Karachi Bioethics Group Meetings 2017

Host of the Year 2017- Aga Khan University (AKU)

The Bioethics Group at AKU had the honor of hosting the Karachi Bioethics Group meetings for the year 2017. Coordinators for the year were Dr. Mustafa Aslam and Ms. Aqsa Rahim. Altogether, six meetings were held during the year, one every alternate month, with active participation from KBG members, attendees from various institutions and faculty, residents and nursing staff of AKU. Following is a brief description of each of the meetings.

  • Meeting #1: Ethical framework of termination of pregnancy
  • Dr. Bushra Afroze, Department of Paediatrics, AKU, presented the summary of a workshop on "Ethical framework of termination of pregnancy". Matters related to terminologies used in the context of termination of pregnancy were explained. Pakistani Law about termination of pregnancy (TOP) was discussed in length and way forward was shared. KBG members shared their experiences and expertise in this matter.

  • Meeting # 2: Medical Error Reporting System: An Initiative by Patel Hospital.
  • Dr. Abeer Salim shared the Medical Error reporting and analysis system developed at Patel Hospital, and also discussed the rationales for instigating the system. This included training of the staff for analysis of error through root cause, significant errors and their potential solutions. Group appreciated the efforts of Patel Hospital in this regard.

    Sindh Healthcare Commission Act-2013-Dr. Tipu Sultan

    Dr Tipu Sultan provided an overview of Sindh Healthcare Commission and his concerns about the challenges of healthcare service and delivery in Sindh. He emphasized the need for establishing a sovereign & independent institution that would regulate both public and private healthcare sectors. A broader aim would be to safeguard healthcare providers from harassment by public, police, media and individuals. Dr Tipu shared the proposed framework of governance, management structure and their key functions. He further mentioned the problems faced during the implementation of the healthcare commission in Punjab and how they learnt to deal with their own experiences, and the issues that are being faced while dealing with government involvement and existing bureaucratic system. The group is looking forward to this initiative being implemented.

  • Meeting # 3: Registration of patients at hospitals as 'male' or 'female' only-what about others?
  • Group discussed the concern of registering infants born with ambiguous genitalia. Issue of delay in gender disclosure was discussed at length. Forum suggested that hospitals should have clear policies in this regard. Emphasis was made that parents need to be informed and properly counseled in this regard and further investigations must be carried out for identification of gender.

    Study Presentation on "Child Sex Abuse (CSA) in Metropolis of Karachi"

    Dr. Mustafa Aslam, Department of Pathology & Laboratory Medicine, AKU, presented a research on CSA. He initiated by sharing some background information about child abuse and its current scenarios in Pakistan. Aims and objectives of the study were highlighted. Study results were shared along with statistical data of child sex abuse in Metropolis of Karachi.

  • Meeting # 4: Ethical dilemmas in clinical care
  • Dr Erfan Hussain, Critical Care consultant and his team (AKU) presented a case in which an older patient with grave prognosis was treated aggressively by her family members, one of whom was a physician. The treating physicians did not agree with line of treatment being insisted by the family members. Members participated in the discussion very actively. However KBG members were opposed to the concept of unilateral DNR but that each case must be judged on its own merit. It was concluded that our means of communication was not to influence family decisions but to guide them what needs to be done in a particular patient's best interest.

    Ethical Issues in Pediatrics

    Dr Sarosh, Shalimar College of Medicine & Dentistry, Lahore, provided her perspective of ethical issues in Pediatrics. Her focus of discussion was that the pediatric population is different because of their age and a different approach is needed when dealing with this population. The importance on communication, especially listening was emphasized in interactions with children and adolescents and their parents.

  • Meeting # 5: Case discussion by Department of Pathology & Laboratory Medicine, AKU.
  • Drs. Rumina Hasan & Imran Ahmed, Department of Pathology & Laboratory Medicine, AKU presented a case in which microbiology cultures that were sent to AKU for examination from another health facility revealed possible sources of ongoing transmission of microorganism, as well as the poor state of the institution's infection control practices. AKU faculty had tried to raise this issue with the concerned health facility, but the practices continued to happen. This raised a number of ethical issues: what is AKU's ethical responsibility towards public health as clearly there weaknesses in the health facility that contributed to high infection prevalence rate. In the subsequent discussion members voiced several concerns, as there were no mechanisms or forums to raise such an issue.

  • Meeting # 6: Case discussion on Ethical Dilemma in perinatal medicine
  • Group was briefed by Dr Mumtaz Lakhani (South City) about the case of a 32 weeks' gestation couple who requested termination of pregnancy on the grounds that fetus on ultrasound was found to have "Agenesis of Corpus Callosum", that carried a poor prognosis for normal development. Discussion was generated related to termination on grounds of medical conditions, research, experiences and parents' decision of termination. Group suggested that it is important to consider the laws of the land before taking any decisions. There are many grey areas related to abnormalities where it is very difficult to go for abortion even before 24 weeks. Caretakers must be given due importance when taking decisions because they are the ones who are going to take care of the child.

    Is social media posing new challenges to medical ethics?

    The role of social media in the current age of IT and the challenges it is posing to medical practice and medical ethics came under discussion. Sohail Bawani gave a talk on the topic "Is social media posing new challenges to medical ethics? The purpose of the presentation was to initiate an "appreciated dialogue" and to examine ethical issues related to this. More work needs to be done in developing guidelines for doctors and other healthcare professionals.