|Year : 2005 | Volume
| Issue : 2 | Page : 47-48
Medical ethics: Old and new challenges
Hajar H.A Albinali
|Date of Web Publication||18-Jun-2010|
Hajar H.A Albinali
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Albinali HH. Medical ethics: Old and new challenges. Heart Views 2005;6:47-8
When a group of men meet in a social gathering in our community, the three top topics they discuss are health, money and sex. Health ranks the top topic that they discuss. This is not surprising because the first question a friend asks his friend after they greet each other and before they talk about anything else is: "How is your health?" Some do not take the question seriously but consider it a ritual part of the greeting, so the standard answer is: "I am fine thank you". Others, especially if they were treated recently for a medical problem, will start talking about their experience with health care providers. Rumors about physicians or medical errors are very interesting and amusing for the laymen. If a health care provider had the misfortune to be caught in such a social gathering, he will be automatically put "on the stand" for interrogation or asked about rumors concerning a colleague. What is an ethical question for the laymen may be unethical for the physician to discuss. As physicians we face numerous ethical challenges that we have to deal with as long as we provide health care to the public.
In this issue, the article "Top Ten Health Care Ethics Challenges Facing the Public: Views of Toronto Bioethicists" by Jonathan M Breslin et al  (pp.49-56) is interesting and useful. The challenges they identified are applicable to many communities around the world including ours in the GCC states. The ranking of these ethical challenges may not be the same. In our local community in Qatar, I would also rank the disagreement about treatment decisions between patients/families and health care professionals (mainly medical doctors), as the number one ethical challenge.
Our situation is unique in that the disagreement is not related to the method or type of treatment but rather where should the treatment be carried out - locally or abroad? Since medical care is provided free for Qatari citizens by our government, in Qatar or abroad, many patients ask the doctors to refer them for treatment abroad  . Since the sophisticated technology is available locally and the doctor is confident that he/she could provide as good medical or surgical treatment as the doctors abroad, the request is refused. The patient feels that the doctor's refusal to recommend treatment abroad is unreasonable because the government will bear the cost and not the doctor. The doctor feels that the patient either does not trust his/her knowledge and experience or is using him/her to get a free trip abroad as a tourist. This situation creates a negative relation between the patient and the doctor, which builds ill feelings, thus clouding the patient/doctor relationship. This local ethical challenge is most disturbing. It is a problem that is difficult to resolve and has continued for the last 35 years of health care history in Qatar.
Another ethical problem that is pertinent to our region is what to tell a patient when malignancy is diagnosed. Unlike physicians in Canada and the rest of the western world where they inform the patient of the real diagnosis, the families here request the doctors that the patient should not be told the truth about the diagnosis. They want their terminally ill loved one to have peace of mind without worries about his/her condition. The physician feels obligated to tell his patient the truth but does not want to be in conflict with the wishes of the family. So the physician has to comply with the family's wish even if he feels that their request is unreasonable or unethical.
One old ethical problem in the GCC states that is no longer as challenging as it was in the past is alternative religious or traditional medical treatment , . When western medicine reached our region in the Gulf about 60 years ago, traditional medicine was the main therapeutic means in many towns and villages in the Gulf. When the patient felt that western medicine did not achieve a quick result as he had anticipated, he would ask the physician to discharge him or allow a traditional local "doctor" such as a beduan or religious Sheikh to treat him while in the hospital.
Some patients thought that such traditional therapy was endorsed by their Islamic principles. In those days, since all the physicians in the Gulf were foreigners, mainly Christian missionaries, they faced an ethical and a sensitive religious challenge. They had to allow the patient to do what they wanted even if it delayed or interfered with their medical care. Gulf traditional medicine is rarely practiced now, but other forms of alternative medicine such as Chinese and herbal medicine is on the rise in the Gulf as well as in many parts of the world. The ethical challenges with the unproven therapeutic claims of the latter and their misleading advertisement pose a new burden on health care authorities in the GCC states.
Some ethical problems are unique to a particular community. A free health care system such as that found in Qatar and the other GCC states generates its own unique set of ethical problems. In addition, culture also plays an important factor in creating ethical dilemmas. There are local customs and traditions that may clash with what is widely accepted as modern ethical conduct for physicians.
However, there are ethical issues that may transcend geography and culture. With the rapid evolution in science and medical technology, physicians and the public face new ethical challenges. Cloning, stem cells, gene therapy, in vitro fertilization, and innovative transplantation techniques are but a few of the ethical dilemmas confronting us today. Each community or culture will have to adapt to the remarkable medical progress being made and at the same time resolve the ethical challenges. In utilizing sophisticated and life-saving technology, we physicians should be sensitive to and respect people's dignity and sense of self. In so doing, we preserve our patients' trust in the medical profession, a tradition that is rooted in our profession for centuries.
| References|| |
|1.||Top Ten Health Care Ethics Challenges Facing the Public: Views of Toronto Bioethicists" by Jonathan M Breslin et al. Heart views. 2005;6(2):44-89. |
|2.||Abroaditis Heart views. 2001;2(3):90-142. |
|3.||Arab Gulf Traditional Medicine: Cautery. Heart views. 2003;5(4):134-190. |
|4.||Arab Gulf Traditional Medicine: Blood-letting. Heart views. 2004;5(2):36-85. |