I read Robert Card's recent paper entitled "Is there no alternative?
Conscientious objection by medical students" with great interest.1 That
Muslim students in America are able to conscientiously object (and this
was entertained) to the cross-gender consultation is somewhat startling. I
have just left the Middle East, where I worked as a medical educator for
five and half years (2006-2011), and, to the best of my knowledg...
I read Robert Card's recent paper entitled "Is there no alternative?
Conscientious objection by medical students" with great interest.1 That
Muslim students in America are able to conscientiously object (and this
was entertained) to the cross-gender consultation is somewhat startling. I
have just left the Middle East, where I worked as a medical educator for
five and half years (2006-2011), and, to the best of my knowledge, even in
the conservative, gender-segregated traditional Muslim culture of the
United Arab Emirates, not once did a male or female student refuse to
examine a patient of the opposite sex.
Several issues, many of which have been described by Padela and del
Pozo,2 should be taken into consideration in relation to Muslim students'
conscientious objection to the cross-gender consultation on religious
grounds. Although Islam prohibits touching or physical contact by the
opposite gender, unless appropriate (e.g. by a spouse), in some
circumstances, the "prohibited becomes permissible".3 Medicine is one such
circumstance. Islam does not preclude a doctor from examining the
opposite gender where a same gender physician is not available or in life
and death situations.2-6 Islam recommends first a same gender Muslim
physician, followed by a same gender non-Muslim and, failing their
availability, a Muslim of opposite gender, and lastly an opposite gender
non-Muslim doctor. 3,5 In cross-gender consultations, however, Muslim
women generally need to be accompanied by a same gender third party.3-5
The ancient literature on medical care attests to the possibility of and
necessity for cross-gender examinations. In the eighth century, Ibn
Quaddama wrote that it was permissible for a male doctor to inspect
whatever parts of the woman's body warranted during the medical
examination.4 Similarly, Ibn-Muflih stated that "A man doctor may inspect
the awra of a women's body as far as the medical examination warrants if
only a male doctor is available to treat her, even if he has to look at
her private parts. The same would be true if a man is ill and there is but
the woman doctor to treat him. She may inspect his body even his private
parts" (p. 3).4 Furthermore, this literature attests to the need for
Muslims to seek the most qualified practitioner for their medical
treatment. Some 600 years ago, Ibn Qayyim Al Jawziyya wrote in The
Prophetic Medicine that Muslims should seek the best authority in each
matter and field because such expertise will ensure that the task is done
with excellence.7 Implicit in this hadith (narrative originating from the
words or deeds of Prophet Muhammad) would be the need to consult an
opposite gender physician if he or she was the most qualified.
The insistence of modern Muslim patients for the same gender physician or
for Muslim medical students conscientiously objecting to the cross-gender
consultation is interesting considering the Islamic history of medicine
during Prophet Muhammad's life. During that time, the medical corps
comprised "lady healers" or asiyaat, who were responsible for treating
wounded soldiers, irrespective of the injuries. Cross-gender medical care
was established during the battles of Badr and Uhud, and so according to
the Prophet's tradition, the rule governing covering of areas of the body
was waived in the interest of medical treatment.3,4
During interviews with final year male and female clerks about the
cross-gender consultation in a society (United Arab Emirates) where women
are generally not free to travel without a member of their mahram (non-
marriageable male chaperone), some female students (more so than their
male colleagues) had initially been apprehensive about touching a male
body. Their mutawa (religious leader) reassured them that as medical
students, they had to treat both male and female patients and were
therefore allowed to touch males. From this study, it also emerged that
although students became more "comfortable" with cross-gender touching in
the clinical consultation, Emirati female patients in Obstetrics and
Gynecology and Emirati male patients in Urology often refused male and
female students, respectively. As little has been published in this
regard, a group of local female students surveyed Emirati women's
attitudes towards male and female medical students as well as canvassed
their physician preference. While their general preference was for a
female student or physician, other factors such as physician certification
and patient education impacted on what parts of the body the women would
or would not allow a male student or physician to examine.8,9
As I indicated at the start of my response, it was startling that
Muslim students in America could conscientiously object to the cross-
gender consultation. This is difficult to reconcile how Muslim students
living in a conservative, gender-segregated and traditional Middle Eastern
society were able to accept that in Islam medical care should supersede
religious teachings and how Muslim students living in a Western country do
not share the same understanding.
