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Crafting perfect children

With technologies for pre-natal diagnosis becoming more accurate and less invasive, it is likely that there will be greater social pressure on women to produce ‘perfect’ babies, greater social endorsement of termination of pregnancies with foetal abnormalities, and even less societal tolerance of disabilities than at present. It is time, say Anoop Kumar Thekkuveettil, Mala Ramanathan and Harikrishnan S, that both service providers and pregnant women began to discuss the ethical dilemmas raised by these diagnostic technologies

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Dilemmas of a mother-to-be

We have medicalised pregnancy to such an extent and made it so technology-dependent and doctor-centred that the women who are pregnant and their families feel lost, alone, fearful and often uninformed of the choices that lie before them as they consent to a battery of tests such as triple markers, 3-D ultrasounds and amniocentesis. Sameera Khan explains

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Negotiating the maze of pre-birth technologies

Duru Shah, former president of the Federation of Obstetric and Gynaecological Societies of India and currently on the ethics committee of the International Federation of Gynaecology and Obstetrics, demystifies pre-natal tests, stresses the importance of counselling before these tests, and discusses the Niketa Mehta case in which a woman sought to abort a foetus with cardiac abnormalities after the legally-permissible 20 weeks. Interview by Sameera Khan 

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Regulate technology, not lives

Should social problems have social solutions or technological ones? Assisted reproductive technologies are reinforcing the importance of ‘one’s own’ children. The normative, genetically-linked family is being strengthened in the process, when we should in fact be building a society that respects a diversity of relationships and families, writes Chayanika Shah

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Women as wombs

The unethical use of technology to control reproduction has a long and contentious history, writes Sarojini N B. There can be no doubt that women need effective contraception. The question is: Are the contraceptives being tested and promoted both effective and safe? Shouldn’t women be able to control their use? Shouldn’t women have the right to choose, with complete awareness of the risks involved?

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Challenges of a paediatric intensivist

A seven-year-old with a certain chance of recovery was removed from ventilator support and died because his parents could no longer afford it; a 13-year-old girl died without life support because her parents didn’t want to spend any more on their daughter. Two paediatric intensivists -- Akash Bang and Arvind Kasaragod -- discuss the tragic ways in which economics and gender bias decide who will benefit from medical technology in India

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X-rays: Too much of a good thing?

The invention of x-ray and ultrasound technologies has had one important negative consequence in India -- sex-selection, with the sex ratio in places like Chandigarh down to 773:1,000. There is another: over-investigation and over-exposure to radiation. With the number of CT scans quadrupling since 1992, as many as 2% of cancers could now be attributable to radiation exposure, writes Sanjay A Pai

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The right to hear, or the right to be deaf?

Is the cochlear implant a medical miracle, giving the deaf the opportunity to listen and speak, albeit with some distortions? Or is it, as many hearing-impaired people themselves believe, the ultimate invasion of the ear, the ultimate denial of deafness, the ultimate refusal to let deaf children be deaf? Shabnam Minwalla reports

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The Wild West of stem cell procedures

From street-side stem cell clinics promising people in wheelchairs that they will walk, to corporate cord blood banks that offer to store your baby’s umbilical cord blood, an unethical and unregulated industry in stem cell procedures is feeding off the desperation of Indian patients. A comprehensive regulatory structure is urgently needed, writes Sandhya Srinivasan

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The great stem cell debate

Should research be encouraged just because something is possible, even if we are not clear about the consequences? Who sets the boundaries, and how does society conduct an informed debate on this subject? The promise of stem cell research is too valuable to be undermined because these ethical concerns are not posed and addressed adequately, says Amit Sengupta

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Moment of truth: Medical ethics and human rights in narcoanalysis

The Supreme Court has declared illegal the use of medical technologies for investigation of individuals without their consent and several safeguards. Nevertheless, narcoanalysis, brain mapping and other medical technologies continue to be used. The participation of doctors in these practices erodes the very core of the medical profession, writes Amar Jesani

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Doctors as executioners

It was a doctor who invented the guillotine, a dentist who helped design the electric chair and an anaesthesiologist who conceived of the lethal injection. It is a doctor who climbs up a ladder to certify that a prisoner kept hanging for several minutes is actually dead, and a doctor who administers the lethal injection. It’s time, says Vijay Hiremath, that the medical fraternity took a stand against capital punishment since every method of execution is intrinsically cruel and violative of their professional ethics

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Disease-mongering: Any which way to find a market

By branding impotence ‘erectile dysfunction’ and heartburn ‘gastro-oesophageal reflux disease’, pharma companies turn commonplace conditions into threatening diseases to market existing drugs or new drugs of doubtful or no utility. This article, by S Srinivasan, is an eye-opener on the extent to which drug companies obfuscate, bribe, offer kickbacks and make irrational, harmful, useless and even banned medicines

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A microscope at the grassroots

Jan Swasthya Sahyog’s experiences in a small hospital with an active village outreach programme show that the cost, versatility, sensitivity and specificity of the microscope make it the most important investment for a small healthcare unit. Biswaroop Chatterjee explains

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Doubts about vaccines

Are strong-arm immunisation campaigns justified in the name of ‘public good’, asks Prabir Chatterjee. What is the ethical responsibility towards those who fall ill despite vaccination -- or because of it? Why is there no notion of parental consent in India? In a shocking instance of unethical practice, the human papilloma virus vaccine for cervical cancer was administered to poor children in boarding schools without their parents’ knowledge and consent

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'New and improved?' Using technology to transform the body

Demand for cosmetic surgery is rising by 230% every year. Invasive and non-invasive surgical procedures are advertised on every street corner. Is this the ‘democratisation of beauty’, with the body becoming a site where it is possible for an individual to maximise life by becoming ‘new, improved’ versions of themselves, employing the latest in science and technology? Or is there a dangerous corollary to this preoccupation of science with the creation of the perfect face and body? Manjima Bhattacharjya looks at the issue

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Making innovative technology work for you

Indian hospitals are frenetically importing every new technology and building glossy mega-hospitals that only 15% of us can afford. But, writes Kavery Nambisan, what we need is innovation that presents simpler and cheaper alternatives. This article by a rural surgeon points to the many innovations already in practice -- from beating heart surgery to the use of mosquito nets for hernia surgeries, and fresh blood transfusions

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