February 15, 2022
Good morning. In today’s either/view, we look at whether doctors should take the Hippocratic Oath or the Charak Shapath. We also look at how schools in Assam are introducing tribal languages as a medium of instruction, among other news.
📰 FEATURE STORY
A Doctor’s Dilemma: Replacing the Hippocratic Oath
Since the late 3rd century AD, medical practitioners have been vowing in the name of Hippocrates to uphold some ethical principles in their profession. And you know that our old Grecian pal did not write 70 whole books of medicine for people to simply cast him aside when convenient. Well, according to some, this is happening in India right now.
As per the minutes of a meeting held on 7 February, the National Medical Commission (NMC) is looking to switch the Hippocrates oath out for the Maharishi Charak Shapath. And people have feelings about it. While some see this as progress being made in the inclusion department of medicine, others think progress for progress’ sake is dangerous.
Is this just more saffronisation of universal principles, or are we fighting for India’s rich technical history?
Context
Last week, the Undergraduate Board of the NMC, the new regulator of medical practice and education in India, held a meeting. The minutes of which read, “No Hippocratic Oath. During white coat ceremony (with parents) the oath will be ‘Maharishi Charak Shapath’ present in NMC website”. This is the informal proposal that started this whole hullabaloo.
The Hippocratic oath, falsely accredited to Hippocrates as its ethics mimic those of a more Pythagorean kind, is one that newly enrolled medical students are made to swear by. While there is no one accepted version of it, different institutions across the globe follow some general principles considered to be the Hippocratic oath. Most of them cover the notion that no doctor will knowingly use their practice to cause harm to others.
The Charak Shapath is mentioned in the Charaka Samhita, one of the foundational texts of ancient Indian medicine. Despite parts of it relying on mysticism – as was the norm back in the 1st-2nd centuries AD – in many ways, the Charaka Samhita surpassed Grecian medicine. Similar to the Hippocrates oath, the Charak Shapath also goes over professionalism, a commitment to one’s patients and doctor-patient confidentiality.
Another similarity between the two is that the Charak Shapath also does not have just one version of it. Since the Shapath is derived from its original Sanskrit texts, medical institutions that do follow it usually have their own version of it. For example, the AIIMS Charak Shapath is, “Not for the self; Not for the fulfilment of any worldly material desire or gain, but solely for the good of suffering humanity, I will treat my patient and excel well.”
Due to this similarity, the doctors of India seem to be split over this proposed change. Even though sources from the NMC have said that the likelihood of this change is very little, people still find the proposal rather concerning. Even the Indian Medical Association (IMA) released a statement objecting to the same.
Making mountains out of molehills
Public opinion around this issue can be split into three camps: the ones in favour of the change, the ones against it and the ones that couldn’t care less about a ceremonial oath. As Centre for Mental Health Law & Policy Director Dr Soumitra Pathare tweeted, “The controversy over Hippocratic oath is symptomatic of our public discourse. The oath is irrelevant to public health care.” You see, an oath, whether Greek or Indian, is simply a part of a ritual that takes place once in a doctor’s life. Some believe that the specifics of this oath really doesn’t matter so long as the practitioner understands the gravity of their duties.
Considering the issue has already entered the realm of public discourse, the implications of it are worth looking into. The World Medical Association (WMA), in 1949, adopted a code of medical ethics expected to be followed by every medical practitioner. It includes general principles like maintaining the highest standards of professional conduct, not working for profit or personal gain, providing the most competent medical service, etc. Of course, due to changing times, this code has been amended several times as well, with the latest change added in May 2021. Yet, those moral guidelines have always been present in the code.
Given the similarities of both the Hippocratic oath and the Charak Shapath, the universal points mentioned in the WMA’s code are covered in these vows as well. Thus, making the main point of contention in this issue the origin of the affirmations. Now, as a post-colonial country that has been riddled with syllabi influenced by foreign powers, the addition of Indian elements to the education system must not be looked down upon. And when it comes to the sciences, such a low-stakes change could be a great place to start.
Besides, in today’s world, certain aspects of the Hippocratic oath are also considered quite outdated. So much so that, if followed to a T, some of the clauses might actually lead to serious lawsuits. Cornerstones of bioethical principles like patient autonomy and consent are not even touched upon by the oath. Considering that the Hippocratic oath is regularly quoted by courts to silence protesting doctors, the ins and outs of the same must match the times. If we are to use an outdated oath, why not use one of a more indigenous effect?
The forced saffronisation of medicine
Here’s the thing, implementing change simply for the sake of changing isn’t the best strategy either. While sure, having an Indian oath would be nice but making lateral moves by replacing one archaic oath with another is only going to add unnecessary logistical issues. Considering the prevalence of the Ayurveda system of medicine in ancient India, a lot of the Charak Shapath’s source text follows the same. The accomplishments of which, despite the current administration’s push, are still considered rather dubious in modern medicine. If anything, we should be looking to codify a new oath that covers today’s ethical norms.
It is also important to note that the replacement of the Hippocratic oath with an ancient Indian oath is not a new demand. For years, a major demand of the Rashtriya Swayamsevak Sangh (RSS) has been to get medical institutions in the country to drop the Grecian vow. In Gujarat, the National Medicos Organisation, associated with the RSS, has been informally anointing medical students with the Charak Shapath. On several occasions, the RSS has also held independent programmes that administered the Shapath to medical students before they started practising.
When it comes to the NMC, this proposal has to be seen with their push for a mandatory yoga course for medical students as well. Something that was proposed to several medical institutions in the same meeting with the informal Charak Shapath proposal. While that, on its own, isn’t necessarily a bad thing, when put in context with sudden direct compliance with Hindutva voices, the precedent being set is quite concerning.
