India being a rapidly developing economy with highly diverse and socioeconomic ,ethnic polulation; cost efficient resources and suitable legal framework,pharmaceutical industry has had potentially perfect incubation environment for clinical research. Concerns for ethics in clinical research naturally has taken top priority. Despite the fact of vulnerability of poor patients willingly participating in the trials; benefits of it’s outcome in the long run e.g. new generic drugs,vaccines etc. can not be denied.
However Nursing care delivery faces dilemmas in the practice of psychiatry , paediatrics and geriatrics. Covert administration of medication essentially is questionable ethical practice especially in absence of multidisciplinary team’s involvement.
I would dare say that the clinical practice itself is the ethical issue.
Modern medicine is practiced in a dehumanizing environment today. Thanks to the so called "biomedical model", the ever increasing emphasis on "scientific" medicine reduces professionals to technicians and patients to objects. Illness as a personal/subjective/emotional/social experience is no longer considered to have any value in practice. The situation is further complicated by the fact that professionals have mutiple roles and divided loyalties today; therefore, it becomes increasingly difficult to assume that professionals have the best interests of their patients at heart. Under these circumstances, the patient-physician encounter today is, at best, an interaction between two distrusting strangers alienated from each other.
(I must say that my perspective summarized briefly above has been heavily influenced by the writings of authors such as Edmund Pellegrino, Eric Cassel, Alfred Tauber etc...)
Interesting topic and comments. We can make the clinical environment more humane as we care for our patients. A model we are using in newborn care is the Individualised Developmentally Supportive Family Centred Care, this model is built on the relationships between health professionals and the Babies and their parents. It is recognising that all of our patients are individuals and modifying our routines to the needs of the patients. Yes it does take some changes from the ritualistic and technological focus that we work under but it does work and just requires some effort from the health professional. By using this model we are providing humane ethical care affording dignity to our patients. That is what I see as the most challenging ethical issue in clinical practice.
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