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Medical Ethics 101- How to Fill in the Gaps and Avoid Failing Humanity

Submitted by on January 31, 2016 – 9:50 PM 46 Comments

5758214“There isn’t any other option available … we have to go for surgery …”

 

These words of a well-known Neurosurgeon, practicing in a recognized hospital, under whose consultation my father was admitted came as a shock to me. Recently, my dad- a 72 year old male with usual activity level, suffered from a stroke (hemorrhagic type) leading to partial paralysis of the right side with loss of ability to speak (aphasic). His condition wasn’tcritical so soon he was shifted to the ward from the emergency as he was fully conscious and well aware of his condition. We were much relieved as we knew that he was in good hands and the stroke will take its due course of time to heal, allowing him to discharge soon.

 

Fortunately, all went well, and as we had proposed, the doc planned to discharge him on the third day. But after the 2nd planned CT, his condition began to deteriorate to unconsciousness, leaving all of us in great shock. After discussing with the consultant, we got to know that my dad had developed hydrocephalus which can only be relieved by a SHUNT in the brain via surgery. This comment gave us a tail spin pushing us to search for a 2nd opinion from another goodconsultantin town. Amazingly the other specialist’s opinion was against the surgery.

 

It raises a lot of queries about the consultant’s approach and the nursing care of the hospital. Whether there is a lapse in the nursing care service or the consultant is making a hit and try approach by keeping the patient and his kin involved in the money game. This attitude setback made me think of the basic medical ethics which I read in the initial years of my med school.

 

Medical ethics is about doing the right thing for achieving the best route for every individual patient. Traditionally speaking there are four basic principles of medical ethics, encompassing

  1. Autonomy
  2. Beneficence
  3. Nonmaleficence
  4. Justice

 

Autonomy

Autonomy refers to the right of the patient to make one’s own decision. It is the principle that enhances the patient’s right to decide what will happen to him and the ability to make choices which should be respected by everyone. Autonomy also implies an obligation to inform and develop trust.

 

Beneficence

It is in fact, the heart and soul of health care, simply meaning doing well. Apart from the medical ethics, it is the moral duty of all the health care providers to strive for their patients’ health in every situation. This concept also ensures that any form of intervention, whether diagnostic, therapeutic or for research must be in the best possible interest of the patient.

 

Nonmaleficence

Nonmaleficence, or avoiding harm, is the most crucial pillar of medical ethics which has most of the share of patient’s concern. No harm should be brought to the patients in terms of physical and socio-psychological aspects. The unintentional harm affecting the patient due to something done in good gesture is also included (doctrine of double effect).

 

Justice

It is the foundation of doctor-patient relationship. This demands to be as fair as possible, basically means giving away one his dueshare. A health care individual should be able to justify his actions in every situation. These principles help the physician to opt for the best care.

 

Now the best physician is the one who treats the patient in the light of his experience and learning selflessly and empathetically. He should be free from the greed of fame and money.

 

But in Pakistan,where the literacy rate is quiet low, the patients are not fully aware of their rights and the significance of physician’s role in practicing these ethics is increased many folds. Also,there are many traps for the physicians by the pharmaceutical companies, for exchanging expensive gifts in lieu of prescribing their drugs, sometimes by hospital administration to get the patient admitted and operated for no reason at all. This allows us to divide the physicians into two types:

 

Those who have undergone extensive studies and are able to correctly diagnose therefore offer a treatment depending on their learning and ethical principles and those who haven’t been through those long years of training but are very good in public dealing and are running their clinics successfully. Both are very popular among the masses. This state of affairs is contributing to increase the hardships of the patients.

 

How to prevent stumbles in Ethics:

The physician should keep in mind that it is her/his utmost responsibility to help patients in achieving the desired health outcomes. This can be augmented by the good patient physician relationship. These can be achieved by:

 

  1. Communication:

Effective and better communication both verbal and nonverbal is the bed rock of interpersonal communication. It is much more than just asking and handing a perception. To ensure that the meaning of the message is transmitted, following multiple strategies should be employed:

 

  • Make your introduction warmly and with a smile
  • Sit down and establish eye contact while listening\talking
  • Listen with no interruptions and pay attention to the answers of the critical questions
  • Use the language which the patient understands, avoiding medical terminology.
  • Provide feedback by summarizing “ If I’m not wrong, you told me that …”
  • Ask for any alternative therapy the patients are using.

 

Nonverbal communication is also very important forphysician patient interaction. By keeping the positive body language,simply nodding and leaning forward doctors make the patient realize his importance and assist him in opening up.