References
1. Card RF. Is there no alternative? Conscientious objection by medical
students. J Med Ethics 2012;38:602-4.
2. Padela A, del Pozo PR. Muslim patients and cross-gender interactions
in medicine: an Islamic bioethical perspective. J Med Ethics 2011;37:40-4.
3. Aldeen AZ. The Muslim ethical tradition and emergent medical care: An
uneasy fit. Acad Emerg Med 2007; 14(3): 277-8.
4. Hathout H. The male gynaecologist. Medical examination of the other
sex. 1986. http://www.islamset.org/bioethics/obstet/examin.html (accessed
21 November 2012).
5. Hedayat KM, Pirzadeh R. Issues in Islamic biomedical ethics: A primer
for the pediatrician. Pediatrics 2001;108: 965-71.
6. Hammoud MM, White CB, Fetters MD. Opening cultural doors: Providing
culturally sensitive healthcare to Arab American and American Muslim
patients. Am J Obstet & Gynecol 2005;193: 1307-11.
7. El-Qadar A. trans. Ibn Qay'em El-Jozeyah on The Prophet Medicine,
2007. http://www.islamhouse.com/p/51834 (accessed 21 November 2012).
8. McLean M, Al Ahbabi S, Al Ameri M, Al Mansoori M, Al Yahyaei F,
Bernsen R. 2010. Muslim women and medical students in the clinical
encounter: A United Arab Emirates study. Med Educ 44:306-15.
9. McLean M, Al Yahyaei F, Al Mansoori M, Al Ameri M, Al Ahbabi S,
Bernsen R. 2012. Muslim women's physician preference: Beyond Obstetrics
and Gynecology. Health Care Women Internat 2012;33:849-76.
I think it's safe to say from the article that organ donations are
lacking and it is obvious that this is a major problem, not only because
people die as a result, but because of the lengths that people will go to
obtain an organ. In foreign countries organs can be bought; this is
illegal in the United Kingdom. People will go out to foreign countries to
have the surgery and we are left to question the safety risks, the...
I think it's safe to say from the article that organ donations are
lacking and it is obvious that this is a major problem, not only because
people die as a result, but because of the lengths that people will go to
obtain an organ. In foreign countries organs can be bought; this is
illegal in the United Kingdom. People will go out to foreign countries to
have the surgery and we are left to question the safety risks, the
implication after the surgery e.g. infection, which will be treated by the
NHS. In places like America where there is a website that you can find
people you would want to donate your organs to (in the UK it is
prioritised by who needs it the most and you wouldn't know who gave it to
you). But saying this statistics show that more organs are donated this
route.
Reasons for not wanting to donate are mainly: fears, religious views,
don't know how or they simply "don't like the idea". Personally being a
student myself I don't believe many people are educated in this matter,
for me, the simple fact of donating your organs and you'll save someone's
life is enough information, but for others I believe it isn't and by
educating them it could potentially increase more organ donors. This way
you have addressed their concerns and provided them with all the
information required to make an informative decision.
Another reason I see for lack of organ donations is people can be
indolent. Personally I knew I always wanted to donate my organs, but I
didn't know how to. Yes the obvious answer would be to Google it and I
would have my answer, but it isn't always a high priority in some peoples
mind so registering is put off. It also isn't a subject that crosses your
mind every day unless something stimulates it e.g. an advert on the TV. I
made sure my family knew of my preferences, but there always lies the grey
area of they could change their mind and go against my wishes. For these
reasons I don't believe an opt out or opt in system is acceptable, because
they both rely upon implicit consent, which is the whole controversy
(mainly) against opt in. People should be required to make a decision once
they reach 18. The question could be asked every time someone goes to
visit the doctors, bringing people's attention to the matter constantly
and people stating their opinion there and then for what they would like
to happen to their body. Maybe when there is a general election there
could also be a box to answer whether they would or wold not want to
donate their organs. Also letters could be sent out when someone turns the
age of 18 with information about organ donation and how to register what
they want. That way there would be more of a distinct answer; there would
be the people who said yes, those who said no and then there would be
those who did not answer. For those who did not answer the decision could
then fall to their family if they died what should happen.
