Abstract
DECLARATIONS
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SC
SC is the sole contributor
James Watson - Noble Laureate and former head of the Human Genome Project - once assured a panel meeting that ‘nobody should worry about the morality of what they were doing’. Because ‘the project allocated millions of additional dollars’, Watson allayed the fears, ‘to get the best ethicists that money can buy’. 1
At first instance, Watson's statement may seem odd - is ethics ‘something’ money can buy? Empirical scientist as he is, Watson is, however, not off the mark as a number of published reports reveal that money can buy biomedical ethics. The for-profit biomedical industry has expended millions of dollars - literally - to fund academic centres of bioethics and their academic programmes. Consider, for example, a recent news-report that Merck pays bioethicists at the University of Pennsylvania to teach Chinese about bribery and corruption. 2 Not only that, hired by the pharmaceutical companies, bioethicists have served the industry faithfully in a number of capacities, including, for example, writing industry-funded research articles, acting as ‘key opinion leaders’ in promotion of marketing, sitting on for-profit institutional review boards and justifying clinical drug research on vulnerable populations such as homeless people. Curiously, these corporate-friendly bioethicists testify as experts in high-level governmental meetings, formulate ethical policy guidelines, show up in the media and counsel the public on bioethical issues. 3 Few would disagree that ethics seems vulnerable in the corporate empire seeking ‘profit over people’ and thus lingers an unseemly spectacle: can we imagine a Buddha or Socrates encashing a cheque from the industry and preaching ethics?
When the moneymaking business of commercialized medicine failed me, I turned to academic medicine. With the mushrooming of for-profit corporate hospitals, private medical colleges and growing industry-academia nexus, academic medicine seemed to be on sale; like many of my colleagues, I sought ethics in medicine for refuge and inspiration. Where will I turn to when biomedical ethics seems to be ethically challenged? What will I teach to my students about moral sensitivity and integrity in medicine if bioethics turns out to be just ‘philosophical window-dressing’?
Desperately searching for inspiration beyond this money-ethics disease syndrome, a glimpse of renewed hope came from unexpected quarters - the voices of medicine and medical ethics who were never welcomed to enter the secular cathedral of medicine and ethics. ‘Far from the maddening crowd’ of the professional associations and conference halls, these healers of diverse health systems mostly work in resource-poor settings and serve the communities -hardly with any official badge of recognition or honour. I was inspired by a Buddhist monk-healer of Thailand who says:
I am very glad to be able to help people and to make myself available to them at all times. I am not tired of this work even if there are too many patients each day. I have no special office because I like to sit where people can find me easily. I always treat the patients impartially, wanting to restore health to all of them. I am providing them not only with free services but also with simple food and lodging when needed and available since these people are poor … This is because as a Buddhist monk, I am obliged to help all those who are suffering. 4
This monk-healer does not ask patient's name and address - something probably unthinkable in contemporary bioethics obsessed with autonomy of the individual:
I do not want to ask their names and addresses. For me they are just suffering people who need help, and I am very glad to be helpful to them. 4
No, this Thai healer does not disregard his patients; he is not interested in recordkeeping lest it is used for collecting money from poor patients. I found these monk-healers have something to offer that was missing in academic medicine and biomedical ethics - empathy, selfless service and compassionate care as their mission in life. It is no surprise that these monk-healers - lauded as ‘unsung heroes’ by the World Health Organization - significantly contributed to promotion of health among rural populations. 5
In my own case, I came into contact with a monk-physician when I visited a TB sanatorium, in a faraway place in rural India, run by the Hindu monks of the Ramakrishna Order. Trained in modern medicine with postgraduate training in tuberculosis and chest diseases, this doctor-swamiji stayed in the temple and served poor patients admitted in the adjoining TB sanatorium for decades. The patients are not consumers of healthcare in a marketplace; they are considered as rogi-narayanas - ‘patient-gods’ (god manifest as patients) - who give physicians the opportunity to serve the deity in the form of patients. To enquire about the number of patients admitted, the doctor-swamiji would ask, ‘how many rogi-narayanas have you served today?’ Thus, healthcare institutions become like sacred houses of worship where the ‘patient-gods’ of all faiths, cultures, languages and social classes are treated with utmost care and dignity. And, the mantra of worship is a healing service to the suffering human beings who need medical help and care.
I found what I badly needed - an unending source of inspiration where moral vision has not been blinkered by skilled philosophical arguments based solely on reasons - in an unjust money-driven world of medicine. Thus, when high-tech commercialized medicine makes me feel empty, when all-brain-and-no-heart bioethics with jargon confuses more than it clarifies on morality in medicine, I renew inspiration and recall these ‘unsung heroes’ of medicine and bioethics whom money cannot buy.
Footnotes
Acknowledgements
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