 

  1. Empathy

To put yourself simply at the patient’s seat and view from his perspective can be very beneficial in building trust in the relationship. Acknowledge patients feeling by saying that “that must be very difficult to you”.

 

  1. Consent

Informed consent remains the burning issue of medical ethics, it usually comprises a clear explanation of the procedure, risks involved and the benefits of treatment. It also comprises of theinstruction that a person is free to withdraw his consent. Health care professional need to be sure that the patient understands the terms and conditions for treatment.

 

  1. Be Broadminded

By keeping the welfare of the patient to the front, feel comfortable in saying “I don’t know”. Keep in mind that it is not mandatory that patient will surely agree with you. Always discuss the options available in the atmosphere of mutual respect.

 

  1. Ethics is about thinking.

Don’t hesitate to think.There may be more than one correct answer. Ask issues and seek advice from the experienced.

 

Medical ethics because of its complexity and human involvement is a very delicate process to balance. To balance the ethical principles with the provision of the best care should be the target of the today’s physician. I summarize in the words of Al-Tabari, the great Muslim physician and the author of the bible of knowledge “Firdaus- ul- Hikmat”, which formed the basics of medical sciences:

“It is essential for a physician to be kind, generous and of good character. A physician should be more kind to his patients than to his own relation and serve the patient before self. Neither should he be greedy of money. These traits will cause damage to his rank and nobility.”

 

References:

  1. Zaidi, Shabih H.(2014), Ethics in Medicine, Springer International Publishing.
  1. http://www.dummies.com/how-to/content/medical-ethics-for-dummies-cheat-sheet.html
  1. http://www.aafp.org/dam/AAFP/documents/medical_education_residency/fmig/tips_relationships.pdf

 

About the Author: Myda Tahir is a medical professional graduated from DMC, Karachi, Pakistan, who is now doing her Post Graduation from CPSP. She is a passionate writer with a special interest in health, education and creativity.

About this article: This article is competing for the JPMS International Medical Writing Contest 2015.

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  • faraz

    Very Informative and eye opening…

    • myda tahir

      Thanks for turning around.

  • Saima Asghar Shahzad

    Very enlightening for a layman. And ur suggestions are also very helpful in practical implementation of medical ethics.

    • myda tahir

      thanks Saima for the appreciation

  • http://www.livebysurprise.blogspot.com Liv by Surprise

    I’ve been very lucky to have had some incredible physicians involved in my care. I would hope that all doctors operate to such a high standard.

    • myda tahir

      Wow, qiute lucky dear,

  • http://itsautumnslife.com/ Autumn

    It’s sad to think about but some are really in it for the money game. I know the past year I’ve seen several big news items here in the US about doctor’s misdiagnosing on purpose and ordering unnecessary things for their patients.

    • myda tahir

      Thanks Autumn,
      the Evil has spread as far as we can see

  • kmaryam

    If you have to study medicine, you have to do it for the love of it. Some things just can’t be motivated by money !

    • myda tahir

      Absolutely kmaryam,
      hope the docs and the docs to be should have eared your advice

  • Time Out Muslimah

    I believe getting a second opinion is so important. Unfortunately, sometimes judgement is clouded by emotions and people often times misjudge the character of the doctor. We are conditioned to believe that doctors are there for the right reasons. Believe me lack of ethics happens here in the US as well. There have been several cases in the last few months where doctors have misdiagnosed people with cancer when in fact they never had cancer to begin with.

    • myda tahir

      Sad to hear this,
      Cancer is such a dreadful term, should be very careful.

  • New Leaf

    The truth is, it is almost impossible to find such physicians anywhere. We should appreciate the UN doctors/few ethical doctors who work with such high morals.

    “Health insurance” -unfortunately is making things more expensive for a common man. And those who have insurance are bombarded with unnecessary medicines! System needs to be improved.

    • myda tahir

      Thanks dear Haya,
      you are right System need to be improved, but who made and run system,
      It is You and me.

  • Irum Irshad Favaz

    This is so realistic. And an eye opener. Thanks for sharing such great information. This is the scenario happening in many hospitals in India aswell.

    • myda tahir

      Thanks irum for your comment.

  • Ruku Kazia

    I hope your father is doing better now, and pray for his speedy & complete recovery. Good doctors are a blessing, and not very easy to find especially in critical situations. I’m glad you went ahead and got another opinion.

    • myda tahir

      Thanks Ruqoiya for your kind words,

  • http://www.djarabikitabs.com Papatia Feauxzar

    I wish a great recovery and shifa to your father, amiin. The Hippocratic oath is taken lightly these days because many people have come to worship money. Great tips and Allah help us all, amiin.

