Medical Ethics

Recently, the Union Home Minister, while addressing a national medical conference in Ahmedabad, highlighted the need to modernise medical ethics and rethink the role of the Indian Medical Association (IMA) as it marks its 100th anniversary in 2025.

• About IMA: The Indian Medical Association (IMA) is a national voluntary organisation of physicians in India, established in 1928. 
  • It represents the interests of doctors practising modern medicine and aims to promote the well-being of the community at large.
• Wellness Over Illness: The Union Minister urged doctors to adopt “wellness over illness” and focus on promoting health, lifestyle, and service alongside treatment.
• Achievements highlighted at the conference: India has recorded a 97% reduction in malaria cases, and the country will soon be free of the disease.
  • The mortality rate from dengue has fallen to just 1 %.
  • There has been a 25 % reduction in maternal mortality.
  • The Centre’s health budget now stands at Rs 1.28 lakh crore.

About Medical Ethics

• Medical Ethics are the moral principles and values that guide doctors and healthcare professionals in making decisions and providing care in a fair, responsible, and humane manner.
• Core Principles of Medical Ethics
  • Autonomy:  Respecting a patient’s right to make informed decisions
  • Beneficence: Acting in the patient’s best interest
  • Non-maleficence: To avoid causing harm to patients
  • Justice: Fair and equal treatment of all patients.
• Hippocratic Oath: The Hippocratic Oath is a traditional ethical pledge taken by doctors, attributed to Hippocrates, the father of modern medicine. 
  • It lays down the foundational principles of medical ethics, guiding physicians to practise medicine with integrity, compassion, and responsibility.

Code of Medical Ethics in India

• Framework: The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, lay down the standards of professional conduct, etiquette, and ethical responsibilities to be followed by registered medical practitioners in India.
• Authority that Established the Code: These regulations were framed by the Medical Council of India, which is now replaced by the National Medical Commission (NMC).
• Key provisions of the Code of Medical Ethics, as per the 2002 regulation, include:
  • Prescription of generic medicines and rational use of drugs
  • Ensuring that only qualified and registered persons assist in medical practice
  • Maintaining patient confidentiality and respecting dignity and autonomy
  • Obtaining informed consent before procedures
  • Duty to provide emergency care irrespective of the patient’s ability to pay
  • Mandatory reporting of unethical or incompetent medical behaviour to the appropriate authorities
  • Adherence to ethical norms in medical research and clinical trials

Need for Redefining Medical Ethics in Contemporary Times

• Lifestyle Diseases: Rise of lifestyle diseases such as cardiovascular conditions, diabetes, obesity, and mental health issues demands focus on prevention, wellness, and quality of life, not merely treatment.
• Technological Advancements: AI, telemedicine, genomics, organ transplantation,etc are raising new ethical dilemmas related to privacy, consent, accountability, and human oversight.
• Commercialisation of Healthcare: Corporate hospitals, insurance-driven care, and profit motives necessitate ethical safeguards against overdiagnosis, unnecessary procedures, and inequitable access.
• Public Health Emergencies: Pandemics like COVID-19 have highlighted ethical conflicts between individual rights and the collective good, resource allocation, and the duty of care.
• Equity and Social Justice Concerns: Persistent health inequities demand ethics that address social determinants of health, universal access, and fairness in resource distribution.

Wellness Over Illness: Ethical Shift in Healthcare

• Prevention and Health Promotion: The wellness approach prioritises preventive care, healthy lifestyles, and early intervention, shifting medical ethics from reactive treatment to proactive well-being and improved quality of life.
• Holistic Concept of Health: It resonates with the WHO’s definition of health as a state of complete physical, mental, and social well-being, expanding ethical responsibility beyond the mere absence of disease.
• Economic Benefits: By preventing chronic and lifestyle diseases, the wellness model ethically reduces long-term healthcare costs, avoids avoidable suffering, and lowers the overall disease burden on society.
• Equitable Services: A wellness-oriented ethical framework reinforces primary healthcare, community health services, and public health systems, ensuring accessible, equitable, and sustainable healthcare delivery.

