The Indus Hospital had the honor of hosting the Karachi Bioethics Group meetings for the year 2016. The coordinators were Dr. Nida Ilyas Shamsi and Dr. Sarosh Saleem. 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 The Indus Hospital. Each meeting was based on a theme related to Bioethics.
- 1. Medical Ethics- Putting Theory Into Practice
- In the form of a presentation and with different scenarios, basic principles of medical ethics, morality, and philosophy of ethics were discussed; the differences between Profession and Business were highlighted. The KBG’s stand on this has already been documented in the form of a booklet and was reinforced. It was established that indirect and unrestricted support from drug companies may be taken by institutes and used for any academic activity.
2. Learning on Patients- Where do we draw the line?
- Some real case scenarios were presented and discussed where procedures were performed on a non-salvageable patient with an already decided, do not resuscitate code. It was evident that such practices are still being carried out in teaching hospitals. However, it needs to be distinguished whether the lack of communication of a code status is leading to such a scenario or young physicians’ need to learn life-saving procedures on an expired patient, hence leading to a very important dialogue on legal and ethical considerations about dignity and rights of dead vs dignity and rights of alive.
3. Ethical Standpoints of the Role of Chaperones in Medical Practice
- An interesting discussion was held on how to define a chaperone. It was questioned whether there was a need for a chaperone. Issues of gender discrimination being currently practiced in teaching sessions and lectures of some of the medical colleges of Karachi were brought to the surface. It was stated that sometimes a chaperone is needed for the safety and autonomy of the doctor too. It was also highlighted that the chaperone policy on the PMDC code of ethics was very unclear and institutions should have a chaperone policy in place based according to the cultural norms of the society.
4. Ethical and Social Considerations in Antibiotic Misuse
- Clinical scenarios highlighting the importance of rational use of antibiotics in clinical medical practice were discussed by incorporating ethics, the response of society, pharmaceutical companies’ ways of approaching doctors, social effects; in addiction to biological, on patients due to the growing number of antibiotic resistance. The idea was floated that in order to show a collective response from society, KBG can be a good forum to lead campaign/s for matters like these. Emphasis was laid upon the importance of the patient’s right to be aware of and being involved in the decision about treatment and prescribing antibiotics and about rationalizing antibiotic use with Antibiotic Stewardship in hospitals for doctors and health-care providers.
5. Ethical Dilemma in Inter-hospital Transfer of Neonates in Critical Condition
- Issues on the importance of newborn care in a critical setting were brought to light. Some actual clinical situations were discussed where newborns with critical conditions require inter-hospital referrals due to the unavailability of services in one place. As the communication means have advanced, the medical world also needs to develop some good means of communication and skills and a proper system of management and transport in place to work in such situations
6. Consent and Confidentiality: Rights of Children!
- The nursing and postgraduate students presented clinical scenarios in the form of role plays to talk about various ethical and legal challenges in the context of consent and confidentiality of children and some very valuable points emerged and were clarified from the discussion regarding consent vs ascent, patient’s vs parents decision for treatment. the importance of good communication skills, proper ethical understanding, and repeated counseling in such situations helps in mutual decision-making, as well as keeping medical, social, and cultural domains into consideration. The legal considerations of ascent and consent in this context were also brought to the attention.
Another area of discussion included why transgender people are so not acceptable to the world around them and how they face discrimination at and in access to work, public accommodations, healthcare, and legal rights. It was reflected from the discussion that such topics are very sensitive and complex.
There was a hospital-wide distribution of The KBG booklet “Understanding Medical Error” in a workshop held at the Indus Hospital on “Medical Error”.
Tribute was given to the humanitarian services rendered by Abdul Sattar Edhi Sahab. Participants appreciated Edhi Sahab as the mastermind of Pakistan’s largest welfare organization; he believed in love and empathy irrespective of religion, creed, and gender.
We had a clinical case for open discussion in each of the meetings. This activity leads to increasing awareness among participants, and a familiarity with how to have an ethical discourse. These topics created a healthy discussion and increased the awareness of the attendees. Considering the importance of these situations, it was reinforced to discuss most on public forums as public awareness because action on such concerns is required.
The hospital is pleased to have hosted the KBG meetings and hopes to do so in the future too. It proved to be a great learning opportunity for all.