To sum it up there needs to be more promotion about donating your
organs along the similar lines of the way that donating blood is e.g.
adverts on the TV, bulletin boards, people coming to your place of work,
school, etc. Resulting in continuously raising awareness and bringing the
issue to the forefront of people's minds, making them actually consider
what they would like to happen to themselves. As said previously people
need to be educated, this could occur by popular TV programmes such as
embarrassing bodies discussing in-depth about organ transplant. One thing
is for sure, we can't expect more people to donate if changes don't occur
to the system. If you are happy to accept an organ you should be happy to
give.
In their recent paper "Informed consent for clinical trials of deep
brain stimulation in psychiatric disease: challenges and implications for
trial design",[1] Lipsman et al. discuss important factors that influence
informed consent for deep brain stimulation when applied in clinical
trials concerning psychiatric diseases. Undoubtedly the issue of informed
consent to DBS and its ethical implications hardly can be overest...
In their recent paper "Informed consent for clinical trials of deep
brain stimulation in psychiatric disease: challenges and implications for
trial design",[1] Lipsman et al. discuss important factors that influence
informed consent for deep brain stimulation when applied in clinical
trials concerning psychiatric diseases. Undoubtedly the issue of informed
consent to DBS and its ethical implications hardly can be overestimated,
especially in the context of the ambivalent history of deep brain
stimulation and psychosurgery.[2] Nevertheless, we would like to take the
opportunity and make some comments on the valuable insights unfolded in
the paper mentioned.
It is utterly correct that researchers/therapists must communicate to
the patient the experimental character of the procedure (when applied for
the treatment of psychiatric diseases); this experimental character arises
from, as the authors lined out, its unclear mechanism of action and its to
some extent unpredictable outcome. In this context it should also be
mentioned that to date there are no studies concerning the impact of a
patient's former therapies on the efficacy of DBS. Moreover, although
usually regarded as "last resort therapy" when all available other options
have failed, there does not exist any scientific rationale why patients
might not benefit from DBS if it was applied in an earlier time point of
disease progress. A reason to consider DBS as a potentially advantageous
therapeutic instrument in earlier stages of a psychiatric disease could
possibly be deduced from clinical and pathophysiological experiences from
the treatment of Parkinson's disease by DBS. In this context a possible
neuroprotective effect which might arise from the stimulation of the
subthalamic nucleus should be mentioned.[3, 4, 5] This could serve as a
rationale for an application of DBS in early Parkinson stages (compare
also the ongoing study "Controlled Trial of Deep Brain Stimulation in
Early Patients With Parkinson's Disease",
http://clinicaltrials.gov/ct2/show/NCT00354133 ). Maybe, there are similar
pathophysiologic mechanisms at work when DBS is used for the therapy of
psychiatric diseases. Moreover, in the case of OCD there are hints that
the efficacy of cognitive behavioral therapy might be improved by DBS.[6]
This could serve as an argument for an application of DBS in early stages
of OCD. However, concerning DBS for the treatment of early stages of
psychiatric diseases in general would pose even more delicate ethical
questions regarding the obtainment of informed consent.
A second comment refers to the authors' strong advice to apply DBS (at
least with respect to the currently available scientific knowledge)
primarily in psychiatric diseases that are ego-dystonic in character, such
as OCD or major depression. However, about 5 to 45% of OCD patients have
been found to have poor insight into their obsessions and compulsions
meaning that they consider their fears to be realistic and their obsessive
behaviour actually capable of preventing disastrous consequences.[7-13] In
1994 the OCD subtype ?with poor insight" was included in DSM-IV ,[14]
whereas this differentiation is not made in ICD-10. In these cases, the
character of a patient's OCD cannot be classified as ego-dystonic in the
stricter sense of the word. Moreover, there is a considerable amount of
data hinting to an inversely proportional relationship of OCD severity and
the level of a patient's insight,[7, 10, 15, 16] which also is in
accordance with our own clinical experience. Taken together and following
the line of argumentation presented in the authors' paper this would mean,
that these patients - at least not first and foremost - should not be
treated by DBS. However, OCD with poor insight might pose the greater
proportion of therapy-resistant cases. Hence, we suggest OCD with poor
insight to be considered as a general exception from the authors' advice
regarding the ego-syn- or -dystonic character of psychiatric diseases
treated with DBS. However, there is an urgent need for extended and
thorough diagnostic efforts to differentiate patients suffering from OCD
with poor insight from those with comorbid psychotic illnesses due to the
fact (as it is also noted in the paper) that there is no sufficient
rationale yet that these patients might benefit from DBS.