Ethical Issues in the Medical Field

• Informed Consent: Patients often lack a complete understanding due to information gaps, illiteracy, and turning consent into a mere formality rather than a genuinely voluntary decision
  • Example: A patient signs a surgical consent form without understanding possible complications.
• Confidentiality and Privacy: Patient data may be disclosed without consent.
  • Example: Revealing a patient’s HIV status to employers or community members.
• Clinical Trials and Research Ethics: Exploitation of vulnerable populations and lack of informed consent violate autonomy and expose participants to undue risk.
  • Example: It was alleged that Covaxin clinical trials in Bhopal violated ethics by not properly taking informed consent, exploiting vulnerable people (poor, illiterate, gas victims), not reporting adverse effects and not ensuring follow-up of participants.
• Resource Allocation: Scarce medical resources may not be distributed fairly based on socioeconomic status, race, or geography.
  • Example: ICU beds during COVID-19 were allocated based on influence rather than medical need
• End-of-Life Decisions: There is an Ethical dilemma between prolonging life and ensuring dignity.
  • Example: Withdrawal of life support in terminally ill patients poses a dilemma between prolonging life and respecting dignity, especially when treatment costs burden poor families.
• Conflicts of Interest: Conflicts of interest in medical ethics arise from financial or personal interests influencing impartial medical decision-making, compromising patient care and research integrity.
  • Example: Pharmaceutical industry relationships with healthcare providers influencing prescription practices.

Challenges in Implementing Medical Ethics in India

• Commercialisation of Healthcare: Rising corporatisation prioritises profits over patient welfare, encouraging overdiagnosis, unnecessary procedures, and conflicts of interest.
  • Example: Andhra Pradesh is expanding medical colleges under the Public–Private Partnership (PPP) model by leasing district hospitals and public land to private investors for long-term leases.
• Overburdened Health System: High patient load, doctor shortages, and inadequate infrastructure reduce the time available for meaningful informed consent and ethical decision-making.
  • Example: The World Health Organisation (WHO) prescribes a doctor–patient ratio of 1:1,000.
    • India has approximately 1:1,200 when only allopathic doctors are counted.
• Gaps in Ethics Education: Inconsistent training and limited practical exposure to medical ethics weaken ethical sensitivity among healthcare professionals.
• Weak Enforcement Mechanisms: Regulatory bodies face capacity constraints, resulting in delayed action and uneven enforcement of ethical standards.
  • Example: Recently, the General Practitioners Association (GPA), Kerala, reported that due to inadequate monitoring by State Medical Councils, unregistered foreign medical graduates and practitioners of alternative medicine are illegally practising modern medicine.
• Socio-cultural Barriers: Illiteracy, paternalistic medical culture, and family-dominated decision-making undermine patient autonomy and informed choice.
• Rapid Technological Change: The fast adoption of AI, telemedicine, and digital health tools outpaces ethical guidelines on privacy, accountability, and consent.
• Vulnerability in Research Settings: Poverty and lack of awareness expose marginalised populations to ethical violations in clinical trials.

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Way Forward

• Strengthening Ethical Regulation and Oversight: The Code of Medical Ethics should be updated to address emerging challenges, including AI, telemedicine, data privacy, and clinical trials, with precise accountability mechanisms.
• Expand Screening Coverage: The Government should extend nationwide Non-Communicable Disease (NCD) screening to ensure universal coverage of adults 30+ (and high-risk younger groups).
  • The screening should prioritising remote, tribal, and urban-poor areas through Health and Wellness Centres (HWCs) and mobile units for equitable early detection of diabetes, hypertension, cancers, etc.
• Curbing Commercialisation of Healthcare: Regulatory authorities should enforce transparency, regulate pharmaceutical–doctor relationships, and discourage unnecessary investigations and procedures driven by profit motives.
• Promoting Ethics Education and Professional Values: Medical education bodies should integrate ethics, communication skills, and public health ethics into undergraduate curricula and continuous professional development to strengthen moral competence among healthcare professionals.

Conclusion

Medical ethics requires balancing professional responsibility with patient trust. Strengthening public confidence in doctors goes hand in hand with redefining their roles, ensuring that care is compassionate, evidence-based, and morally accountable.