On ethics.

                                                       

                                   “What is it, man,” asks Vivekananda in one of his discourses, “that forces you to be ethical?” Is it the fear of god? Or hellfire? Is it the fear of man and his laws? Of punishment and prison? Or is it perhaps the looming pall of conscience? Will we run dry of nobler reasons should we set out to choose a foundation, a motive for morality? We are a sorry and miserable species if the above choices limit us. Egalitarian objectives would be without fair footing.

But is there such a thing as a rational reason for ethical behavior? Since empathy is often said to be a prerequisite, we need to look for the source of that. In our search we will be disappointingly met with precious few examples in the animal kingdom. While our empathy may be safely assumed to be bestowed at some point by evolution upon our prehistoric ancestors, perhaps molded by the unseen forces of social constraints on the instinct to survive, we are still not in sight of a proper understanding. Why must ‘survival of the fittest’ bend in our case and in such formidable magnitude? Does it somehow help in our survival as a whole?

For long has questions such as this assailed the best of my reasoning, without respite has it bested my efforts to ignore it for they have practical bearing on life. And they are not aimless, nor simple. Their import is for us to decipher. They can prove drowning even before one finds the valid questions, one will be disheartened even before the menacing inquisition can be faced. Before long, one might question its very utility, the worth of such an effort.  

My pensive ponderings have not been in vain however.  Upon joining med school, I have been exposed to a variety of enlightening and thought provoking situations, most of them taking me by surprise. They have revealed to me many other aspects not yet considered. While they have in a way muddled my already confounded comprehension, they have also yielded a rich array of experiences from which I may, should time force me one day to choose, mold out my own stand.

My entry into clinical life at the hospital was right away into surgical oncology, my first posting. Here, at the barren outset, I had my first sampling taste of the insurmountable ethical challenges dotting the life of a doctor. A female patient whose many successive consultations had failed to yield a diagnosis, let alone an attenuation of her suffering. Finally, as I watched, the doctor who must remain anonymous, read the reports of a few tests and breaks to her the identity of her tormentor, the name of the tyranny whose clutches she cannot escape from. 

“Ma’am, you have cancer. It has spread. I am sorry” I saw fear gripping her face and the flooding in her eyes start to spill over. Soon she could not hold back her sobs. The doctor took her into his room for a longer session to convince her it was alright or not the end of it or so.

I did not pick up any expression in the doctor’s face as he spoke his words. His voice was clear and unrestrained. His tone determined and stern. Was he sad? Must he be? Must he at least pretend to share her inestimable sorrow? Or must he merely state facts and move on? Is giving false hope condemnable? Must the interlude till death be subdued by fear or replete with hope? These questions battered my already clueless heart.

My most lasting impression was about the doctor. How courageous he was! How strong and battle hardened a medical veteran one must be to face a patient of bleak hopes and reveal the truth! How many such patients must he have had to face so far! How many such battles will I have to face in my own life! The same me who already has more questions than answers.

I am of the opinion now that being ethical is often to oppose very many innate instincts that propel our subconscious. The instinct to survive, to preserve oneself, to prosper, to avoid injury or shame to oneself, to be acknowledged by society and so on. In a very general sense it could be said that pure ethics kills the self for the good of all. The one must sacrifice for the other. The veracity of such ideals cannot be established by utilitarian arguments. But humanity will prosper and see glory if individual, then the family, then the society, then the country and then countries among themselves conform to “one for all, all for one”.

As a doctor in the making, I realize that these ethical conundrums will ceaselessly present themselves and test my integrity. How much of the pressure of circumstance can I withstand before I compromise on my principles, which I hope not too far away in the future I would have formed, I hope to not find out. I am ever in the eager lookout for more such experiences to help me one day contribute to the world of my aspiration. I rest my case.

The above essay was among the selected and published by St Johns Medical college, Bangalore, under the 'silk routes' project of Iowa university, USA. 

https://iwp.uiowa.edu/silkroutes/bangalore-india?type=all