Whether they hold the scalpel, prepare the bed, schedule the appointments or respond to the first anxious call for help… everyone working in health care plays a role in the lives of people using its services. While many cases need only guidance and patient listening by the doctors, serious patients require continuous attention and application of the medical care providers as well as investigations and latest technology to treat patients. There the issues of life and death also arise and a decision has to be taken whether medical care can at all help to save the patient or he needs only relief from pain etc and cure is unlikely. The issues of elderly/lone patients where help is needed to access medical service or after the demise, last rites also arise. One also has to ponder if this situation could have been prevented by simple health measures or healthy lifestyle education? Their attitudes and behavior of care providers can have a big influence on every person seeking medical attention. Some observations made at the seminar ‘minimum medicine, maximum health for senior citizens’ held on Feb 26, 2018 held at Mahatma Gandhi State Institute of Public Administration, with the support of GOI, find a place here.
Human rights exist for serious, dying or even dead persons
Respecting human dignity is a moral and social aim when it comes to either health policy or medical care. In the context, of seriously ill patient or end of-life situation, appeals to dignity are actually appeals to promote patient autonomy in decisions about life-sustaining treatment. Appeals to dignity may also stand in for other principles, such as respect for persons, privacy and confidentiality in the doctor-patient relationship etc. Human dignity is implicated when patients and families face decisions about ending life, but it also is implicated before that, when patients are undergoing treatment for serious illness. Economic aspects of the family, society and nation cannot be overlooked either. During this time, the patient’s dignity can be honored or compromised in numerous ways. Howsoever sick or old, person inside still needs to be recognized, and valued with empathy and compassion? Many dignity violations occur when patients feel they are regarded as objects, pushed around, neglected or shouted upon, rather than as persons worthy of respect. There will always be some ways in which respect can be shown, for example, in relation to how a person is addressed. In sitting in a chair next to a person rather than standing over him or her. In apologizing for any lack of courtesy or kindness one has shown in the past. A useful prompt would be to ask oneself: in what ways would respect be shown if this were a person of high social status? And if this is how high social status is acknowledged, what is the decent respectful degree of public acknowledgement that every person is due?
Safeguard the person’s dignity
It is concerned with justice, rights, respect, dignity, autonomy of the individual and the community. The Supreme Court has held that the right to live with human dignity, enshrined in Article 21, derives from the directive principles of state policy and therefore includes protection of health and dignity. Failure of a government hospital to provide a patient timely medical treatment or neglect in any manner, results in violation of the patient’s dignity. Government cannot shut its eyes from unethical practices of the corporate sector and unaffordable medical services. Some points of importance:
- Remember that procedures that may be routine for those who work in patient care are not routine for most patients and may violate the privacy or esteem of the patient.
- Make treatment of physical pain a priority.
- Provide information about the expected medical course, treatment options, cost and the way in which the illness can be managed.
- Detect and treat symptoms of cognitive impairment, including delirium.
- Give people the opportunity to participate in decisions about their care or other personal issues. Often the patient’s requests are ignored and the process of treatment continues, despite his protests and eventual adverse outcome.
- Acceptance of every person’s individuality and identity -giving people full attention by listening, hearing, validating and responding to their concerns, feelings and experiences is necessary to respect dignity.
The Supreme Court March 9 said a person has the “right to die with dignity” and can make an advance “living will” authorizing the withdrawal of life support systems if in the view of medical professionals he or she has reached an irreversible stage of terminal illness, called passive euthnesia. In the historic decision, the top court said right to lead a healthy life also includes “leaving the world in a peaceful and dignified manner” and “has right to refuse medical treatment including withdrawal from life saving devices.” The fundamental right to a “meaningful existence” includes a person’s choice to die without suffering, it held. Chief Justice spoke about how societal pressure and fear of criminal liability by relatives and medical doctors ultimately led to the suffering and the undignified death of the patient.
However, for the few who can afford such treatment, maintaining life with advanced medical technologies and palliative care has become routine but it leads to wasteful use of national resources.
National Pharmaceutical Pricing Authority (NPPA) found that drugs and diagnostic services constituted major components of charges billed to patients in four private hospitals in Delhi and national capital region (NCR) with margins as high as 1,192 per cent or even more e g Adrenor 2 ml injection with an MRP of Rs 189.95, the purchase price for the hospitals was Rs 14.70 but the patients were charged Rs 5,318.60. People are not getting medical treatment because of the huge cost observed a bench of Supreme Court comprising Justices Madan B Lokur, Kurian Joseph and Deepak Gupta. The bench also asked the Centre to give publicity to various steps being taken to tackle the issue of air pollution to make the people aware of preventive health aspects.
In this campaign related to public health and prevention, apart from the Health Ministry, other ministries such as sanitation, AYUSH Ministry, Ministry of Chemicals and Fertilizers, Consumer Affairs and Women and Child Development Ministry have to join hands. Today, the sanitation coverage has increased from 38 percent to 80 percent in the country. As Health Care, Yoga has established a new identity for itself and is becoming a mass movement. Earlier the growth rate of vaccination was just 1 percent in the country, which has increased to 6.7 percent today. Ministry of Chemicals and Fertilizers is working in the direction of opening thousands of Jan Aushadhi centers across the country. More than 800 medicines are being provided at a reduced price. Ministry of Consumer Affairs has decreased the price of heart stents by 85 percent. Along with that the prices of knee implants have also been controlled, which has reduced prices by50 to 70 percent.
The Ayushman Bharat Scheme 2018 is going to provide great help to poor people of the country. About 100 million families, that is, about 45 to 500 million citizens will be free from worrying about treatment. If there was a sickness in the family, then the Government of India and the insurance company would spend Rs 5 lakh in one year. Apart from supply of cheaper devices and medicines, GOI has increased the medical seats from 52 thousand undergraduates and 30 thousand post-graduate seats in medical colleges to 85 thousand and 46 thousand respectively. If number of medical professionals grows, then affordability and access will also increase. However, the need is to produce better trained and humane doctors rather that half trained more doctors. If the emphasis is on wellness, the role of doctors can be curtailed in a big way and wellness experts can take care of a pocket of population under their charge. This will create millions of jobs in the country. These graduates in wellness are not doctors; they will work to keep the nation healthy.