28 January, 2023



By Rusiripala Tennakoon –

Rusiripala Tennakoon

There was a time in history where people were made to believe that health problems were a result of unseen super natural forces beyond the understanding of the patients. There was also a period when the medical profession was dominated by untrained quacks who portrayed themselves as Physicians. What they really did was swindling the patients stripping them of money and wealth by making them believe those myths. The qualified physicians who honestly believed in treating the patients were in a dilemma due to those highly unethical and unprofessional individuals dominating the scene hell-bound to make a quick-buck.

It was in this background that the famous historical “Hippocratic Oath” of the medical profession came to be accepted universally. This oath in its original format was designed to ensure to provide a basis for the people to distinguish between the professional physicians from the con-men, and to create a trust in the ordinary people in medicine as a profession.

The oath is for persons entering the profession to serve as a guide for the moral ethics that one has to observe in the profession and it is a model code of professional ethics. The things that a doctor can do and cannot do are included in it. The basic theme of the oath is “heal but don’t harm”. It also emphasizes the fact that the medical knowledge is something that embodies several obligations to be observed by those who possess such knowledge.

This Hippocratic Oath underwent changes and amendments many times subsequently. The General Assembly of the World Medical Association meeting at Geneva in 1948, adopted a new Physicians Oath. This was known as the “Declaration of Geneva”.

The declaration mainly focused on the importance of a physician’s dedication to the humanitarian aspects of the medical profession. It was regarded as a revision of the original oath to encompass the modern developments in up keeping the moral truths that underlined the Hippocratic Oath. World Medical Association adopted the revised version in 1948 and named it as the “Declaration of Geneva”.

As it stands today, when a person enters the medical profession, to be admitted has to take this oath which in outline reads as follows:

  • I solemnly pledge to consecrate my life to the service of humanity;
  • I will give to my teachers the respect and gratitude that is their due;
  • I will practice my profession with conscience and dignity;
  • The health of my patient will be my first consideration;
  • I will respect the secrets that are confided in me, even after the patient has died;
  • I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
  • My colleagues will be my brothers;
  • I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
  • I will maintain the utmost respect for human life;
  • I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
  • I make these promises solemnly, freely and upon my honour

What our country was experiencing in the recent past about the doctors and their activities appear to be a big contrast to those universal norms of the profession.  With a huge quota of civilian casualties, affecting those in need of medical assistance, the general public has to ask whether what the doctors are doing is in conformity to the code of ethics they are bound by.

Government is responsible for ensuring the free medical services to the public, who are paying taxes to the government to be entitled for such rights and to uphold the human rights guaranteed in the constitution of the country.  The doctors resorting to Trade Union actions are protected under the freedom of association and the rights associated with such provisions.  They have a right to protest demonstrate and pursue any action legally permitted.

Government is also bound to uphold the agreements and principals under which permission has been granted to operate a private medical college, if such permission has ever been granted.

Trade Union rights apart, the doctors are bound by their professional ethics and conduct. Those are more relevant to the public.

The intervention of the leading Buddhist monks and other religious prelates is very timely and of extreme importance at this juncture, the religious leaders decided to come forward and make an appeal when the issue reached a critical stage.

Prof. Carlo Fonseka / Photo Credit – You Tube Victor Rathnayake

Professor Carlo Fonseka’s name figured in the controversy due to a stand taken by him as a member of the Sri Lanka Medical Council with regard to its response to the order given by the Court of Appeal to register the SAITM medical graduates.

Prof. Carlo Fonseka himself is a controversial person in the Sri Lankan society. He is not a politician per-se in that sense but very much into politics, with his own choice of party politics. He was well known as a rationalist who gained prominence by exposing mythical beliefs and disproving many such. He is a highly respected person in the medical profession and a leading figure in the contemporary scenario.

I listened to an interview given by him to a TV Program recently where he expressed his opinion on some of the matters related to the SAITM fiasco.

In this interview he referred to the history and the development of the medical education in this country going back to 1879 

1962 the 2nd Medical faculty was started in Peradeniya. Currently there are 8 Medical Faculties in the country producing about 1,000 doctors a year and according to him there is an acute shortage of doctors in this country. He candidly agreed that we need private medical colleges if the state for some reason or the other cannot fulfill the required numbers. He cited as an example the case of the Colombo North Medical College which started in 1981. It has produced 850 doctors among who we have more than 100 top quality doctors of very high standards not second to the doctors produced by the State. It amply proves that the private sector too can produce excellent doctors.

Supporting his views in favour of establishing private medical colleges he gave four clear reasons :

  1. Referring to the density of available doctors, he said there are only about 55 doctors for every 100,000 persons. The number is hardly adequate from any standard.  Comparatively our country is only above Nepal and Bhutan among all other countries in the region.
  2. The selection process followed currently is flawed and defective due to discriminatory standardization under the district quotas system. The best performers at the entry level are eliminated as a result of this system.
  3. Demand for medical education is very high.  Hundreds of students go overseas every year for medical education.
  4. This costs the country a huge amount of foreign exchange and if we set up more private medical schools we can earn foreign exchange as a regular income source for the raising national income in addition to saving the drainage.

So Prof. Carlo Fonseka in his eminent appraisal states in no uncertain terms that Private Medical Education is acceptable, wanted and very advantageous in many respects. Some of the apprehensions by groups like the students are according to him due to mis-information and misguidance.

We therefore have a clear picture of the actual situation for us to find a solution to this problem. The pros and cons are as follows:

  • Private Medical Colleges are good for the society, there is a big dearth of doctors.  The state sector cannot produce the required number of doctors.  There are inherent weaknesses in the accepted selection procedures followed for admission to government Medical Colleges.
  • There is a big potential to attract foreign students and earn the much needed foreign exchange for the national income through the establishment of private medical colleges.
  • There is a drain on our exchange currently due to large numbers migrating overseas for medical studies.

