Gopichandran Vijayaprasad, Satish Kumar Ch
Doctoral Research Fellow, School of Public Health, SRM University, Kanchipuram District, Tamil Nadu 603 203 INDIA e-mail:
Indian J Med Ethics. 2012 Oct-Dec;9(4):272-7. doi: 10.20529/IJME.2012.091.
The National Rural Health Mission has stated as one of its key mandates the mainstreaming of the Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy (AYUSH) systems in order to help solve the human resource shortage in Indian healthcare. This has been planned at the primary level by providing training to AYUSH practitioners on primary care and national health programmes; at the secondary level by establishing departments of AYUSH in the district and taluka level hospitals; and at the tertiary level by establishing AYUSH centres of excellence as referral centres, and research, development and supervision points. The practical challenges to be considered include a gross divergence in the basic philosophy of practice; disparities in approach to specific clinical conditions; differences in their normative approach in decision making; an unclear policy for cross referral and problems of cross practice that could potentially rise in this condition. Mainstreaming of AYUSH into the existing public health system can have certain ethical implications: not doing good by failing to concentrate on the community value judgments about AYUSH; doing harm by a confusing plurality in approach and unhealthy segregation of practices without healthy dialogue between practitioners of either system; not disclosing which type of practitioners (AYUSH or allopathy) the patient is seeing; lack of proper public accountability mechanisms at the primary care and grassroots levels; and, finally, lack of social justice. These ethical issues have to be considered while mainstreaming AYUSH.
国家农村卫生使命将阿育吠陀、瑜伽、自然疗法、尤纳尼、悉达和顺势疗法（阿育吠陀医学体系）的主流化列为其关键任务之一，以帮助解决印度医疗保健领域的人力资源短缺问题。这项计划在基层层面通过为阿育吠陀医学体系从业者提供初级保健和国家卫生计划方面的培训来实施；在二级层面通过在地区和乡级医院设立阿育吠陀医学体系科室来实施；在三级层面通过设立阿育吠陀医学卓越中心作为转诊中心以及研究、开发和监督点来实施。需要考虑的实际挑战包括实践的基本理念存在严重差异；针对特定临床病症的方法存在差异；决策中的规范方法存在不同；交叉转诊政策不明确以及在这种情况下可能出现的交叉执业问题。将阿育吠陀医学体系纳入现有的公共卫生系统可能会产生某些伦理影响：未能关注社区对阿育吠陀医学体系的价值判断而未行善；由于方法上的混乱多元以及各体系从业者之间缺乏健康对话导致实践的有害隔离而造成伤害；不告知患者所看的是哪种类型的从业者（阿育吠陀医学体系或西医）；初级保健和基层层面缺乏适当的公共问责机制；最后，缺乏社会正义。在将阿育吠陀医学体系纳入主流时必须考虑这些伦理问题。
