Case 1: A middle aged lady being given an amulet/ring for treatment of depressive symptoms
Autonomy The lady would have much choice to continue wearing amulet/ring or not. Autonomy unlikely to be significantly impaired
Beneficence The amulet/ring might have been given with the intention to do good
Non-maleficence No direct or indirect harm is likely to be due to the wearing of amulet/ring.
Justice Access to treatment in a place and form which is acceptable to the person concerned. Likely to work through placebo effect.
Case 2: An man with long standing alcohol dependence being subjected to ‘jhaadphook’ for treatment of jaundice resulting from liver dysfunction
Autonomy The autonomy is likely to be constrained during the period of the procedure lasting minutes to hours, and the patient possibly would not allowed to leave. Likely to be brought by the family members.
Beneficence The procedure conducted to remove the evil spirits might be done with a conceptualization to do benefit. Such benefits are unproven
Non-maleficence The procedure is not likely to find the cause of jaundice or treat it in any manner. Indirect harm if it causes delay to appropriate treatment in a medical facility
Justice Might be a more accessible form of treatment, but lack of any efficacy makes it unhelpful to the community as a whole.
Case 3: A young man being branded with hot iron-rod and chained in temple after he started ‘hearing voices’ and showing other symptoms consistent with schizophrenia
Autonomy Involuntarily chaining and branding impairs the autonomy of the patient.
Beneficence Beneficence towards the patients cannot be clearly established. May appear like a punitive measure to control aberrant behavior.
Non-maleficence The procedure is potentially harmful to the patient, inflicting pain and may lead to secondary infection. Withholding potentially beneficial medications if additional psychiatric services are not provided.
Justice Chaining of patient may be comparable to institutionalization of the patient in a long term facility. But the quality of care is likely to be better in a psychiatric facility. Might serve the community for a while, but in view of effective medications available to control schizophrenia, such acts would be considered unjustified
Table 1: Ethical principles applied in select case scenarios
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