Health care, Safety and Bioethics

By Y.SRINIVASA RAO, PRINCIPAL SENIOR CIVIL JUDGE, TIRUPATI.

Introduction:-

According to the article titled “Issues of creating a new cadre of doctors for rural India” published in 2013, in International Journal of Medicine and Public Health, there are 1.4 million doctors in India. But, Yet, India failed to reach its Millenium Development Goals realting to health issues. Under Article 21 of the Indian Constitution, Right to health i.e. right to live in a clean, hygienic and safe environment is a right flowing. Bioethics means the study and research of the ethical issues emerging from advances in biology and medicine. Bioethics include moral understanding as it relates to medical policy and practice because health care and safety are important rights to the citizens. It is important to note that ethics also relates to many other sciences outside the realm of biological sciences. In fact, the word ”Bioethics” was used in 1926 by Fritz Jahr in an article about a “bioethical imperative” regarding the use of animals and plants in scientific research. The fundamental principles , regarding ethics, were announced in the Belmont Report in 1979. It is to be remembered that the medical scholars believe that the patient should always have the freedom to choose their own treatment. Medical ethics is the study of moral values and judgments as they apply to medicine. It is to be noted that Bioethicists come from a wide variety of backgrounds and have training in a diverse array of disciplines. Similarly, numerous religious people have their own histories of inquiry into bioethical issues and they formulated rules and guidelines on how to deal with these issues from within the view point of their religious faiths.


Duty of the State:-

Under the Indian Constitutional scheme, every state is responsible for “raising the level of nutrition and the standards of living of its people and the improvement ofpublic health as among its primary duties”. The Government of India established health insurance project in 2018 by the Government of India. It is known as ” Ayushman Bharat Yojana”. It aims at making interventions in primary, secondary and tertiary care systems, covering both preventive and promotive health, to address healthcare holistically. There are several health schemes in India. National Health Protection Scheme (NHPS) is started by subsuming multiple schemes including Central Government Health Scheme (CGHS), Rashtriya Swasthya Bima Yojana, Senior citizen health Insurance Scheme (SCHIS), Employees’ State Insurance Scheme (ESIS) etc. In addition to that the National Health Policy, 2017 has pictured Health and Wellness Centres as the foundation of India’s health system which the scheme aims to establish. Benefits of the NHPS scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public or private empaneled hospitals across the country.


Healthcare in private sector:-

Since 2005, most of the healthcare capacity added has been in the private sector. The private sector consists of 58% of the hospitals in the India, 29% of beds in hospitals, and 81% of doctors. Ex. Narayana health hospitals, Appollo Hospitals etc. Curiosuly enough, in India, the private medical sector remains the primary source of health care for 70% of households urban area in and 63% of households in rural areas. Private insurance is also available in India, as are various through government-sponsored medical insurance schemes. In 2012, it was known from the report of the World Bank that about 25% of India’s population had some form of health insurance in 2010.

Role of judiciary:-

The Apex Court observed in Occupational Health and Safety Association Vs. Union of India and others – (2014 (3) SCJ 538 (Division Bench) that Clean surroundings lead to healthy body and healthy mind. But, unfortunately, for eking a livelihood and for national interest, many employees work in dangerous, risky and unhygienic environment. Right to live with human dignity enshrined in Article 21 derives its life breath from the Directive Principles of State Policy, particularly clauses (e) and (f) of Articles 39, 41 and 42. Those Articles include protection of health and strength of workers and just and humane conditions of work. Those are minimum requirements which must exist to enable a person to live with human dignity. Every State has an obligation and duty to provide at least the minimum condition ensuring human dignity. But when workers are engaged in such hazardous and risky jobs, then the responsibility and duty on the State is double-fold. Occupational health and safety issues of CFTPPs are associated with thermal discharge, air and coal emission, fire hazards, explosion hazards etc. Dust emanates also contain free silica associated with silicosis, arsenic leading to skin and lung cancer, coal dust leading to black lung and the potential harmful substances. Necessity for constant supervision and to the drive to mitigate the harmful effects on the workers is of extreme importance.


