Page 4 - Suggestions For The Future Continued
It has also been suggested that interviews be arranged with patients who have undergone the leg lengthening procedure (2, 4). If possible, interviews should be arranged between a prospective patient and a person undergoing leg lengthening surgery, as well as a person who has already undergone the surgery. This would enable prospective patients to see for themselves the challenges faced by those undergoing the treatment, and would help to reassure them with respect to the final outcome.

Ethical Dilemmas
It is important to appreciate the differences in the outlooks of different societies. Western countries are individualistic, whereas Indian society continues to have a collective outlook and is somewhat paternalistic as well. The newspaper article mentions that as a mature adult, the patient made the decision himself, but his father raised objections because he was not involved in the decision-making process. The patient seems to have worked in an IT company and probably earned a high salary. He was used to his freedom and probably wanted to take decisions independently. He did not feel the need to inform his parents about his decision. This patient’s outlook could be symptomatic of India’s changing society. It is pertinent to ask whether it is ethically appropriate for newspapers and journals to take a stand against the patient and the orthopaedic surgeon. Is the reporter violating ethics by questioning the ethics of the medical professional? By publishing the report and naming the individual patient, has the reporter not breached the patient’s confidentiality? Did the patient give his consent for the publication of his name in the newspaper article? Moreover, ethics cannot be isolated from culture and society. The ethical theories and points that have been used to support the doctor’s view have essentially been developed and propagated in western countries, which have a different sociocultural milieu and are resource-rich. If we carried out a survey on this issue among the members of Indian civil society, they may not have agreed with us. Would this mean that it is unethical? Theirs would be a democratic view, not considered ethically right, and may be criticised globally. If we carried out the same survey globally, it is highly probable that the orthopaedic surgeon who performed the height gain procedure would be vindicated. In our opinion, unless the eastern countries develop their own theories of bioethics that are in line with their worldview, they will always struggle with such problematic cases which pose ethical challenges.

While this case may not provide the right platform to debate ethics on a larger scale, it underscores the fact that the application of bioethics theories developed in the West will give rise to dissatisfaction among us. The larger issue which is not understood is that we are imposing ethical guidelines developed in the West (and people who have been trained in the West) on researchers and clinicians in India. This applies to even the code of ethics of the Medical Council of India (MCI). Unless we develop our own theories of ethics, there will always be a schism between ethics as taught in textbooks and what is felt as being ethical.

The fact that this schism can exist in otherwise morally upright individuals indicates that we are not closer to the truth – the truth of what constitutes ethics in our milieu.

Conclusion
We acknowledge that our report is important as it is an independent review of the case and puts it under the ethical scanner, with the caveat that we do not have the full details of the case. Our report is based on the information published in the newspaper (1) and it is possible that the article may not have mentioned important details. The scientific evidence shows that cosmetic limb lengthening has excellent and good outcomes, even among patients whose height is normal and who have a subjective feeling of being short. Though some level of risk and complications are to be expected during the course of the treatment, the benefits seem to outweigh the risks as the problems do not seem to cause any permanent disability. The surgeon’s decision to perform cosmetic limb lengthening may be supported by different ethical theories; however, refusing to perform the procedure seems to violate all ethical theories. A surgeon’s decision to perform the surgery seems to be fair and appropriate from the ethical and clinical perspectives. This is a good case for instructing medical professionals in ethics.