Where are all the bioethicists when you need them?

Abstract

Is biomedical ethics just casual talk? Is it merely medical etiquette, philosophical window dressing, full of empty rituals and little substance? Do doctors take ethics seriously? What should we expect from bioethicists when the ethical practice of medicine is at stake? One cannot ignore these questions in the aftermath of a shameful saga – ‘upon which it is difficult to speak, and impossible to be silent’ – that unfolded over the election of a president-elect of the World Medical Association (WMA).1 The WMA is an international association of doctors established in the aftermath of Nazi medicine to ‘work for the highest possible standards of ethical behaviour and care by physicians at all times.’2 In keeping with its goal to provide ‘ethical guidance to physicians,’ the WMA ‘has adopted global policy statements on a range of ethical issues’ including the International code of medical ethics, and the Declarations of Geneva and Helsinki.3 The annual assembly of the WMA, hosted by the Indian Medical Association in New Delhi on October, 2009, featured ‘the unopposed election in his own country’ of Ketan Desai, [then] president of the Medical Council of India (MCI) as president-elect of the WMA.4 Six months later, in April 2010, Desai was arrested on charges of seeking a bribe of 20 million rupees (£296,000; €350,000; $450 000).5,6 No stranger to accusations of unethical behaviour, Desai was ousted from his position as president of the MCI in 2001 by order of the Delhi High Court,7–9 which observed that Desai and his family had ‘received unexplained payments totalling 6.5 million rupees (£92,000; €105,000; $150,000).’1 The Supreme Court of India dismissed this case against Desai as no evidence was found that he had ‘extended official favours to those from whom he had received payments.’ Eventually Desai was reinstated as head of the MCI in 2009.5 Reports of corruption and new bribery charges against Desai in 2010 led the government of India to disband MCI and re-establish it with a new board of governors. Undeterred by being removed as president of the MCI for a second time, WMA president-elect Desai, who had been jailed on the bribery charges, obtained bail and was about to assume his position as the new president of the WMA at its annual assembly in Canada. The MCI's new board of governors revoked Desai's license to practice medicine and informed the WMA that ‘It would be a travesty of justice if Desai, who has brought disgrace to the medical profession, is allowed to take charge as the president of the World Medical Association.’1 When the annual assembly of the WMA met in Vancouver, Canada, in October 2010, the president-elect of the WMA was found ‘unable to carry out his duties’ and his ‘inauguration’ as president was ‘suspended indefinitely.’10 In an extraordinary election, Wonchat Subhachaturas from Thailand was elected as president of the WMA. This incident – ignored or unnoticed by doctors, professional medical associations, and other stakeholders – deserves careful reflection by all who are concerned about the cause of ethics in medicine. That an ethically compromised doctor became president of a medical council or professional association is shameful but not impossible in a country like India, where corruption is endemic.9 It is difficult to believe, however, that no one in the WMA knew about Desai's past record given the fact that his removal from the MCI was reported in both national and international medical journals.7–9 The case of Desai, and the anemic reaction to his election and suspension, raise several questions about the place of bioethics in medicine: How could an ethically challenged doctor become the president-elect of the WMA? Is ethics simply a look-good decorative badge on the white coat? What will prevent this kind of ethical lapse from being repeated? This case is not about a single person or a professional association, but rather about the integrity of the medical profession and the place of ethics in medicine. Regrettably, there is no indication – at least publicly – that Desai's case generated any introspection on the part of the WMA. Corruption was noticeably absent from the agenda when the WMA adopted a number of resolutions on several health-related issues in their assembly. Is it not an ethical imperative for a professional association of the stature of the WMA to come clean and explain their position?