Is it Time to Revise Medical Ethics?

Is it Time to Revise Medical Ethics?

– Dr Pratyasa Padhi, Bhubaneswar

One afternoon, while visiting the medical oncology ward for palliative care consultations, I encountered a 45-year-old man with a bandage on his right lower limb, sitting on the bed alongside his wife. As I was about to see him, the ward attendant informed me that the patient was “positive”. He meant his serology for ‘Hepatitis B’ was positive, prompting me to exercise caution during the examination. I thanked him for the information and proceeded to ask the patient about his journey since the onset of his illness.

This couple hailed from Kandhamal, a tribal district in Odisha, known for its unique natural beauty and having a demographic where women outnumber men. The man’s story began in 2008, when he developed a small wound on his right lower limb. Over time, this wound worsened and eventually required skin grafting. He had travelled extensively across the State, visiting various hospitals, before being diagnosed with “Hepatitis B-related Polyarteritis Nodosa”—a rare autoimmune disease where the body’s immune cells attack the blood vessels.

Ten years ago, he developed another wound on his right lower limb, which was yet to heal! The wound constantly discharged. It is a condition known as “pyoderma gangrenosum” (which is related to his primary diagnosis). He had been in severe pain for years and had received countless “Tramadol” shots  to manage it. His buttocks now bore wounds, likely linked to his underlying condition. Two months ago, he developed neurological complications, including “foot drop due to mononeuritis multiplex”, a  consequence of Polyarteritis Nodosa. His ordeal didnt’t end there—he was recently diagnosed with hepatocellular carcinoma (liver cancer), possibly due to his chronic Hepatitis B infection.

Listening to his story, I inquired about their source of livelihood. His wife explained that since he has been unable to work for a long time, she has been the primary breadwinner, proudly growing turmeric in their village. However, due to the prolonged hospitalizations, she hadn’t been able to sow this year’s crop. She emphasized that they have no children and only have each other for support.

When I asked about the duration of his Hepatitis B infection, the patient seemed unaware of the diagnosis. With an innocent smile, he asked me to focus on the pain in his leg, assuring me that he was fine otherwise. His wife added that they were aware of the challenges in accessing quality healthcare in their hometown, and that they had willingly come to the State capital for treatment.

The Need for Palliative Care

This interaction made me reflect on palliative care and its fundamental role in healthcare. According to the World Health Organization (WHO), palliative care is “an approach that improves the quality of life of patients and their families who are facing challenges associated with life-threatening illness, whether physical, psychological, social, or spiritual.” It takes into account the holistic care of patients,    aiming to alleviate suffering in all its forms.

Despite the advances in medical technology, there is a glaring gap in our healthcare system. This middle-aged couple from a remote tribal district, dealing with the complexities of Hepatitis B-related Polyarteritis Nodosa, pyoderma gangrenosum, mononeuritis multiplex, and hepatocellular carcinoma,   is a stark reminder of how deeply patients need palliative care.

Revisiting Medical Ethics

The first step in delivering good palliative care is patient education, which we, as healthcare providers   often overlook. This man didn’t fully understand his condition, which highlights a failure in communication. It is essential to remember that palliative care is not a luxury but a basic human right that should be integrated into standard treatment plans.

Moreover, we must uphold the first ethical principle in medicine: Patient Autonomy. Every patient has the right to be involved in decisions about their treatment. “Shared decision-making” is vital but often neglected in clinical practice. Empowering patients by involving them in their care plans fosters trust and ensures that treatments align with their values and preferences.

Addressing Systemic Loopholes

This case also sheds light on the broader systemic issues in healthcare. The couple’s socio-economic struggles—traveling far from home, losing their source of livelihood—reflect the inadequacies of our healthcare infrastructure. Patients from marginalized regions often have limited access to specialized care, which further complicates their treatment journey.

Palliative care should not be limited to a selected few; it should be available to every individual facing  a serious illness. As healthcare professionals, we must advocate for policies that bridge these gaps and  improve access to comprehensive care in underserved areas.

Compassion and Humanity in Medicine

In our journey as physicians, we must not lose sight of our humanity. Compassion is an innate quality  that cannot be learned from textbooks—it must come from within. Medicine should not be reduced to just procedures and prescriptions; it is about healing, in the truest sense.

Revisiting medical ethics is essential to ensuring that we, as healthcare providers, remain grounded in compassion, respect, and dignity. This is the foundation upon which true healing can occur. When we start asking the right questions and re-connect with the core values of care, the act of treatment will transform into something deeper—healing.

Conclusion

The experience with this patient and his wife reminds us that healthcare in our country must evolve. It  is time for a paradigm shift—where patient autonomy, shared decision-making, and holistic care are prioritized, and where palliative care is seen as a fundamental right. Only then will we truly progress toward meaningful development in healthcare.

At the end of the day, we must remember who we are—not just doctors, but humans, entrusted with the well-being of others. Compassion, when it returns to the forefront of our practice, will transform   treatment into true healing.