The Benefits & Burdens of Importing Bioethical Principles’ Approach

DeenDayal B. Reddy

Abstract


A teachable point of this paper is that we cannot hurriedly pedal our way through the portals of the Internet and get enlightened about bioethics. Just like any other subject in medicine, bioethics needs to be studied seriously and taught systematically. In view of the growing demand for western ethics, in India, this paper will focus primarily on the benefits and burdens of importing bioethics, under four sections. Section I, considers the reasons for relying on western ethical principles and paradigms. Section II, highlights the pros and cons of such reliance. Section III, offers credible reasons why India’s ethical heritage has not stepped up to the plate and produced a meaningful treatise on medical ethics. Section IV, suggests how we may expand the reach and repertoire of the bioethical principles. A two-fold theme runs through the sections: (a) There exists an internal vacuum where the indigenous methods of moral enquiry have become sterile; (b) This vacuum can be filled by a systematic study of bioethics—besides importing the Four Principles’ Approach (FPA). As with any import, FPA comes with its share of burdens and benefits. The burdens include reducing the principles as conscious-raising ceremonials or as contradictio in adjecto. The benefits include extending the reach and repertoire of the principles. To wit: The bioethical principle of beneficence encompasses a fiduciary duty towards moral strangers besides family or friends; the principle of nonmaleficence includes offences against fellow human beings other than cows or trees; justice supports both fair-play and natural rights; and respect for autonomy is attuned to the inherent moral worth than the material worth of a human person. Perhaps the ultimate benefit, of studying bioethics systematically, is that it helps us to ascertain whether the ethical thought inherited under the aegis of history, recent or remote, is as ineffectual as ancient surgery or as precious as ancient sculpture. If it is the former, we should be wrong to take it seriously; if the latter, to lose it would impoverish us.  

 

Keywords: Bioethical Principles; Four Principles’ Approach; Autonomy; Beneficence; Justice; Nonmaleficence; Indian Ethics; Swarājy-ka-āadar; Daya, Upakaar; Nyāya; Ahimsa

Full Text:

PDF

References


Ethical Guidelines for Biomedical Research on Human Participants, Indian Council on Medical Research, 2016. VISION 2015 Medical Council of India. Retrieved from www.icmr.nic.in and www.mciindia.org on 17Jan2016.

International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 04, July 2015, Pages 8-12.

BMJ2013;346:f2794doi:10.1136/bmj.f2794 (Published30April2013). Indian Journal of Medical Ethics, [S.l.], v. 8, n. 3, p. 135-138, Jul. 2011. ISSN 0975-5691. Ramana K V, Kandi S, Boinpally PR. Ethics in medical education, practice, and research: An insight. Ann Trop Med Public Health 2013;6:599-602.

G.D. Ravidran, “Medical Ethics Education in India.” Indian Journal of Medical Ethics. 5(1):18-9, 2008; Cromwell Crawford, Hindu Bioethics for the Twenty-first Century 2003:8; Pandya, Sunil K. Journal of Asian and International Bioethics 10 (2000): 40-44; and National Seminar on BIO ETHICS - Jan. 2007.

For the purposes of this paper, I relied extensively, albeit not exclusively, on the internationally renowned text book, by Tom L. Beauchamp and James F. Childress: Principles of Biomedical Ethics, 7th ed. (2013).

A Google search (key words: Indian Medical Ethics, Principlism) confirms countless ethics websites and articles on the Four-Principles’ Approach. And their tribe appears to be on the increase! Retrieved on 17 Jan2016.

Campbell, AV. “The Virtues and Vices of the Four Principles.” J Med Ethics 2003; 29:292- 296.

Gillon, R, ed. Principles of Health Care Ethics. London: John Wiley & Sons, 2007, p 332.

Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 7th ed. (2013): 15-25.

