THIS is with reference to the letter ‘Medical ethics lost in training culture’ (April 5), which rightly raised valid concerns about patient dignity, privacy and consent. No ethical professional can deny that what happened in Lahore’s Lady Willingdon Hospital was unethical. A patient is never a spectacle, and an operation theatre must never become a place of casual commentary or public viewing. These values are fundamental to the practice of medicine.

However, while acknowledging the lapse, it is equally important to look beyond the surface and ask a harder question: who created the environment where such behaviour became possible? It is easy to place the burden entirely on postgraduate trainees and young doctors.

They are the most visible faces in such incidents. But are they truly the architects of this system? Or are they, in many ways, its most overburdened and under-supported participants?

This is by no means a justification for unprofessional conduct. Rather, it is a call to understand context. When young doctors are pushed into environments where exhaustion, overcrowding and lack of supervision become routine, the line between discipline and desensitisation can blur. Training turns into survival.

Where are the administrators, policy-makers and senior leadership? These are the individuals responsible for designing healthcare systems, allocating resources, and enforcing standards. Accountability must extend upward. Instead of isolating and penalising postgraduate trainees alone, there must be a broader institutional review. True reform lies not in scape-goating the most junior members in the system, but in addressing the roots of the problem.

As such, ethics in medicine cannot thrive in a vacuum. It requires infrastructure, leadership, and a culture that supports dignity at every level. Without fixing the system, we risk repeating the same incidents, only with different faces to blame. If we are serious about protecting patient dignity, we must be equally serious about holding those in charge accountable, not just those struggling within the system.

Dr Bushra K. Naeem
Karachi

Published in Dawn, May 16th, 2026