1 Lipsman N, Giacobbe P, Bernstein M, et al. Informed consent for
clinical trials of deep brain stimulation in psychiatric disease:
challenges and implications for trial design. J Med Ethics 2012;38:107-11.
2 Skuban T, Hardenacke K, Woopen C, et al. Informed consent in deep brain
stimulation - ethical considerations in a stress field of pride and
prejudice. Front Integr Neurosci 2011;5:7
3 Benazzouz A, Piallat B, Ni ZG, et al. Implication of the
subthalamic nucleus in the pathophysiology and pathogenesis of Parkinson's
disease. Cell Transplant 2000;9:215-21
4 Piallat B, Benazzouz A, Benabid AL. Subthalamic nucleus lesion in
rats prevents dopaminergic nigral neuron degeneration after striatal 6-
OHDA injection: behavioural and immunohistochemical studies. Eur J
Neurosci 1996;8:1408-14
5 Nakao N, Nakai E, Nakai K, et al. Ablation of the subthalamic
nucleus supports the survival of nigral dopaminergic neurons after
nigrostriatal lesions induced by the mitochondrial toxin 3-nitropropionic
acid. Ann Neurol 1999;45:640-51
6 Denys D, Mantione M, Figee M, et al. Deep brain stimulation of the
nucleus accumbens for treatment-refractory obsessive-compulsive disorder.
Arch Gen Psychiatry 2010;67:1061-8
7 Catapano F, Perris F, Fabrazzo M, et al. Obsessive-compulsive
disorder with poor insight: a three-year prospective study. Prog
Neuropsychopharmacol Biol Psychiatry 2010;34:323-30
8 Eisen JL, Rasmussen SA, Phillips KA, et al. Insight and treatment
outcome in obsessive-compulsive disorder. Compr Psychiatry 2001;42:494-7
9 Foa EB, Kozak MJ, Goodman WK, et al. DSM-IV field trial: obsessive-
compulsive disorder. Am J Psychiatry 1995;152:90-6
10 Ravi Kishore V, Samar R, Janardhan Reddy YC, et al. Clinical
characteristics and treatment response in poor and good insight obsessive-
compulsive disorder. Eur Psychiatry 2004;19:202-8
11 Marazziti D, Dell'Osso L, Di Nasso E, et al. Insight in obsessive-
compulsive disorder: a study of an Italian sample. Eur Psychiatry
2002;17:407-10
12 Matsunaga H, Kiriike N, Matsui T, et al. Obsessive-compulsive
disorder with poor insight. Compr Psychiatry 2002;43:150-7
13 Storch EA, Milsom VA, Merlo LJ, et al. Insight in pediatric
obsessive-compulsive disorder: associations with clinical presentation.
Psychiatry Res 2008;160:212-20
14 Jakubovski E, Pittenger C, Torres AR, et al. Dimensional
correlates of poor insight in obsessive-compulsive disorder. Prog
Neuropsychopharmacol Biol Psychiatry 2011;35:1677-81
15 Solyom L, DiNicola VF, Phil M, et al. Is there an obsessive
psychosis? Aetiological and prognostic factors of an atypical form of
obsessive-compulsive neurosis. Can J Psychiatry 1985;30:372-80
16 Turksoy N, Tukel R, Ozdemir O, et al. Comparison of clinical
characteristics in good and poor insight obsessive-compulsive disorder. J
Anxiety Disord 2002;16:413-23
The topic that Professor Hon has raised is quite interesting. How
should the dignity of a person after death is protected. We have to draw a
delicate balance between the dignity of a person after death and the
educational value of the corpse to the archeologists and general public. I
would tend to feel that the corpse does not have a soul and a lot of
people will benefit after seeing a corpse in the...
The topic that Professor Hon has raised is quite interesting. How
should the dignity of a person after death is protected. We have to draw a
delicate balance between the dignity of a person after death and the
educational value of the corpse to the archeologists and general public. I
would tend to feel that the corpse does not have a soul and a lot of
people will benefit after seeing a corpse in the museum.
I agree with the author that immunisation should not be given by lottery in face of influenza pandemic.
There are several professions that are vital to the continuation of public healthcare in an influenza pandemic, including police, doctors, nurses and other workers in the hospitals. As their survival is important for the control of influenza and reduction of mortality in the general public, the...