Public have to view all these factors and express views and opinions to bring about a feasible and long term solution.

Print Friendly, PDF & Email

Latest comments

  • 3

    Professor Carlo Fonseka also states that though there is a reasonable need for private medical faculties he cannot support SAITM as it is now due to inadequate quality standards available there to produce quality doctors for the country.

    • 0

      Prof Carlo referred to the days when Colombo North medical college started
      He said it has by now produced some best of the best
      Prof Carlo I know never mince his words
      It is left to those who understand him clearly
      Anyway people kneel before they walk!

  • 7

    Everytime I see Buddhist monks get involved in government affairs, I cringe.

    Not because of their knowledge of Buddhism. But, their lack of experience in dealing with the dirty politics of our country and trade unions. Self-serving Politicians are dragging Buddhism along the mud road.

    GMOA has done more harm than good for the country and Buddhist monks would invariably be a part of it.

    Buddhist monks should be confined to temples, if not, Buddhism would be part of dirty politics and purity is lost for the future generations.

  • 2

    Also don’t forget that the majority of those who go to overseas universities do NOT return to the island. That is a huge loss to the country and the free education system. Had some of them be able to become a doctor in Sri Lanka. they would have stayed and helped Sri Lankans, instead of Britons, Australians and Americans.

  • 5

    Rusiripala Tennakoon in “SAITM – SAITM – SAITM” talks talks talks medical ethics. Unfortunately politicians have no qualms when it comes to wealth accumulation, religious leaders preach but do not practice, accountants are there to assist with tax evasion, police to guard the wealthy and so on and so on. Why pick on GMOA? If GMOA is exploiting the public’s health security, then so is SAITM holding the public to ransom.
    Pro-SAITM has supporters in high places. Yesterday there was this news in “The Island” that Colombo and Peradeniya Universities are to be privatized. This is a red herring prior to “Why not a place for SAITM too”
    Colombo is turning into a hub of elitists and SAITM is elitistic among the elitists. GMOA, SLMC and the staff of 8 medical faculties are worried.

    • 3

      Some of the best universities in the world are “elitist”. E.g. Oxford, Cambridge, Harvard, Yale, etc.

      The not-so-elitist universities are striking at tax-payers’ expenses, and while GMOA is demanding an elitist standard by holding the government to ransom by demanding “elitist” schools for their children, duty free cars, private pratices, etc. and now to ban competition.

      A sucker is born every second.

  • 0

    why was carlos interview not given prominence in any of the newspapers
    only what he told the press about saitm
    is it because they prefer the gmoa ,ns version

    • 0

      Perhaps it will b of interest to you to know that Carlo appealed to the GMOA not to resort to any TU action using his name
      This was televised nation wide
      He also said GMOA has no right to demand who should be appointed to the MC

  • 1

    SAITM seems to have facilities including its teaching staff that are on par with Colombo and Peradeniya at least. In addition to undertakings enshrined in the “Declaration of Geneva” it is vitally important to test aptitude in emotional quotient of medical study aspirants which demonstrates the ability to feel empathy with the suffering patients.

    For too long, an ability to memorise facts and regurtitate them at an exam was enough to enter medical school in Sri Lanka. Sports and Arts, aesthetics and music are excellent additional criteria to establish maturity and intelligence that cramming for ALs do not establish. It is clear that many relatively young Sri Lankan doctors who practice do not possess mature humanitarian or ethical notions that are critically important in medicine.

    The Sri Lankan standards in non-partisan assessments and evaluation are notoriously horrendous. A foreign accrediting body would be ideal. This would leave out the tribal jealousies and petty politics of local assessors that has brought a very bad name to a once noble profession.

    Proficiency in AL subjects will not determine the mettle of a graduate, medical or any other.. It is merely a bar that helps to screen out less competent candidates at that level. A holistic and apolitical approach is long overdue in providing health services.

  • 2

    The declaration of Geneva is very clear that Drs are not suppose to go to trade union action or establishing a trade union. as their strike actions violate the human rights for health as well as for right to education of an individual. If the government three forces, Police service, Prison department are not legally permitted to have trade unions. Thus banned formulating of trade union by all categories of medical personnel described by Medical Ordinance when those persons are issued licenses to practice as medical practitioners, dentists and nurses etc.in terms of Medical ordinance. It is high time to bring this piece of law without further delay.

  • 0

    Well, SAITM has been in operation for quite sometime, and with change of Government now, it is said that their standard of training is not good. Where are the standards to determine acceptable level of a doctor training institution? Has SLMC developed or adopted any such standards? or a method to determine such compliance to such standards? Have they used that and determined what the deficiencies in SAITM? Have they given time for SAITM to adjust like the civilised world do in cases like this? Is it the GMOA, with clear self interest for keeping country’s doctor supply down and earn more at the expense of patient, who decides it? Or do they like hippocratic politicians who only think of themselves attempt to mislead general public and the students who ever agitate while reaching maturity? Well, we can very well understand why Trade Union rights of GMOA are much more important than lives and human rights of patients, especially those who are not so affluent. Of course the members of GMOA who built up themselves through poor man’s tax money, should feel proud/ ashamed that their authority is much more above that of the Government or the lives of less affluent helpless patients. Why not GMOA become Government themselves?

Leave A Comment

Comments should not exceed 200 words. Embedding external links and writing in capital letters are discouraged. Commenting is automatically disabled after 5 days and approval may take up to 24 hours. Please read our Comments Policy for further details. Your email address will not be published.