Topic 2 Clinical ethics in the practice of Kayachikitsa

Clinical Ethics in the Practice of Kayachikitsa

Integrating classical Āyurvedic wisdom with modern principles

1. Ethical Principles

1. Satya (Truth-telling) & Ahimsa (Non-maleficence)
   • “सत्यवाकदनं अक्रोधं च निर्वृत्तं मद्यमैथुनात् …” (Āchāra-Rasāyana 1/4/30-35) – Speak honestly, avoid anger, intoxication and harm .
   • In practice: never withhold diagnosis; choose therapies that minimize harm.
2. Beneficence (Hitam) & Non-maleficence (Ahitam)
   • “अतुरेणैव विनारभेत् ।” – Treat the ailing with utmost care, avoiding aggravation.
   • Uphold śodhana–śamana sequence (e.g. snehana before virechana) to prevent iatrogenesis.
3. Autonomy & Informed Consent
   • Explain diagnosis (rogi-roga parīkṣā), prognosis and all major interventions.
   • Respect patient’s right to accept or refuse śodhana, pāṇā­yadāna, etc.
4. Justice & Equity
   • Provide care equitably, regardless of caste, creed or socio-economic status.
   • Ensure access to essential formulations and pañc̣akarma facilities.
5. Confidentiality
   • Maintain discretion over patient’s personal, medical and lifestyle information.
   • Share information only with explicit patient permission or urgent public-health need.

2. Qualities of a Vaidya (Professionalism)

“चिकित्स्य पुरुिषे चतुर्षटु गुणाः सम्पद्यन्ते” – The four limbs of successful therapy are the physician, medicine, attendant and patient .

*traditional madhukara-kavya reference

3. Effective Communication Skills

• Active Listening
  • Give full attention; reflect back (“So you’re experiencing śītasnata…”).
• Empathetic Language
  • Use warm words: “You are not alone in this journey.” (प्रियावचनम्)
• Clear Explanations
  • Translate Sanskrit terms: e.g. virechana → mild purgation.
• Non-verbal Cues
  • Open posture, eye contact, nodding to encourage dialogue.
• Cultural Sensitivity
  • Respect dietary taboos, family-centred decision-making.

4. Ethical Decision-Making Framework

1. Identify the Ethical Dilemma
   • E.g., patient refuses virechana despite clinical indication.
2. Gather Clinical & Contextual Data
   • Review dosha-dhātu status, rogi’s mental strength (sattva), socio-economic factors.
3. Refer to Ethical & Āyurvedic Principles
   • Satya, Ahimsa, autonomy, śodhana → śamana sequence.
4. Explore Alternatives
   • Offer mild anuvāsana basti instead of virechana; adjourn procedure after counselling.
5. Make & Document Decision
   • Obtain informed consent; record rationale in case-sheet.
6. Implement & Reflect
   • Monitor outcomes; debrief with team; integrate learnings into future practice.

5. Practicing Professionalism & Ethics

• Punctuality & Reliability: Respect patient’s time; follow through on referrals.
• Continuous Learning: Regularly update knowledge of classical texts (Caraka, Sushruta) and modern guidelines.
• Teamwork & Accountability: Collaborate with nadi-pariksa, lab-analysis colleagues; admit errors promptly.
• Self-care & Boundaries: Maintain svasthavritta; avoid burnout to ensure sustained compassionate care.

This module equips the Kayachikitsa practitioner with a robust ethical compass—grounded in Āyurvedic śāstra and enriched by contemporary bioethical standards—to deliver safe, compassionate and equitable care.