    • myda tahir

      YEAH, the Hippocratic oath has just changed into a simple recitation with nothing from the heart.

      • http://www.djarabikitabs.com Papatia Feauxzar

        Yea…Many people are empty inside *sigh*

  • Amina Edota

    May Allah grant your father complete shifa and turn his pain and discomfort into kaffarah.
    This is a great reminder and wake up call to safeguard professional ethics and especially the medical ones.
    May our dear Ummah be blessed with medical doctors and workers who value humanity beyond material gains.

    • myda tahir

      Ameen,
      thanks for your comments

  • http://www.muslimmummies.com/ Foz

    I hope your father is doing better now in sha Allah! May Allah (swt) grant him shiffa Ameen!

  • http://themuslimbricks.com Najmah Capal

    You did the right thing for asking second opinion. Experienced this myself. I was brought to hospital due to breathing problem then the doctor requested me to do the x-ray and ecg, then after that she suggested me to stay in the hospital because she could not detect the problem and she suggested for a surgery in lungs area. I was only with a friend that time and few relatives. I was 16 years old and clueless of what was happening. I called my parents overseas and they got worried and against it, they told me to leave that hospital right away and to move to another hospital. We did that. And the doctor just diagnosed it as stress and mild pneumonia. She just gave me medicine and discharged me after a day. If my relatives didnt move me to another hospital, they would have operated me for no valid reason.

    May Allah grant your father shifa and your entire family good health.

    • myda tahir

      Thanks Najmah for sharing such an incident, glad to know that you were safe from these greedy souls.
      Ameen to your Dua.

  • muneeb

    Thank you for sharing your experience,
    May Almighty give him complete Shifa and rapid recovery.Ameen.
    As money is rapidly creeping into the medical practice, converting it into
    a business, the importance of having a second opinion is increased many
    fold.

  • Eugenia Nazarova

    I am so sorry for that, I know it’s not an easy task to find the doctor who really cares about their patient and does well his job! Money shouldn’t be the only motivation for work. Totally agree that “medical ethics is about doing the right thing for achieving the best route for every individual patient”. I wish a great recovery to your father. Hugs to you and your family :-)

    • myda tahir

      Thanks Eugenia,
      Much love to you also and keep us all healthy.

  • Zayeneesha Farooq

    May Allah grant your father the complete shifa soon. Most doctors lack empathy on almost an epidemic level but alhamdulillah there are many who communicate with you like they really care.
    Jazakillah khair for your efforts

    • myda tahir

      You are right it is due to the fact we are going away from our ideology.
      Thanks for commenting.

  • Jameela Ho

    How is your father? You didn’t conclude the story of what happened to him. (Sorry I’m one of those people who likes to have closure.)

    Very true! Always get a second opinion (and search for natural therapies) before you go to surgery.

    • myda tahir

      Thanks Jameela,
      Alhamdolillah, he is doing fine with prayers and physio.

  • Hil D

    Wow, this is a very in-depth post. A lot of good points here. It sounds That sounds really scary. I hope your dad was ok. I like the tips at the bottom

    • myda tahir

      Thanks Hillary for your appreciation.

  • http://www.fruityflamingo.co.uk/ Melissa Zia

    such a very well written post and some very good points too.
    I hope your dad is ok

    • myda tahir

      Thanks Melisssa,
      He is doing fine now.

  • rachael orr

    I hope your dad is doing well!! Wonderfully written, and very insightful.

    • myda tahir

      Thanks Rachel.

  • Fatima Ali

    Lots of best wishes and prayers for you and your dad. May Allah give him a long and healthy life.

  • Khansa Mohammed Alavi Erooth

    May Allah grant your dad shifaa and thank you for sharing the experience..

    • myda tahir

      Aameen,

  • Dr. Hina Fatima

    Thank you for such an informative article Dr. Myda. It’s sad how people are forced to believe that surgery is the only option they have to survive a clinical condition. Especially for young pregnant women, whose c-section dates are pre-decided long before due date. I wish people would become more aware and fight for their rights. And this article would certainly open some closed doors.Thanks for sharing your story.

    • myda tahir

      Thanks Dr. Hina Fatima, really appreciate your comment.

  • Umme Hafsa

    A really informative and very important article. It’s scary to see how a lot of mistrust and not holding onto principles occurs. Having a second (or more) opinion is crucial. I pray that Allah grants your father shifaa and complete health x

    • myda tahir

      Thanks Umme Hafsa and ameen .