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44 Cardio Diabetes Medicine 2017

Diabetes and Ethical Issue

Professor. Dr. Russell Dsouza, MD., DSc.,
Chair Asia Pacific Division, UNESCO Chair in
Bioethics Haifa, Melbourne Australia

INTRODUCTION “Ethics” stands for a set of philosophical beliefs and
The worldwide prevalence of diabetes is estimated practices concerned with the distinction between
to increase from 4% in 1995 to 5.4% by 2025. The right and wrong or system of moral values or code
increase will be sharpest in developing countries, of conduct relating to morals in human beings. Eth-
where the number of diabetics will almost triple from ical principles are intellectually derived by a particu-
84 million to 228 million. The developing world will be lar profession for its specific needs and may / can
responsible for more than 75% of diabetics in 2025, be changed or modified as per needs of the society
up from 62% in 1995. Among developing countries, or community. Medical ethics refers chiefly to the
the highest increase in prevalence will be in China rules of etiquette adopted by the medical profession
followed by India. However, the greatest increase in to regulate professional conduct with each other,
numbers will be seen in India, where the number of with individual patients, with society, including con-
diabetics will rise from 19 million in 1995 to 57 million siderations of the motives behind that conduct. In
in 2025, heading the list of countries with the great- modern era, traditional medical ethics changed into
est numbers of diabetics. an interdisciplinary field involving theologians, law-
yers, philosophers, social scientists and historians,
The World Bank estimates that diabetes will account as well as physicians and other health professionals
for 1,870,000 Disability Adjusted Life Years in India, because of increasing impact of science and tech-
with a per capita health expenditure of $21. Already, nology, public expectations from new medicines and
some two-three per cent of the health-care budget surgical techniques, changes in the financing and de-
is spent on diabetes-related problems. An increase livery of health care.
in the number of diabetics is likely to have a serious
impact on our country’s Ethical Issues with managing Diabetes: An increase
in the number of diabetics is likely to have a seri-
health-care system This scenario raises many eth- ous impact on a country’s health-care system raising
(3).
ical and social issues related to diabetes. Long term many ethical and social issues related to diabetes.
care for chronic diseases like diabetes goes beyond Performing research and preventing, diagnosing,
the traditional boundaries of medicine and single and treating diabetes will raise ethical, legal, social
sector responsibility. One of the main characteristics and policy issues. The Issues raised by diabetes
of chronic diseases is the involvement of caregivers can surround the understanding and addressing of
and other professionals from many disciplines. At the identified barriers to research, such as analyzing the
same time, there are medicosocial implications in the impact of patents on genes related to diabetes; as-
need for long-term care for chronic diseases. One sessing the challenges of bringing new diabetes-re-
major goal of diabetes care is to achieve a condi- lated technologies through the regulatory approval
tion of wellbeing in the presence of chronic disease process; conflicts of interest in research and medi-
and disability. In this context, the harmful effects of cine; and understanding and protecting the rights of
medicalizing chronic care need to be recognized . human subjects in diabetes research, including ge-
(2)
In most developed countries, such medicalization netics based research on collected or stored tissue
increases health-care costs without meeting the re- samples. Further ethical issues arise with regards to
cipient’s non-medical psychosocial needs. India must distributive justice related to assuring population’s
avoid this. access to appropriate services and healthcare; pre-

GCDC 2017