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Evaluation of understanding of medical ethics and law among undergraduate students.

BACKGROUND

Ethics is a moral conduct of right and wrong in a civil society, which comes from within. It is a branch of Philosophy. Medical Ethics guides doctors in dealing with their patients, for the best possible outcome. Unlike Law which is enforced on an individual after commission of crime, ethics prevent an individual from committing wrong. As per definition: Medical ethics deal with moral principles which should guide the members of medical profession, in dealing with each other, with patients and with the state. [1]

India can boast of its own code of ethics proposed by Charaka roughly 4700 years ago. The ethics prevented physicians to eat meat, drink alcoholic beverages and commit adultery. Physicians should not harm their patients and be solely devoted to patient care, even if this puts their lives in danger.

In Western World, medical ethics had its foundation as Hippocratic Oath. The examination of moral issues in medicine largely began in 4th century BC by the great Greek physician Hippocrates (sometime between 460-377 BC the accepted life period). [2]

Presently there is a doubt as to who actually penned down the Oath of Hippocrates. It is believed that Oath existed even before Hippocrates and perhaps Hippocrates has compiled it. Other school of thought believes it was written by students of Hippocrates. However. these theories have been questioned due to the lack of evidence.

International Code of Medical Ethics is modernised version of the Hippocratic Oath. It was approved at the Declaration of Geneva, in the II General Assembly of the World Medical Association. This prompted the WMA Council to appoint a Study Committee to prepare an International Code of Medical Ethics, which after an extensive discussion, adopted in 1949 by the III General Assembly of the World Medical Association at London in 1949; it was further amended in 1968, 1983 and 2006. Main goal was to establish the ethical principles of the physicians worldwide, based on his duties in general, to his patients and to his colleagues. [3]

All member countries of World Health Organization adopted the international Code of Medical Ethics. India has also updated the Declaration of Geneva in the form of 'Code of Medical Ethics'.

By the power conferred under s 20A read with s 33(m) of the Indian Medical Council Act 1956, Medical Council of India brought out the new code of medical ethics in 2002 replacing the older one of 1972 and updated on 18 July 2000 as Indian Medical Council Regulation 2002 (Professional Conduct, Etiquette and Ethics). Any violation of the code of conduct by the medical practitioners would lead to the charges of misconduct and if proved, he/she may be either temporarily or permanently debarred from practising medicine. Medical ethics and Law go hand in hand or they are the two sides of same coin, hence both are dealt together.

Knowledge of Indian Medical Council Regulation 2002 (Professional Conduct, Etiquette and Ethics) is very important because if we take the example of West Bengal, the website of West Bengal Medical Council (WBMC) lists 376 cases of medical negligence in Bengal till May 2015, which are at various stages of investigation. Since 2000, action has been taken against 25 doctors, as per RTI query.

Even historically, India was a country of ethics. In 5th and 4th Century BC, teachings of Buddha consisted of Sila or ethics of life. Ethics was practised not only by doctors but also common man.

Sila or Ethics Practised by Common Man had Five Precepts

1. To abstain from killing of any living being.

2. To abstain from stealing.

3. To abstain from sexual misconduct.

4. To abstain from wrong speech.

5. To abstain from all intoxicants. [4]

Ethics and medical law is taught in forensic medicine as per MCI Course curriculum. Duty of teachers in Forensic Medicine is to ensure that students understand the chapters clearly. Teacher of Forensic Medicine should also be able to convince the students to follow the path of medical ethics and law.

Objective

To evaluate the knowledge on medical ethics and law among medical students, after the subject is taught to them.

MATERIALS AND METHODS Type of Study Cross sectional.

Study Area

The study was conducted in the Department of Forensic Medicine and Toxicology of a Medical College in Kolkata.

Time of Study

The study was conducted between February 2016 and July 2016.

Plan of Study

Preparation of questionnaire, Pre-testing of questionnaire, Data collection, Analysis and writing of the article.

Population of Study

All students of 5th semester who completed the course of Medical Law and Ethics.

Method of Selection of Study Population

Total 105 students, who attended lecture class, were selected. They were properly briefed about the study and its objective, informed not to disclose personal identity and consent was taken.

Study Tool

Predesigned and pre-tested questionnaire based on medical ethics and law.

Questions

Contained 20 questions. Analysis

Using suitable statistical and mathematical technique. Distribution of Marks

Correct answer, 1 mark; wrong answer '0' mark. Total score: 20 marks. Clearance was taken from Institutional Ethics Committee.

