The ethics of ART

Several national news reports in early 2004 reported a young couple’s public demand for stringent laws to check unethical practices in infertility clinics in the country. It was after eight painful years that this couple from a small town in Kerala—school teacher Anitha and her lawyer husband Jayadevan—decided to create a noise about the unscrupulous medical practices of which they had been victims. They sued the hospital where Anitha almost lost her life due to gross incompetence and oversight on the part of the staff, and wrote to several state and union ministers, including the then health minister Anbumani Ramadoss, pressing for the necessity of legislation to control techniques adopted by infertility clinics.

In her memoir, Malicious Medicine, translated from Malayalam, Anitha gives us a step by step recount of her ordeal. At the age of 23, she is married and eager to have a child soon after, but is unable to conceive. Test results are inconclusive and the family travels from one town to the other in Kerala in search of a clinic that can offer them the required treatment. As a young, impressionable couple, glossy promises made by one such clinic appeal very much to them, into which they unquestioningly put a large share of their resources, and much of their faith. It’s their first step into the speciality treatments offered under ART (Assisted Reproductive Technology). ART, one understands, includes treatments such as in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI), which, if carried out competently, assists pregnancy. As a technology and practice, ART isn’t worrisome; it has, in fact, helped conception to a measurable extent. Unfortunately, there are not yet any guidelines (by law) that ART clinics are required to adhere to, and so they are a haven for unethical practice. Patients, too, are largely unaware of the technicalities of ART procedures, and it’s easy to be fooled into believing that a particular treatment is being followed when in reality it is quite another.

In the case of Anitha, even without determining the root cause of the infertility, she is immediately signed up for an ICSI by the clinician, a painful and expensive procedure.

Worse, the couple discovers only much later that in the garb of an ICSI treatment (which takes the couple’s own sperm and ovum), a donor ovum had been used without the consent of the couple. Further, due to incredible oversight, Anitha develops a life-threatening infection and has to be transferred to another hospital in a critical condition. Many years and two abortions later, Anitha pens down her findings, of how she was duped and almost killed in the process. If nothing else, she writes, her account should serve as a warning to others seeking similar treatment, and avoid falling into the same trap.

More than a medical account, Malicious Medicine is an emotional memoir, where the author craves for ‘motherhood’, which eludes her for a close to a decade. Author Anita Nair highlights this in her foreword to this book—speaking of the birth of a child that is dear to many—while also implying that Anitha, through Malicious Medicine, does not seek to attack or weaken medical science, or ART, for that matter. “She does raise pertinent questions that could lead to the institution of a code of laws to regulate the use of ART in India.”

It’s pleasing to note that the book does not point fingers at any one particular institution or person, and takes a larger point of view of the issue concerning ART. However, in totality, it remains a fragment given the magnitude of malpractice in medicine today. Cynicism about ethical medical practice is fairly commonplace, and there is no dearth of those who have been witness to that, and victims, too. It isn’t shocking, therefore, that Anitha’s condition is never diagnosed on paper, or that a medical network built on mutual benefits dodges DNA tests across states to continue to keep the truth from them. This book, however is important in its attempt to flesh out the need to fill the gaps that remain in the field of ART. Even a decade after ART is freely recognised as a superior alternative in helping to counter infertility, virtually no checks or controls over the procedures have led to scientific journals repeatedly questioning its indiscriminate use.

Translated from Malayalam by one of the doctors who stood by Anitha through the years, Dr P K R Warrier (and also C S Unni), the memoir certainly falters in its flow. The language remains mediocre and stilted but the content is educative. The author has compiled, alongside her accounts, the technicalities of her treatment and other arguments with which she fights her case in court, and on paper, as also her letters to various ministers and the PILs she has filed over the years.

MALICIOUS MEDICINE

Anitha Jayadevan
Penguin
Pages 105
Price Rs 150