In Common Cause Vs. Union of India (2014 (5) SCJ 677 (Full Bench), – it was observed that the stand that Government advertising is a mode for the Government to disseminate to the members of the public, of information about a government program, policy or initiative, or about any public health or safety or other matter(s), that is funded by or on behalf of a Government agency, is an outright fact and is a must in our democratic setup. This Court, in its Constitutional wisdom, understands that it is only through such advertisements that the Government communicates with its citizens which plays an important role in efficiently and effectively achieving the goals of public policy.
The Hon’ble Full bench of Supreme Court in Swami Achyutanand Tirth and others Vs. Union of India and others – 2016 (6) ALT (DN) (SC) 4 (Full Bench) took serious note about growing sales of adulterated and synthetic milk in India. Under Article 32, a Writ Petition by way of public interest litigation was come before Supreme Court with regard to menace of growing sales of adulterated and synthetic milk. In this case, the Apex Court observed that Union of India and State Governments must come out with suitable amendments to Food safety and Standards Act, 2006, or with a new legislation to stop adulteration and production of synthetic milk, which is consumed by the infants/children and by the public at large Parliament Standing Committee on health and Family Welfare recommended that Government of India may re-look into all the aspects of the matter and come up with comprehensive Bill at the earliest.
With regard to Kudankulam Nuclear Power Project Setting up of, in Tamil Nadu at Kudankulam is concerned, the Apex Court in G. Sundarrajan Vs. Union of India and others – 2013 (4) SCJ 641 (Division Bench). it was held that maintaining safety is an ongoing process not only at the design level, but also during the operation for the nuclear plant. Safeguarding NPP, radioactive materials, ensuring physical security of the NSF are of paramount importance. Whereas in Inter Globe Aviation Ltd. Vs. N. Satchidanand – – 2011 (6) SCJ 282 (Division Bench), it was held that No public utility service can say that it is not bound to care for the health, welfare and safety of the passengers because it is a low cost carrier.


Safety – Bioethics:-
As part of the Global Patient Safety Challenge: Medication Without Harm, WHO has asked countries and key stakeholders to prioritize three areas for strong commitment, early action and effective management to protect patients from harm while maximizing the benefit from medication, namely: Medication safety in high-risk situations; Medication safety in polypharmacy; and Medication safety in transitions of care. High-risk situations are more often associated with significant harm due to unsafe medication practices or medication errors. As the population ages more people are likely to suffer from multiple long term illness and take multiple medications. It is essential to therefore take a person-centred approach to ensure that the medications are appropriate for the individual to gain the most benefits without any harm. Medication discrepancies impact almost every patient that moves across transitions of care, e.g. admission to or discharge from hospital. WHO urges countries to prioritise early and sustained action to reduce medication-related harm arising at transitions.


Conclusion:-

As was observed by Apex Court in Swami Achyutanand Tirth’s case (supra), while making necessary amendments in the Food Safety and Standards Act, 2006, respondent-Union of India shall also make penal provisions at par with the provisions contained in the Indian Penal Code and the States Amendments therein Also desirable that Union of India revisits the Food Safetyand Standards Act, 2006 to revise the punishment for adulteration making it more deterrent in cases where the adulterant can have an adverse impact on health. Further, it is significant to see that a range of training materials and tools are to be developed more to help individuals and organizations improve their understanding and knowledge of patient safety. the study and research of the ethical issues emerging from advances in biology and medicine are highly essential in this globalization era. Three factors related to access to healthcare I.e, provision, utilization and attainment are to be developed in India. India has to overcome differential distributions of services, power, and resources which have resulted in inequalities in healthcare access. In addition to that there is a lack of sufficient infrastructure in areas with high concentrations of poor individuals. Still, there are no qualified doctors in rural areas and poor rural people
depend upon the mercy of RMP doctors. Because of shortage of medical professionals in rural area, this is become a major issue for rural access to healthcare. The Government of India has to take immediate steps for rural access to healthcare.

Miscellaneous

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