RESULTS

105 students participated, with mean age of 20 years. Majority (78%) of the students were from English medium school. Highest score obtained: 20, by 2 students. They answered all questions correctly. Lowest score obtained 06. Knowledge on history of Indian code of Medical Ethics, Charaka was known to 86.7% of students, definition of Medical Ethics was correctly replied by 85.7%, knowledge on Hippocratic Oath was correct for 90.4% of students. Knowledge on Indian Medical Council Regulation 2002 (Professional Conduct, Etiquette and Ethics) and basic principles of medical ethics was correct in 83.8% of students. Knowledge on Professional misconduct was correct in 83.8% of students. Knowledge of State Medical Council on professional misconduct was correct in 72.3% students. Knowledge on Warning notice was correct in 75% students. Knowledge on Implied consent was correct in 61.9% students. Knowledge on right of Registered Medical practitioner to choose patient was correct in 62.8% students. Knowledge on Patient's right to refuse treatment was correct in 87.6% students. Knowledge on Medical Negligence was correct in 84.7% students. Knowledge on what is not a Medical Negligence was correct in 79% students. Knowledge on Vicarious Liability was correct in 70.4% students. Knowledge on CPA-86 was correct in 60% of students. Knowledge on confidentiality was correct in 51.4% of students. Knowledge on euthanasia was correct in 68.5% of students. Knowledge on organ donation was correct in 77.14% of students. Knowledge on how Medical practitioners are viewed in society and practical problems problem faced by medical practitioner during practice was correct in 71.4% of students (Table 1).

Students scoring 15-20 were categorised as good. 60.9% had good knowledge on Medical Law and Ethics. Score between 10-14 were categorised as adequate knowledge, 29.52% of the students were in this category. Scoring equal to or below 9 is categorised as poor, 9.52% of students were in this category (Table 2).

37% of students' fathers were graduates, 32% of students' fathers were doctors, 19% of students' fathers were postgraduates and 12% of students' fathers were undergraduates. (Table 3).

DISCUSSION

60.95% students had good knowledge and 29.52% had adequate knowledge on medical ethics and law. Total more than 90% (60.95% +29.52%) of students had more than adequate knowledge on medical ethics and law. This points out students were interested and understood the subject. A study was done in Sri Lakshmi Narayana Institute of Medical Sciences, Osudu, Agaram, Puducherry on "Are tomorrow's doctors aware of the code of medical ethics?" This study covered 172 medical students who were administered a questionnaire, based on the 'medical code of ethics' as set out in the chapters on 'unethical acts' and 'misconduct' of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002. Result shows only 128 (74.4%) of the 172 medical undergraduates enrolled in the study returned the completed questionnaire. None of them answered all the questions correctly. The overall mean score was 6.13 out of 10, with an SD of 1.36. There were no significant differences between second-, third- or final-year students. There was no significant difference in the performance of boys and girls. Most of the students erred in scenarios related to decision-making and communication. It was concluded "There are major deficiencies in the understanding of medical ethics among medical undergraduates. Including medical ethics as a mandatory and separate subject in the first few years of undergraduation can help students understand and follow ethical principles". Our study does not agree with the above study. We found 90% (60.95% +29.52%) of students had adequate knowledge on medical ethics and law. [5]

A study was done in Christian Medical College, Vellore 632002, Tamil Nadu titled "Survey of ethical issues reported by Indian medical students: basis for design of a new curriculum". Education in ethics is now a formal part of the undergraduate medical curriculum. However, most courses are structured around principles and case studies more appropriate to western countries. The cultures and practices of countries like India differ from those of western countries. It is, therefore, essential that our teaching should address the issues which are the most relevant to our setting. An anonymised, questionnaire-based, cross-sectional survey of medical students was carried out to get a picture of the ethical problems faced by students in India. The data were categorised into issues related to professional behaviour and ethical dilemmas. Unprofessional behaviour was among the issues reported as a matter of concern by a majority of the medical students. The survey highlights the need to design the curriculum in a way that reflects the structure of medical education in India, where patients are not always considered socioculturally equal by students or the medical staff. This perspective must underpin any further efforts to address education in ethics in India. [6] Our study shows that students are comfortable with the course and there is no need to change the curriculum.