D. K. Clouser; B. Gert. “A Critique of Principlism.” Journal of Medicine and Philosophy 15 (1990): 232.

It is peculiarly an American concept (famously noted by SCOTUS Justice Cardozo (1870-1938), a by-product of its politics, culture and legislation. Insofar as it lifts the external barriers to exercise the power of free choice—that all rational beings antecedently possess—it is of immeasurable worth; but if it is pursued down the path of anarchic liberty, so that any emancipated adult may exercise her free choice to ‘act’ as she pleases, then it’s of little worth.

When one thinks of India, one often thinks of Hinduism and vice versa. Hinduism’s dominance and its presence since three millennia make its study both attractive and imperative to further our understanding of the question. Though over the years Hinduism splintered into more subdivisions than Christianity, Judaism, and Islam combined, it continues to exert its matriarchal influence and enjoy more attention and homage than any other native traditions.

Violatti, C. The Vedas. Ancient History Encyclopedia. Retrieved on 17May2017 (http://www.ancient.eu/The_Vedas/).

Dalitbahujans = Untouchables. Rechristened by Mahatma Gandhi as Harijans = Children of God. Dalitbahujans are about 16%, according to Navsarajan (Human Rights Organisation). When combined with Muslims, Christians, Sikhs, Buddhists, it is around 33%. Source: http://navsarjan.org/navsarjan/dalits/whoaredalits (accessed on 24 Jan2016).

Journal of Religious Ethics 30.3 (2002): 347-372.

Pragnesh Parmar et, al. Lessons in Medical Ethics from Ancient Indian Teachers. IAIM, 2015;2(2):161-164.

By extension medical students who, at 18 years, enter medical colleges with no background in logic + humanities.

Crawford, Cromwell S. Hindu Bioethics for the Twenty-First Century. New York State Univ. Press, 2003, p 7-8.

Lott, Micah. Journal of Religious Ethics 30.3 Fall 2002, 320 -321.

Emerging Market Report: Health in India 2007, PricewaterhouseCoopers, 2012.

Transparency International (TI) ranked India #76 on the Corruption Perception Index of 168 countries. Denmark ranked #1 (least corrupt) US #16; China #83; Pakistan #117; and Somalia #168 as the most corrupt nation, in 2015. Source: http://www.transparency.org/policy_research/surveys_indices/cpi/2010/ (accessed:27Jan2016).

Cromwell Crawford, in his treatment of beneficence in Hindu Bioethics prefers the word daya; while Robert Florida used karuna for beneficence in his exposition of Lotus Sutra and Healthcare Ethics.

Robert Veatch: Hastings Center Report 1972; 2:5-7.

Priyavrat Sharma, ed. Caraka Samhitha, 3 vols. (Varanasi/Delhi: Chaukamba Orientalia, 1981) 62-63.

Arti Dhand: Journal of Religious Ethics 30.3 (2002): 347-372.

Health Care in India: The Economist, March 2009.

My commentary on Hindu moral particularity is not to be conceived as a key that unlocks sacred insights but rather as a discursive method by which we may unpack imbedded values that may be universalized. The contribution I hope to make is to communicate its fundamental insights in language and examples that have currency today, thus making them more accessible to the contemporary reader. After many readings of Hindu texts, much remained that I could not assimilate to our purpose and much remained obscure. Therefore, I will dwell on those ideas that I could expound clearly, defend as true, and put together into a coherent moral train of thought. For additional information readers are advised to refer to: Dumont, Louis. Homo Hierarchicus: The Caste System and Its Implications.

Wendy Doniger O’Flaherty, The Concept of Duty in Southeast Asia (New Delhi): Vikas Publishing (1978) 96-97.

The Nehru Report” (after Motilal) declared that the “first concern of Indians was to secure the Fundamental Rights that have been denied to them.”

Unscrupulous clinicians-and there are plenty-have been quick to…. refer every patient with a headache or a backache for such scans, often without a detailed clinical examination (Pandya 40-44).

They also warn that FPA is not to be understood as the ‘be all and end all’ of medical ethics but as provisional principles upon which to build an ethical framework.


Refbacks

  • There are currently no refbacks.