Mains Practice Questions

Introduction:

You are a senior surgeon at a reputed Bengaluru hospital and chairperson of the Ethical Medical Practitioners Association. During a routine audit, you find that overpriced medical supplies are being consistently purchased despite more effective and affordable alternatives. The arrangement benefits certain senior doctors through kickbacks from suppliers. They pressure you to stay silent, citing hospital profitability. The issue impacts not only financial integrity but also patient care and trust in the healthcare system.

Body

(a) Identify the main stakeholders and ethical issues involved.

• Stakeholder
• Role and Interest
• Patients
• Primary recipients expect affordable, effective, and ethical treatment.
• Senior Surgeon (You)
• Ethical medical professional responsible for upholding medical integrity and patient welfare.
• Hospital Administration
• Focused on profit margins, but ethically responsible for patient-centric care.
• Senior Doctors
• Beneficiaries of kickbacks, compromising ethics for personal gain.
• Ethical Medical Practitioners Association
• Advocates for ethical practices and transparency in the medical profession.

Following are the ethical Issues Involved:

• Violation of Medical Ethics (Hippocratic Oath); The practice of prescribing high-cost and less effective treatments, despite the availability of better alternatives, violates the ethical principle of non-maleficence, the obligation to "do no harm."
  • It undermines the Hippocratic Oath by placing institutional and personal interests above patient welfare.
• Lack of Transparency and Breach of Trust: The undisclosed and exclusive procurement agreements between the hospital and select suppliers indicate a systemic lack of transparency. This erodes public trust in the institution and undermines the ethical principle of accountability.
• Commercial Medical Care vs. Ethical Duty: The pursuit of higher profit margins at the expense of patient-centered care reflects the ethical dilemma between institutional profitability and the moral obligation of healthcare professionals to prioritize human dignity and access to equitable treatment.
• Erosion of Professional Integrity: As a senior surgeon and chairperson of an ethical body, remaining silent would amount to moral complicity.

(b) Analyze the potential consequences of exposing the unethical practices for both the hospital and the healthcare system.

For the Hospital

• Legal and Regulatory Action: Authorities may initiate inquiries, impose penalties, or revoke licenses, affecting operational continuity.
• Reputational Damage: Public disclosure may severely tarnish the hospital’s image, leading to loss of patient trust and decline in footfall.
• Short-term Financial Losses: Profit margins may decline due to cancellation of unethical supplier contracts and increased scrutiny.

For the Healthcare System

• Systemic Reforms: The exposure could prompt policy changes in procurement and billing practices across private healthcare institutions.
• Restoration of Ethical Standards: It can reinforce professional ethics, patient rights, and accountability norms within the medical fraternity.
• Improved Patient Trust: Public confidence in the healthcare system may improve if corrective actions and transparency follow.
• Deterrent Effect: Other institutions may refrain from unethical practices due to fear of exposure and consequences.

(c) What actions would you take in this situation, and what ethical principles would guide your decision-making process?

Actions You Would Take:

• Internal Escalation: First, raise the issue with the hospital’s ethics committee and management in a documented manner. Maintain proper documentation of inflated pricing, supplier contracts, and available alternatives.
• Encourage Whistleblower Protection: Ensure anonymity and safety for staff who support exposing the malpractice.
• External Reporting (if internal mechanisms fail): Escalate to medical regulatory authorities or the Medical Council of India.
• Patient Advocacy: Ensure patients are informed and, where possible, offered alternatives within ethical and legal limits.

Ethical Principles Guiding Action:

• Beneficence: Upholding the duty to act in the best interest of patients by advocating for effective, evidence-based, and affordable care that enhances health outcomes and patient dignity.
• Non-Maleficence: Avoiding decisions or complicity in practices that could cause physical, emotional, or financial harm to patients. Rejecting overpriced and substandard treatments aligns with this foundational medical ethic.
• Equity and Fairness: Ethical action must aim to dismantle unjust systems that prioritize profit over patient rights and social equity.
• Moral & Ethical Leadership: Demonstrating the strength to act rightly in the face of institutional resistance or personal risk. Ethical leadership involves setting a precedent for others, fostering a culture where truth and justice are non-negotiable.
• Fidelity to Professional Oaths and Social Contract: Remaining faithful to the Hippocratic Oath and the implicit social contract between medical professionals and society - that of prioritizing human life, trust, and welfare over all other considerations.

Conclusion

As a senior medical professional and ethical leader, you are bound to uphold the principles of transparency, justice, and patient welfare. While exposing malpractice may cause short-term disruption, it ultimately strengthens institutional credibility, ensures patient-centric care, and fosters a more ethical healthcare system. True leadership lies in safeguarding values, even when it is inconvenient or personally costly.