The Hindu Editorial Vocabulary– May 06, 2022; Day 283

Standing on ceremony: On Charak Shapath and medical education

An overemphasis on a ritualistic oath does not aid quality medical education

Observance of rituals largely serves a symbolic function; they are infused (Fill, as with a certain quality) with meaning that gives a semblance (An outward or token appearance or form) of human-made order to the vagaries (An unexpected and inexplicable change in something (in a situation or a person’s behaviour, etc.)) of nature. But pushing the meaning beyond the symbolism is fraught (Marked by distress) with danger. Standing on ceremony, particularly, does not quite fit in with the roles and the responsibilities of a medical professional, and the Charak Shapath row in Tamil Nadu, in which a top official of a government medical college was put on a waitlist, has clearly dragged one ceremony beyond its original intent and purpose. While things came to a head with the suspension of the dean of Madurai Government Medical College, the controversy has been brewing (to begin to form) since February, when the minutes of the National Medical Commission’s (NMC) discussions with medical colleges were leaked. One of the points read: “No Hippocratic Oath (An oath taken by physicians to observe medical ethics deriving from Hippocrates). During white coat ceremony, the oath will be Maharishi Charak Shapath.” The Charak oath appears as part of Charaka Samhita, an ancient text on Ayurveda, and seeks to, much like the Hippocratic Oath, lay down the ground rules for the practice of medicine for a student. While it emphasises compassion (A deep awareness of and sympathy for another’s suffering), and the scientific and ethical practice of medicine, it also highlights certain values embedded (Fix or set deeply) in the cultural and social ethos (the distinctive spirit of a culture or an era) of the time of Charaka, and seen today as retrograde (Moving or directed or tending in a backward direction). References to caste, old-style subjugation (Forced submission to control by others) of student to a guru, and gender bias have been flagged since. Though it was later clarified that the oath was not compulsory, there were valid concerns about projecting it as a substitute for the Hippocratic Oath.

In the English version that was read out at Madurai Medical College, there were two references that are repugnant (Offensive to the mind) — ‘Submitting myself to my Guru (teachers) with complete dedicated feeling,’ and ‘I, (especially a male doctor) shall treat a woman only in the presence of her husband or a near relative’. The rest of the oath stresses, in simple language, the very principles of the Hippocratic Oath, including serving the sick, a pleasant bedside manner, and not being corrupt. Subsequent investigations have revealed that the dean was not even part of the decision to substitute the Charak Shapath for the Hippocratic Oath (the Students’ Council claimed responsibility), and he has since been reinstated (Restore to the previous state or rank). But launching severe (Intensely or extremely bad or unpleasant in degree or quality) action for what might have been just procedurally deviant (Markedly different from an accepted norm), rather than a crime or violation of ethics (Motivation based on ideas of right and wrong), seems a knee-jerk reaction (made or occurring as a predictable and automatic response, without thought), or worse, the pursuit of a political agenda. The focus should rather be on ensuring quality medical education, inculcating (Teach and impress by frequent repetitions or admonitions) in students a scientific temper, and a sense of service to patients. While Tamil Nadu has often rightly argued for States’ autonomy in a federal structure, this act adds little heft (importance) to that critical issue. For the NMC, even more so, the stress should not be on the bells and whistles (features which are nonessential but very attractive), but rather on the quality of education.

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