Ethics

11 07 2012

By: Joy Liu

My past three weeks have been filled with courses ranging from female feticide to healthy agricultural practices. It’s been complemented by trips to the Ellora Caves to see the wonders of ancient India as well as to a Bollywood movie (in Hindi with no subtitles) in Pune to participate in the culture of modern India. In between, I’ve been to villages with the mobile health team and the farm that CRHP keeps. I’ve watched sunsets from the rooftop and gone trekking through plots of empty farmland.

In between this schedule, I’ve started to reflect on what I’m learning—the challenges, successes, and complexities of running a comprehensive primary health care program. One of the most thought-provoking situations came in the form of a visit to the Julia Hospital, the anchor of the CRHP model. It’s a low-cost secondary care hospital that serves about 20,000 outpatients each year. As we toured the various rooms, I observed the practicality of the design while listening to the medical students in our group talk about what it would be like to practice medicine in an environment where the availability of resources and medical technology is drastically different from their training.

Towards the end of our hospital tour, we entered a general ward. I saw a young woman lying on the hospital bed closest to the door. From her features, she looked about my age, but she carried the maturity of a woman who is a mother. She responded softly but without hesitation to the questions that the doctor and health worker asked, looking at them with a steadfast, unwavering gaze. We were told that she was pregnant with her second child. The village health worker had brought her into the hospital because her amniotic fluid levels were too low, and it had been found that her baby didn’t have kidneys. We stepped outside, where the family members were told that the baby would not survive, but the doctor chose not to tell the mother because it would psychologically affect her too much since she still has to go through the birthing process. This immediately plunged our group into a discussion about the ethics. According to the medical students in our group, if this had been the case in the US, the mother would have been told all the details of her condition. Most likely, at that point she would choose to have an abortion. However, in this context, for a combination of reasons involving resources, traditional taboos, and the hospital’s concerns, performing an abortion was not presented as an option. Ethically, was it right to not inform her, to let her carry the child for another two or three months with the knowledge that it wouldn’t survive? What had just transpired was culturally acceptable and justified in this society and this context, but what things can be accepted in the name of culture? We all seemed to disagree because there’s no definite line between cultural relativism and things that we would categorize as wrong. In many cases, it’s a matter of perception, and that’s where the biggest questions are. The other question that relates to this is what it would be like to be a Western-trained doctor working in a different cultural setting. It’s not possible to operate under your own traditional ethical framework, but I imagine that it would be difficult at times to find the line to put your foot down on.

I’ve often told people that I really don’t like ethics because it’s big and complicated. You can argue with someone for hours and hours and end up even more confused than you were before without ever reaching a conclusion. At the same time, I grudgingly pay my dues to ethics because I realize its necessity and value. This occasion cemented my love/hate relationship with ethics, but more importantly, it made me think (I still haven’t formed a very definitive, coherent opinion on this instance yet), and for that I’m grateful.

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One response

12 07 2012
dukeglobalhealth

great post, Joy!

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