Public Health Ethics in the Medical College Curriculum: Challenges and Opportunities

  • Mario VazEmail author
  • Manjulika Vaz
  • Arvind Kasturi


This chapter offers a historical background of medical education in India and the place of ethics within it. It traces the journey of training of the “medical graduate” in healthcare: from uniformity of competence to the social role of the physician and the evolution of aims of the current undergraduate medical education programme. There are several current challenges in medical education that run counter to the social role of the physician: commercialization of medical education, privatization of medical education, the hidden curriculum, basic degree vs. the basic doctor, basic doctor vs. the specialist, skill based vs. education based, technical vs. humanistic skills, cure vs. cause, and consequences vs. social determinants. The case of St. John’s Medical College in Bangalore, with its historical institutional inspiration, and efforts to reach underserved areas, the evolution of the 2-year compulsory rural placement scheme on graduation, the pioneering effort at the introduction of medical ethics, and the community health outreach efforts have been highlighted. The outreach activities serve as a good stimulus for public health ethics as also public health research at the undergraduate and post-graduate levels. Challenges and opportunities exist in the conventional medical college setup and within the present medical curriculum in integrating public health ethics.


Education Medical college Ethics Public health Institutional history India 



The authors wish to acknowledge Tom Mishael, a medical student at St. John’s Medical College, who researched the evolution of medical ethics in India as part of a Waltraud Ernst Studentship in the Department of History of Medicine, and Dr. Savitha D. and Dr. Olinda Timms for the permission to use student quotes from a study on the hidden curriculum in medical education.