I agree with the author that immunisation should not be given by lottery in face of influenza pandemic.
There are several professions that are vital to the continuation of public healthcare in an influenza pandemic, including police, doctors, nurses and other workers in the hospitals. As their survival is important for the control of influenza and reduction of mortality in the general public, they should be prioritised to receive the vaccine if such situation arises.
In the real scenerio, some people would not like to be vaccinated because of fear of side effects etc. This is one of the main reasons of low take up rate of influenca vaccination in Hong Kong. I think individual choice should be weighed heavily if influenza pandemic really occurs
Robert Yuen FRCP RCPCH FRCPE FRCPG FHKAM FHKCPaed Hong Kong
The perception of prostitution as something intrinsically immoral is,
in and of itself, harmful. Indeed, Yolanda Estes , the former prostitute
who is a philosophy professor at Missippi University, is quoted in the
article stating clearly that her job prospects would have been harmed had
she mentioned her previous career.
Moreover, users of prostitutes are also harmed because they pay for
sex. The variety of ster...
The perception of prostitution as something intrinsically immoral is,
in and of itself, harmful. Indeed, Yolanda Estes , the former prostitute
who is a philosophy professor at Missippi University, is quoted in the
article stating clearly that her job prospects would have been harmed had
she mentioned her previous career.
Moreover, users of prostitutes are also harmed because they pay for
sex. The variety of stereotypes of prostitutes can be matched by those of
their clients. Most assume it is deviant and malicious men. Whilst clients
are mostly men, there is little to suggest these men are necessarily
deviant and/or malicious.
There is a significant proportion of the clientele who want to have
sex, cannot achieve this otherwise and pay prostitutes for this service.
This is seen as socially unacceptable either because of the arguments
outlined in the article or because being unable to find a consensual
sexual partner in other ways is seen as a failing in that person's
character.
There is no justification for this criterion that I know of. It is
harmful to those people as they feel inadequate and in so feeling do not
use prostitutes despite the fact this may be of benefit to both client
that they can have sex and prostitute for reason, again, outlined in the
article.
Whilst the harms that prostitutes endure must not be forgotten,
arguments that prostitution is intrinsically wrong harms not only the
service providers. Clients are castigated for what is essentially a desire
to have sex and an inability convince others to do so.
I was pleased to read the article, Does medical insurance type (private vs public) influence the physician's decision to perform Caesarean delivery?. This article addresses contentious issues regarding private and public insurance and how they influence Cesarean deliveries in the society.
Hospitals and physicians are continually taking advantage of private insurance because they are out to make a kill and huge profits. Medically u...
I was pleased to read the article, Does medical insurance type (private vs public) influence the physician's decision to perform Caesarean delivery?. This article addresses contentious issues regarding private and public insurance and how they influence Cesarean deliveries in the society.
Hospitals and physicians are continually taking advantage of private insurance because they are out to make a kill and huge profits. Medically unnecessary caeserean section delivery is not ethical as it contributes to maternal mortality. Also, it is not easy to tell the cause of deaths in as much as a Cesarean section is done because of other underlying complications that lead to eventual death. It is also a big challenge to find out from health delivery records why a caesarean section was electively chosen and there still remains a large gap to knowing the true factor that is driving Cesarean section deliveries up.
I believe all the commentaries on the piece by Sinnott-Armstrong and
Miller miss a really fundamental problem with their account of the
wrongness of killing. Sinnott-Armstrong and Miller claim that what makes
killing wrong is that it totally and irreversibly disables the person
killed. They then infer from this that, if someone is universally and
irreversibly disabled, they cannot be wronged if they ar...
I believe all the commentaries on the piece by Sinnott-Armstrong and
Miller miss a really fundamental problem with their account of the
wrongness of killing. Sinnott-Armstrong and Miller claim that what makes
killing wrong is that it totally and irreversibly disables the person
killed. They then infer from this that, if someone is universally and
irreversibly disabled, they cannot be wronged if they are killed. Unless
there is some other reason for making it wrong to kill such people, we do
no harm to them if we kill them and, therefore, if harvesting organs kills
them, we do no harm to them in harvesting their organs.
Neat though the argument is, it has needlessly invoked the ire of
disability interest groups (which may indicate real difficulties with the
argument ever forming the basis of a genuinely legal option), and is open
to a fundamental conceptual objection.