CONCLUSION

This study is an eye opener. Students of medical college, do have adequate knowledge on medical ethics and law. The result shows 60.95% students had good and 29.52% had adequate knowledge on medical ethics and law. That is more than 90% of students had sound knowledge on medical ethics and law. Highest score 20 was obtained by two students. As to why doctors are accused of unethical act is difficult to explain. Maybe the society has become restless to physical illness and unnecessarily blames doctors. Interestingly, it is only the doctor population of our society which is still ethical.

The curriculum of medical ethics and law in Medical College as per MCI is adequate. It is evident from the study. There is no dearth in teaching of medical ethics and law in medical colleges as per our study, if the curriculum is followed correctly.

REFERENCES

[1] Pillay VV. Textbook of forensic medicine and toxicology. 18th edn. Hyderabad Paras medical publisher 2017:P 30.

[2] Nandy A. Principals of forensic medicine including toxicology. 3rd edn. Reprint, New Central Book Agency (P) Ltd, Kolkata 700009, 2010:P 24.

[3] World Medical Association: https://www.wma.net/policies-post/wmainternational-code-of-medical-ethics/2006.

[4] Ko Lay U. Manual of Vipassana meditation. 3rd edn. Reprint, Vipassana research institute, Dhamma Giri. Igatpuri422403, 2010:P40.

[5] Babu AT, Venkatesh C, Sharmila V. Are tomorrow's doctors aware of the code of medical ethics? Indian J Med Ethics 2013;10(3):192-4.

[6] Rose A, George K, AD T, et al. Survey of ethical issues reported by Indian medical students: basis for design of a new curriculum. Indian J Med Ethics 2014;11(1):25-8.

Mrinal KantiJha (1), Rina Das (2), Kunal Kanti Majumder (3), Somnath Das (4)

(1) Associate Professor, Department of Forensic Medicine and Toxicology, KPC Medical College, Jadavpur, Kolkata.

(2) Assistant Professor, Department of Forensic Medicine and Toxicology, RG Kar Medical College, Kolkata.

(3) Professor, Department of Community Medicine, KPC Medical College, Jadavpur, Kolkata.

(4) Professor, Department of Forensic Medicine and Toxicology, Medical College, Kolkata.

Financial or Other, Competing Interest: None.

Submission 29-07-2017, Peer Review 21-08-2017, Acceptance 28-08-2017, Published 04-09-2017.

Corresponding Author: Dr. Rina Das, #56A/34, Banerjee Para Road, SBI Housing Complex, Plot 97, Kolkata-700041. E-mail: somnath1976@rediffmail.com

DOI: 10.14260/jemds/2017/1094
Table 1. Question wise Correct Response

No.         Knowledge on          Number of     %
                                  Students-
                                   Correct
                                  Response

1     History of Indian code of      92       86.7%
           Medical Ethics
2       Definition of Medical        90       85.7%
               Ethics
3     Knowledge on Hippocratic       95       90.4%
                Oath
4      Indian Medical Council        88       83.8%
           Regulation 2002
       (Professional Conduct,
        Etiquette and Ethics)
5        Basic principles of         88       83.8%
           medical ethics
6      Professional misconduct       88       83.8%
7     State Medical Council on       76       72.3%
       professional misconduct
8          Warning notice            79        75%

9          Implied consent           65       61.9%
10       Right of Registered         66       62.8
       Medical practitioner to
           choose patient
11      Patient has right to         92       87.6%
          refuse treatment
12       Medical Negligence          89       84.7%
13      What is not a Medical        83        79%
             Negligence
14       Vicarious Liability         74       70.4%
15             CPA-86                63        60%
16         Confidentiality           54       51.4%
17           Euthanasia              72       68.5%
18       Knowledge on organ          82       77.14
              donation
19    Medical practitioners are      75       71.4%
          viewed in society
20     Practical problem faced       75       71.4%
       by medical practitioner
           during practice

Table 2. Distribution of Students According to Individual Score

Score    15-20: Good   10-14: Adequate   <9: Poor

Number       64              31             10
%          60.95%          29.52%         9.52%

Table 3. Distribution of Study Population According to Father's
Education

             Undergraduate   Graduate   Postgraduate   Doctor   Total

Number            13            39           19          34      105
Percentage        12%          37%          18%         32%     100%
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Article Details
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Title Annotation:Original Research Article
Author:Jha, Mrinal Kanti; Das, Rina; Majumder, Kunal Kanti; Das, Somnath
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Geographic Code:9INDI
Date:Sep 4, 2017
Words:2282
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