The Ethics Of Healing Over The Wire Ambiguous Still

New Delhi: | Updated: Dec 23 2002, 05:30am hrs
I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel. With purity and with holiness I will pass my life and practice my art.-- The Oath by Hippocrates (400 B.C.)

Healing over the wire, is how the Time magazine refers to telemedicine. But with the numerous spinoffs, there are many issues that need to be sorted out. With medical practitioners now answerable to law, telemedicine has thrown up new ethical and medico legal questions. However, the most important point that needs to be established is: Who is responsible

If a medical practitioner in the village or a small town refers a critical case to a specialist in the town through telemedicine and some goof-up occurs, who is liable AIIMS deputy director and head of computer facility, Dr R S Tyagi dismisses the contention. There are no medico-legal aspects that need to resolved. Telemedicine is the same as consultation, with the difference being that it is (dispensed) over a distance. There is a concept of informed consent, and the specialist in the case is not liable. The doctor who treats the patient uses his own judgement. Simply by referring a case to the specialist, the responsibility does not shift.

But doctors are wary of the technology. The DICOM (digital imaging and communications in medicine) images that are utilised for diagnosing in case of telemedicine are not fool-proof. With the improvement in technology, the systems are bound to become more reliable. Anyway, the doctor can always ask for another report. Dont they do it always, queries Dr Tyagi.

Yet, technology has the tendency of dividing the population between the haves and the have-nots, simply by being unaffordable. With India spending approximately 0.9 per cent of GDP (gross domestic product) on healthcare (World Health Organisation or WHO advises 5 per cent), government-run hospitals can ill afford the latest gadgetry. Hence, it is the private hospitals yet again that are investing millions and it doesnt seem likely that they are going to make it affordable.

Technology is great, if and only if, its benefits filter down to the lowest denominator of the population. There should be a transfer of knowledge from cities to towns, and for this to happen non-government organisations and administration need to play a more pro-active role, says the founder director of the Institute of Pathology, Dr S Sriramachari.

Dr Sriramachari further emphasises the role played by the family doctor in the treatment of the patient. Family physicians act as the buffer. They are trusted friends of the patients. In the past decade, they have been relegated to the fringe. I hope with the advent of telemedicine, they will again bounce back into prominence, he says.

Another lament of some traditional doctors is that IT has only aided allopathy stream of medicine and methods like ayurveda and unani are being made obsolete. Says a medical practitioner (ayurveda) at a local hospital, Most of the initiatives of the government are only centred around allopathy, while the western world is waking up to the cause of ayurveda and such traditional forms of medicine.

There is also an urgent need for standardisation of the processes involved, right from the hardware to the software. The Apollo Hospital group, for instance, is working on the telemedicine standards and a committee has also been formed by the ministry of information technology to look into the issues.

Dr Sriramachari correlates IT in medicine to vishnupradarshanam: a whole universe of knowledge is accessible now, due to IT, he says.

But it remains to be seen, whether this knowledge helps the farmers in the interiors of Bihar and labourers in Arunachal Pradesh.