  1. Benatar, S. R. (2003). Public health and public health ethics. Acta Bioethica; año, IX(2), 195–207.Google Scholar
  2. Berger, D. (2014). Corruption ruins the doctor-patient relationship in India. BMJ, 348, g3169.CrossRefGoogle Scholar
  3. Berger, D. (2017). Time for an overhaul at the world medical association. BMJ, 357, j1955.CrossRefGoogle Scholar
  4. Bonah, C. (2002). Experimental rage: The development of medical ethics and the genesis of scientific facts Ludwik fleck: An answer to the crisis of modern medicine in interwar Germany? Social History of Medicine, 15(2), 87–207.CrossRefGoogle Scholar
  5. Borkar, G. (1957). Health in independent India (pp. vi–vii). New Delhi: Ministry of Health, Government of India.Google Scholar
  6. CBCI Centre. (2005). Commission for health care—Catholic Bishops Conference of India, sharing the fullness of life. New Delhi: Health Policy of the Catholic Church in India.Google Scholar
  7. Chattopadhyay, S. (2013). Corruption in healthcare and medicine: Why should physicians and bioethicists care and what should they do? Indian Journal of Medical Ethics, X(3), 153–159.Google Scholar
  8. Clouser, K. D., & Gert, B. (1990). A critique to principilism. The Journal of Medicine and Philosophy, 15, 219–236.CrossRefGoogle Scholar
  9. Crowe, S., Clarke, N., & Brugha, R. (2017). ‘You do not cross them’: Hierarchy and emotion in doctors’ narratives of power relations in specialist training. Social Science & Medicine, 186, 70–77.CrossRefGoogle Scholar
  10. Goel, S., Angeli, F., Bhatnagar, N., Singla, N., Grover, M., & Maarse, H. (2016, July–August). Retaining health workforce in rural and underserved areas of India: What works and what doesn't? A critical interpretative synthesis. The National Medical Journal of India, 29(4), 212–218.Google Scholar
  11. Government of India, Ministry of Health. (1955). Conference on Medical education in India. Programme and Information. Delhi: Cambridge Printing Works, p. 33.Google Scholar
  12. Government of India, Ministry of Health. (August 1959–October 1961). Report of the Health Survey and Planning Committee (Mudaliar report, Vol 1, Chapter II, pp 19–20). Accessed 23 October 2017.
  13. Govt. of India. (1946). Report of The Health Survey and Development Committee -Bhore Committee (Vol II, pp. 340, 356).Google Scholar
  14. Hehir, P. (1923). The medical profession in India. London: Oxford Medical Publications.Google Scholar
  15. Jain, M., Gupta, S. A., Gupta, A. K., & Roy, P. (2016, April–June). Attitude of would-be medical graduates toward rural health services: An assessment from government medical colleges in Chhattisgarh. Journal of Family Medicine and Primary Care, 5(2), 440–443.CrossRefGoogle Scholar
  16. Joseph, K. P. (1998). Bishop Jonas Thaliath of Rajkot. a biography (p. 115). Rajkot: Deepti Publications India.Google Scholar
  17. Levy, B. S. (1998). Creating the future of public health: Values, vision, and leadership. American Journal of Public Health, 88, 188–192.CrossRefGoogle Scholar
  18. Mahajan, V. (2010). White coated corruption. Indian Journal of Medical Ethics, VII(1), 18–20.Google Scholar
  19. Mankad, D. (Ed.). (1991). Medical education re-examined. Bombay: Medico Friend Circle and Centre for Education and Documentation.Google Scholar
  20. Medical Council of India. (1916). The Indian Medical Degrees Act 1916. Accessed 23 October 2017.
  21. Monteiro, L. (1988). 25 years silver Jubilee souvenir, St. John’s Medical College, p. 51.Google Scholar
  22. Narayan, R. (1979) The Ross Institute and St. John’s. St John’s Annual, pp. 66–69.Google Scholar
  23. Newman, C. (1957). The evolution of medical education in the nineteenth century. London: Oxford University Press.Google Scholar
  24. Pandya, S. K. (2009). Medical Council of India: The rot within. Indian Journal of Medical Ethics, VI(3), 125–131.Google Scholar
  25. Pati, S., Sharma, A., & Zodpey, S. (2014, July–September). Teaching of public health ethics in India: A mapping exercise. Indian Journal of Medical Ethics, 11(3), 185–190.Google Scholar
  26. Ravindran, G. D., Kalam, T., Lewin, S., & Pais, P. (1997). Teaching medical ethics in a medical college in India. The National Medical Journal of India, 10(6), 288–289.Google Scholar
  27. Savitha, D., Vaz, M., & Vaz, M. (2017a). “Thinking ethics”: A novel, pilot, proof-of-concept program of integrating ethics into the Physiology curriculum in South India. Advances in Physiology Education, 41(2), 306–311. Scholar
  28. Savitha, D., Vaz, M., Timms, O., Ravindran, G. D., & Vaz, M. (2017b). On the integration of ethics into the physiology curriculum. Indian Journal of Medical Ethics. Accessed 07 Oct. 2017.
  29. Schröder-Bäck, P., Duncan, P., Sherlaw, W., Brall, C., & Czabanowska, K. (2014). Teaching seven principles for public health ethics: Towards a curriculum for a short course on ethics in public health programmes. BMC Medical Ethics, 15, 73.CrossRefGoogle Scholar
  30. Secretary General of The World Medical Association. (1950). Standard of medical education report 1. New York: Council of The World Medical Association.Google Scholar
  31. Shuster, E. (1997). Fifty years later: The significance of the Nuremberg code. The New England Journal of Medicine, 337(20), 1437–1440.CrossRefGoogle Scholar
  32. Sood, R., & Adkoli, B. V. (2000). Medical education in India – Problems and prospects (editorial). Journal, Indian Academy of Clinical Medicine, 1(3), 210–212 Scholar
  33. St. John’s Medical College Bangalore. (1977, January 11). A perspective Report to the CBCI.Google Scholar
  34. Ten Have, M., de Beaufort, I. D., Mackenbach, J. P., & van der Heide, A. (2010). An overview of ethical frameworks in public health: Can they be supportive in the evaluation of programs to prevent overweight? BMC Public Health, 10, 638.CrossRefGoogle Scholar
  35. Thomas, J. C., Sage, M., Dillenberg, J., & Guillory, V. J. (2002). A code of ethics for public health. American Journal of Public Health, 92(7), 1057–1059.CrossRefGoogle Scholar
  36. Vaz, M., & Timms, O. (Eds.). (2016). Bench to bedside: An anthology of medical student narratives. Bangalore: St. John’s Research Institute.Google Scholar
  37. Vollmann, J., & Rolf, W. (1996). Informed consent in human experimentation before the Nuremberg code. BMJ, 313, 1445.CrossRefGoogle Scholar
  38. Vision. (2015). Medical council of India, page 9.
  39. WHO-SEARO. (2010). Guidelines for Preventive and Social Medicine/Community Medicine/Community Health Curriculum in the Undergraduate Medical Education. Accessed 20 Sept. 2017.
  40. World Health Organization. (2017). WHO guidelines on ethical issues in public health surveillance. Geneva: WHO. Accessed 20 Sept. 2017.
  41. Wujastyk, D. (2012). Well-mannered medicine. Medical ethics and etiquette in classical Ayurveda. New York: Oxford University Press.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Physiology and Division of Health and HumanitiesSt. John’s Medical College and St. John’s Research InstituteBangaloreIndia
  2. 2.Division of Health and HumanitiesSt. John’s Research InstituteBangaloreIndia
  3. 3.Department of Community HealthSt. John’s Medical CollegeBangaloreIndia

Personalised recommendations