatment. Physicians should never arbitrarily refuse treatment.
• Prognosis: Physicians should avoid exaggerating or downplaying the seriousness of a patient's condition. Consultations should be beneficial to the patient, timely, and free from rivalry or insincerity. Physicians should not criticize the referring physician.
• Physician-Assisted Suicide and Euthanasia: The Hippocratic Oath states that physicians should not provide deadly medicine or counsel on its use. However, in cases of terminal illness or irreversible life-threatening diseases, it may be ethical to cease attempts to prolong life, allowing death with dignity.
• Strikes by Physicians: Despite the essential nature of medical services, it is unethical for physicians to go on strike and withhold medical care.
• Rebates, Commissions, and Courtesies: It is unethical for physicians to offer or accept gifts, bonuses, or kickbacks for referring patients or recommending treatments. Receiving gifts from pharmaceutical suppliers or medical equipment manufacturers is also unethical.
• Research and Publications: Fraudulent research practices, such as plagiarism or data manipulation, should be condemned and punished as professional misconduct. The proper codes of conduct should be followed for scientific publications.
• Professional Certificates: Physicians should not issue false medical certificates for personal or monetary gain, or under political or bureaucratic pressure.
• Running an Open Shop (Dispensing Drugs and Appliances): Physicians should not operate a shop for dispensing medications or medical appliances prescribed by other doctors.
• Human Rights: Physicians must not assist in torture or inflict mental or physical harm. They should not conceal any acts of torture inflicted by others, as this would be a violation of human rights.
• Adultery or Improper Conduct: Physicians who abuse their professional position by engaging in adultery or improper conduct with a patient, or by maintaining an improper relationship with a patient, will face disciplinary action as per the Indian Medical Council Act, 1956 or the relevant State Medical Council Act.
• Sex Determination Tests: Physicians should never perform sex determination tests with the intent to terminate a female fetus, unless it is required by the Medical Termination of Pregnancy Act, 1971, for valid medical reasons.
• Non-disclosure of Medical Information: Physicians must maintain confidentiality regarding patient information unless required by law, in cases where there is a serious risk to a person or community, or when dealing with notifiable diseases, in which case public health authorities should be informed.
• Prohibition from Denying Duty: Physicians cannot refuse to assist in procedures such as sterilization, birth control, circumcision, or medical termination of pregnancy solely on religious grounds, unless they feel personally incompetent to perform the procedure.
• Prohibition of Using Touts or Agents: Physicians should not use agents or touts to procure patients.
• Claiming Specialization: A physician should not claim to be a specialist unless they possess the necessary qualifications in that specific branch of medicine.
• Informed Consent for Assisted Reproductive Technologies: No in vitro fertilization or artificial insemination procedures should be conducted without the informed consent of both the female patient and her spouse, as well as the donor.

Biotechnology and Ethics

Biotechnology, the application of biological knowledge for practical purposes, raises significant ethical concerns as scientific abilities outpace wisdom. 
Key ethical issues in biotechnology include:

• Human Enhancement: Technologies such as genetic editing, synthetic biology, and brain-computer interfaces enable the enhancement of human traits and abilities. However, altering human nature raises concerns about long-term, unpredictable consequences. Additionally, unequal access to these technologies could create greater advantages for the privileged. There is a need for regulation and clear guidelines.
• Cloning: Reproductive cloning to produce human clones raises concerns about the wellbeing, dignity, and individuality of the clones, as well as the ethical implications of controlling human life. While most nations ban reproductive cloning, therapeutic cloning, which involves stem cells, continues and raises ethical debates regarding the use of human embryos for research that could save lives.
• GMOs (Genetically Modified Organisms): Genetically modified crops raise concerns about the loss of biodiversity, insufficient testing due to the rush to market, potential allergenicity, and the impact on non-GMO farmers. Despite these concerns, GMOs promise to enhance food security and alleviate malnutrition and poverty. There is a need for regulations to guide responsible development and consumer labeling, though scientific uncertainty and polarization remain.
• Synthetic Biology: The creation of artificial life forms and biological systems allows for the radical redesign of organisms. However, synthetic biology is poorly understood and difficult to control, potentially enabling the development of dangerous biological weapons. The regulatory framework has not kept pace with the progress in this area, raising concerns for human health and safety. Researchers should adopt "responsible innovation," ensuring transparency and considering the ethical implications of each advancement.
• Data Privacy: The collection and sharing of biological data and samples in research raise privacy concerns, particularly with large datasets. While sharing this data can advance scientific progress, participants must provide informed consent, and their data should be de-identified or securely protected. As precision medicine progresses, the issue of data privacy becomes increasingly important, but there is no clear path forward.
• Access to Treatments: New technologies offer promising therapies to save and improve lives, but access is often limited to those who can afford them, exacerbating inequalities. Patents incentivize innovation but also restrict access. Governments must find a balance between rewarding risk-taking and ensuring universal human rights. This issue sparks debates on justice and policy reform.
• Animal Rights: Genetic engineering often involves animal experimentation, and animals are used to produce hormones and even donor organs. The ethical question of animal protection in the context of genetic engineering and other biotechnology practices becomes more pressing as these methods advance.
• Designer Babies: "Designer babies" refers to the genetic modification of embryos to ensure certain desired traits. While some argue it could prevent genetic diseases, others believe it is unethical and unnatural to create children based on desired qualities. The concern is that such practices could lead to a "race" or "class" of genetically modified children, potentially creating a sense of superiority over those who are not genetically altered.
• Clinical Trials: Clinical trials involve human participants and raise ethical concerns, particularly regarding the fact that those who benefit from the trial results are not always the same individuals who bear the risks and burdens of participation. This raises important questions about the fairness of clinical research.

In Summary: Biotechnology has the potential to improve lives by redesigning biology itself, but it also presents significant risks that cannot be ignored. As technology progresses rapidly, society must engage in open and reflective dialogue to determine ethical boundaries and ensure that progress is shaped by values that promote inclusive good, rather than just financial gain. Our future depends on how we balance technological advancement with ethical responsibility, ensuring that humanity remains at the heart of every decision.