Medical Profession’s Handling of the Adhikari Couple

The sight of a couple is very familiar to us now, from the print media and the television. The woman is a motherly woman with spotted blouse and the man a haggard-looking man with unkempt beard and hair. A deep seriousness and sadness pervades these images. After nearly nine years of their silent and personal struggle in search of justice, our society has been finally introduced to Mrs. Ganga Maya Adhikari and Mr. Nanda Prasad Adhikari, who are now over 40 days into fast-unto-death.  

This couple’s story is deeply heart-wrenching. Their 18-year-old son was abducted and killed by Maoists in 2004. From what media tells, even after their son’s murder, the Maoists and the state have pestered this family. Because they had registered a FIR against the suspected murderers, they were repeatedly threatened by Maoists, their livestock were killed and they were ultimately chased out from their home. Despite all of these threats they have persevered in their search for justice which has largely remained elusive. They demand that action be taken against the murderers of their son. When the usual channels of justice offered no recourse in sight they started hunger strike in front of the Prime Minister’s office in the capital city early this year. They were allegedly detained at a police station for 48 days and then taken to Gorkha, handcuffed, to be dumped. But they returned back and staged a hunger strike.

According to Asian Human Rights Commission (AHRC) appeal letter, they were arrested in mid-June and taken to Bir Hospital. The appeal letter says, “The doctors there recommended their transfer to a mental hospital. They were transferred to the Mental Hospital Lagankhel, Lalitpur where they were diagnosed with mental illness and decided that they should stay in the mental hospital.” They were forced to stay in the mental hospital for 35 days. On discharge, they apparently revised their initial diagnosis as wrong. Now the couple is back in Bir Hospital, but this time with a pledge to fast-unto-death until the justice is served. They are in the intensive care unit in dire strides. On Tuesday, we learned that the Supreme Court has ordered the government “to either coax them into breaking fast or force-feed them” according to Kantipur newspaper.

As a citizen of this country, it is chilling to learn about the fate of this couple. Whatever might be the details of this case, what is clear to us is that a son was murdered and his grieving parents seek justice. Is it too much to ask for? Rather, the power holders are persecuting this couple using their institutions and personnel. What kind of society are we living in? Shouldn’t there be a shame?

As a physician practicing in this country, however, I would like to focus on the involvement of my profession in this injustice based on the reports from news media and AHRC.

Bir Hospital and its doctors and the Mental Hospital and its doctors have been involved recently with the Adhikari couple. Apparently, Bir Hospital doctors recommended transfer of this couple to the Mental Hospital where they were diagnosed with mental illness and detained for more than a month. What should be clearly understood is that these two institutions and the responsible doctors have identified this couple (not just a single person) as mentally ill (concomitantly) amidst a political protest and used their creed and institutions to help detain them against their will.

If they indeed did this deed, it is a serious violation of medical ethics. Stance of the medical profession is quite clear on this. Code of Ethicsof Nepal Medical Council, to which all doctors registered to the council are signatories, mandates the doctors to declare before they are registered, “Even under threat and duress I will not use my knowledge contrary to the norms of humanity.” Furthermore, in its 2003 Resolution on the Responsibility of Physicians in the Denunciation of Acts of Torture or Cruel or Degrading Treatment of which They are Aware, the World Medical Association provides specific guidance to physicians who are in this situation: “Physicians should report to the appropriate authorities any unjustified interference in the care of their patients, especially if fundamental human rights are being denied.”

Several questions remain about the handling of Adhikari couple in these medical facilities. Did these doctors make decisions under pressure or political influence? Did they debate their ethical obligations? Did they seek help if they felt pressured?

These are the questions that the authority tasked with ensuring ethical practice of medicine should be asking. Since the registered doctors are signatories to the Nepal Medical Council’s declaration, it seems like the Council should be taking the lead to investigate the participation of medical profession in this injustice. However, we have yet to hear any words from the council.

Another recent development is the Supreme Court order to force-feed the couple if they do not comply. Again, in this, the global stance of the medical profession is clear. World Medical Association Declaration categorically says: “Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially. The decision as to the capacity of the prisoner to form such a judgment should be confirmed by at least one other independent physician.” Jeremy Lazarus, the President of American Medical Association, had paraphrased the exact same declaration in a letter that clarified the Association’s position that the forced feeding of detainees on hunger strike at Guantanamo Bay Naval Base violated the core ethical values of the medical profession.

As a profession, we should not comply in force-feeding the Adhikari couple if we are to maintain our ethical integrity.

The reports raise questions of serious ethical violations by the above mentioned institutions which should be investigated seriously by the Nepal Medical Council. The medical profession should stand clear that it will not comply with force-feeding of the Adhikari couple who are using hunger strike as the last measure to seek justice in an utterly unjust and callous power structure. Otherwise, we should be prepared to bear the shame of a disgraceful deed. 

Note: This article was published by Republica with title "Violation of Ethics" on September 5, 2013 along with some edits.