Phutke Gajanan, Laux Timothy, Jain Priyank, Jain Yogesh
Senior Resident, Family Medicine, Jan Swasthya Sahyog, Ganiyari village, Chattisgarh, INDIA, and Global Health Fellow, The HEAL Initiative, CA 94612, USA.,
Hospitalist, The HEAL Initiative, CA 94612 and Jan Swasthya Sahyog, Ganiyari village, Chattisgarh, India.,
Indian J Med Ethics. 2019 Jan-Mar;4(1):39-45. doi: 10.20529/IJME.2018.041. Epub 2018 May 18.
The Pre-Conception and Pre-Natal Diagnostic Techniques Act was written to prevent societally unacceptable harms including intentional sex selection. The pragmatism required to enforce this law has profound effects on the ability of rural Indians to access diagnostic ultrasonography. In so doing, it may have inadvertently placed a heavier burden on the poorest and worsened health inequity in India, creating serious ethical and justice concerns. It is time to re-examine and update the law such that diagnostic ultrasonography is widely available in even the most peripheral primary health and community health centres. Shorter, more accessible ultrasonography training courses should be offered; collaboration between radiologists and rural practitioners and facilities should be encouraged. Finally, modern ultrasound machines can carefully record all images via a "silent observer" modality. With some modifications to previously used silent observer modalities, this technology allows both greater access and better policing of potential misuse of ultrasound technology.
《孕前和产前诊断技术法案》旨在防止包括性别选择在内的社会不可接受的危害。执行该法律所需的实用主义对印度农村居民获得诊断性超声检查的能力产生了深远影响。这样做可能无意中给最贫困人群带来了更沉重的负担，并加剧了印度的健康不平等，引发了严重的伦理和正义问题。现在是重新审视和更新该法律的时候了，以便即使在最偏远的初级卫生和社区卫生中心也能广泛提供诊断性超声检查。应提供更短、更易获得的超声检查培训课程；应鼓励放射科医生与农村从业者及医疗机构之间开展合作。最后，现代超声机器可以通过“无声观察者”模式仔细记录所有图像。对以前使用的“无声观察者”模式进行一些改进后，这项技术既能扩大获取途径，又能更好地监管超声技术的潜在滥用情况。
