A year spent working as a doctor in India taught British National Health Service physician Hannah Fox “how a publicly funded healthcare system creates an optimal environment for ethical decision-making,” especially in end-of-life care.

Fox explains at The Guardian:

In West Bengal there is no government palliative care policy or funding, so services rely on charitable organisations and private hospitals. Dr Dam is a palliative care doctor who has established his own NGO. He says referral rates are low and “oncologists have this attitude of ‘not letting go’ of their patients”. He argues that this is due to misconceptions about palliative care and economic factors including consultation fees, benefits from pharmaceutical companies and financial rewards for investigations. 

The Indian healthcare system is one of the most privatised in the world and is largely unregulated. A recent report in the BMJ by Dr Gadre, from Kolkata, exposed the extent of malpractice. He interviewed 78 doctors and found that kickbacks for referrals, irrational drug prescribing and unnecessary interventions are commonplace. In corporate hospitals doctors are pressurised to generate profit by performing unnecessary operations or procedures such as angioplasties. This undermines a fundamental medical ethic of “first, do no harm”. It is alarming that doctors “succumb to the pressures and get involved in these rackets”, as Gadre puts it. Those who do practise ethically cannot sustain their careers in these institutions.

I work in a private not-for-profit hospital with a philanthropic ethos. Twenty per cent of the adult beds are free for the poorest patients. However, it is still a business and requires bed occupancy to be high and state-of-the-art equipment to be used. Many palliative measures such as symptom-controlling medications, good nursing care, communication and compassion, are inexpensive. I am aware of the conflict of interests when I challenge treatment decisions, such as admitting a terminal patient to intensive care to die a prolonged costly death …

Read more here.

— Posted by Alexander Reed Kelly.