Dr Muraleedharan, the chairperson of the IMA’s public health awareness committee, even went over the casteist implications of the Charak Shapath recently. According to him, the Shapath begins with “O dwija” which means “Brahmins”. It also talks about facing east in the “presence of a holy fire” and treating women in the presence of her husband or close male relative. Clearly, the sexist, casteist and regional connotations have to be addressed and reworked. In fact, the reworking of the Hippocratic oath by the WMA makes it more appropriate for the times compared to the Charak Shapath.
Finally, in the words of Shashi Tharoor, “I am all in favour of introducing Indian elements into Indian education, but not at the expense of universal values and standards.”
What’s your opinion on this?
(Only subscribers can participate in polls)
a) The Hippocratic oath must be replaced with the Maharishi Charak Shapath.
b) The Hippocratic oath must not be replaced with the Maharishi Charak Shapath.
🕵️ BEYOND ECHO CHAMBERS
For the Right:
How the Hindutva project is trying to reconfigure Indian Muslim identity – and why it will falter
For the Left:
Karnataka hijab controversy: Why Modi government should seriously think about Uniform Civil Code
🏴 STATE OF THE STATES
Tribes let down (Uttarakhand) – Van Gujjars, the community that lives in the forest areas of the state are disillusioned by political parties. They feel politicians only remember them come election season and are then forgotten. The 60,000-member community needs their rights to be protected since none of the Panchayats is registered under the Forest Rights Act (FRA). The community could gain economically by being allowed to sell their homemade goods.
Why it matters: The FRA has been implemented in other states like Maharashtra and Odisha. In Uttarakhand, it hasn’t been yet. Many political parties haven’t made forest or tribal rights a priority in the current campaign. More than 70% of the state is classified as forest land. Almost half the state’s population consists of forest dwellers. At least 24 lakh people could benefit by having the FRA implemented.
Vizhinjam port by 2023 (Kerala) – India’s first mother port will be ready by 2023 at Vizhinjam. State ports minister Ahammad Devarkoil visited the site and said the project will keep its 2023 completion date. Exporters and importers can move their cargo without incurring additional costs. Since the work on the port started, land prices in the coastal town have increased ten-fold. Apart from a separate freight corridor, major roads in the area are being upgraded.
Why it matters: In 2014, Adani was the sole bidder for the port and the following year agreed to construct and maintain the port for 40 years. The estimated cost is ₹7,525 crores. The project’s completion was delayed from 2019 due to cyclone Ockhi in 2017 and Tauktae last year. The local fishing community protested citing backwater construction will affect their livelihoods. Currently, more than 60% of India’s trans-shipment cargo is handled by Colombo, Singapore, and Jebel Ali. For India, the port will be a big achievement in the absence of an efficient trans-shipment terminal.
Credit potential (Chhattisgarh) – The National Bank for Agriculture and Rural Development (NABARD) said the state’s total credit potential for 2022-23 is ₹39,170 crores. Agriculture Minister Ravindra Choubey said schemes implemented by the government have strengthened the agriculture sector and helped farmers economically. In light of future development schemes, he asked banks to increase the ground-level credit flow. He also thanked NABARD for its financial assistance.
Why it matters: The share of agriculture and the MSME sector in the credit potential are ₹21,805 crores and ₹12,556 crores, respectively. For 2020-21, NABARD estimated the state’s credit potential at ₹34,421.38 crores, and for 2021-22 it was ₹36,260.11 crores. Agriculture is important to the state, and the government has undertaken policies to help farmers. Last May, the state government sent ₹1,500 crores to 22 lakh farmers as input cost subsidies to allow them to sow Kharif or monsoon crops. In June 2020, the state announced that more than 7.6 lakh farmers were granted interest-free loans worth ₹2,721 crores.
No non-veg clause (Rajasthan) – In Tonk district, a Congress-run municipal council proposed a clause banning the consumption of non-vegetarian food in its terms for bidding on 10 toll plazas. It stated that non-vegetarian food like fish, meat, and eggs should not be allowed at toll plazas. Activists criticised the move saying it goes against people’s fundamental rights. Ali Ahmed, the chairperson of the council, said the clause has been a part of the terms even when the BJP was heading it in 2017. He said it will remain amid calls for it to be dropped.
Why it matters: Many of the residents of Tonk district eat non-vegetarian food, and this move would affect them. It would also prevent people from minority communities from becoming prospective bidders. In 2015 following Maharashtra’s lead, the BJP-led state government ordered meat and fish shops to close during festivals. The order was to prevent animal slaughters during Jain festive days.
Tribal languages in schools (Assam) – The state education department will introduce four tribal languages as a medium of instruction in the upcoming academic session. The four languages are Rabha, Mising, Tiwa, and Deuri. The initiative is part of the New Education Policy (NEP). A search has begun to recruit teachers who can communicate in the stated languages. Earlier, education minister Ranoj Pegu said a tribal language will be an option for classes 6 to 8. Bodo, Hmar, and Garo are other languages already being taught in schools.
Why it matters: Part of the reason to include tribal languages in the school curriculum is to preserve them. Some have concerns about the future of Assamese and English in tribal pockets if imparting education begins with tribal languages. In November, Union Education Minister Dharmendra Pradhan said Assam will be a lab for language-based education in the coming decade. Part of the NEP’s emphasis is teaching in the mother tongue or local languages.
🔢 KEY NUMBER
₹4.31 crores – The average assets per candidate in the upcoming Punjab assembly elections, according to a report from the Association for Democratic Reforms (ADR). Before the 2017 polls, that figure was ₹3.49 crores.