You are working as a senior doctor in the oncology department of a super specialty hospital located in Delhi. While accessing the quotations from reputed pharmaceutical companies to hospitals, you unearth a nexus between pharma firms and the hospital administration. You get to know that they are hand-in glove with each other and trying to fleece cancer patients by selling drugs at exorbitant prices, even though low cost alternative drugs are available in the market. Being the head of Alliance of Doctors for Ethical Healthcare, who is working against the arbitrary price regime of life saving drugs, you get a chance to represent your case before the Health Minister of your state. However, certain other doctors of the Alliance have asked you to present a distorted reality in front of the Minister since they are obtaining pecuniary benefits from such a scheme of nexus, which would cease if the nexus gets exposed. 20 (a) Identify the main stakeholders and ethical issues involved. (b) Analyse the possible solutions for addressing the issues. (c) What would be your final course of action and why?

a) The stakeholders and ethical issues involved are -

1. Hospital administration

• Selling drugs at high prices despite availability of low-cost drugs
• Accepting illicited money from pharma companies
• Looting patients despite the severity of the disease (cancer)
• Potentially going to be responsible for death of poor patients

1. Patients

• Loss of their trust in hospital
• Potentially will finish their life-savings

1. Pharma companies

• Commerce without morality
• Using helplessness of patients for own profits
• Bribing doctors

1. Alliance of doctors for ethical Healthcare

∟ Many are going against the alliance's core mission and values ∟ Involuntary consent to the ongoing unethical practices

b) The possible solutions are -

1. Staying quiet Merit → ∟ No trouble for the hospital and colleagues ∟ Potentially saves my job

Demerit → ∟ Unethical, especially as I am the head of the Alliance ∟ Compromises my integrity ∟ Forever regret of being the cause of deaths of patients ∟ Possibility of case coming out in open later

1. Reporting the case Merit → ∟ Fulfil my duty as head of the alliance ∟ Punishment for the wrong-doers and justice for the patients ∟ Potential reward for my role in unearthing

Demerit → ∟ Loss of job most probably ∟ What if I am unable to prove the case? ∟ Possibility of government ignoring the case

c) As a doctor who listens to his conscience, my final course of action will be -

• Collect all possible evidences, facts and proof of misdoings
• Collect information on the doctors involved in the scam
• Present the report to the Minister and take moral responsibility, as members of my own alliance were involved
• Recommend reimbursal for the patients who have been robbed