The difficulty is that it makes no sense to describe dead persons as
disabled persons. When I say that my dad passed away, I am not saying that
he has become totally and universally disabled. If I were, then it would
make sense for me to explain to people that I am frustrated at not being
able to go to the football game with my dad, or play squash with him,
because he has become totally and irreversibly disabled. But that
explanation is ludicrous. To say that my dad has died is just not
tantamount to saying that he has become universally and irreversibly
disabled, nor is the latter claim implicit in the former as some unnoticed
implication, contrary to the claims of the authors.
The reason for this is that to say my dad is totally and irreversibly
disabled is to imply his continued existence, but on death we simply do
not continue to exist (I leave aside here the questions raised by DeGrazia
about an afterlife). We must be careful here not to conflate (legitimate)
claims about the things that I am no longer able to do (such as go to the
game with my dad) with the very different (illegitimate) claims about
things that he is no longer able to do. There is nothing he is no longer
able to do, because he simply does not exist, and only of beings who exist
does it make sense to say that they can and that they cannot do things. To
put the point another way: it is not logically possible for dead people to
do things, whereas it is only physically impossible for disabled people to
do things.
For these reasons, the better account about the wrongness of killing
remains the general harm based account, as discussed by Jeff McMahan.
We read with interest the report by Anthony-Pillai (1) and we largely
agree with her. Self-determination always involves a choice of the
individual, but individual choice is not necessarily synonymous with
loneliness, while its opposite almost always does. The choice of a patient
at the end-of-life must be open to the advice of others, their critics,
their offers of aid, their requests to reconside...
We read with interest the report by Anthony-Pillai (1) and we largely
agree with her. Self-determination always involves a choice of the
individual, but individual choice is not necessarily synonymous with
loneliness, while its opposite almost always does. The choice of a patient
at the end-of-life must be open to the advice of others, their critics,
their offers of aid, their requests to reconsider the issue, somehow even
to their suggestions and influences, without ceasing for this to be
completely free. This means that any free and aware choice of the
individual cannot be considered unchangeable. Appearing in palliative care
registers without the patient's consent is at risk of violating the
fundamental right of human beings to change their disposition about such
important issues as palliation and end-of-life care.
We think that further resources should be rather directed to improve the
training of attending physicians to lead conversations on the end-of-life,
in order to allow them to be active, critical and coherent when they
support the patients in their decisions (2).
REFERENCES:
1. Anthony-Pillai R. Palliative care registers: infringement of human
rights? J Med Ethics 2012;38:256.
2. Lamas D, Rosenbaum L. Freedom from the tyranny of choice -
teaching the end-of-life conversation. N Engl J Med 2012;366:1655-7.
I laud authors for attempting to understand the substitute decision
making. The study may probably not be conclusive but, one can understand
the differences between the patient's substitute decision maker to that of
others.
Respect for patient's autonomy is considered to be the fundamental
principle in medical ethics, where competent patient has a right to accept
or reject medical intervention. However, t...
I laud authors for attempting to understand the substitute decision
making. The study may probably not be conclusive but, one can understand
the differences between the patient's substitute decision maker to that of
others.
Respect for patient's autonomy is considered to be the fundamental
principle in medical ethics, where competent patient has a right to accept
or reject medical intervention. However, this may grossly undermine the
physician knowledge to decide on the appropriate medical intervention.
Physician may be at times apprehensive about the competent patient's
decision on the intervention. They succeed in convincing the patients and
also fail at times. And then the problem of shared decision making and
substitute decision making, where a decision is made by patient and
patient's authorized person/guardian and decision made entirely by
authorized person/guardian respectively. There may be notable difference
between the decision made by the competent patient, physician decision and
substitute decision maker's decision. Any mismatch or major difference in
decision would result in unease among the decision makers. However, there
are certain procedures in place in case of any untoward event happen to
the patient. In case of any untoward event or death of a patient would
induce a tremendous stress on the decision maker.
The scenario is slightly different in India where there is a lot of
influence of parents in decision making irrespective of the age of their
children. Let it be a medical intervention or his/her career. There is
also a considerable consideration and respect given to physician's
decision on medical intervention. There are certain incidences where the
patients and his/her parents blindly follow the decisions of a physician.
However, we cannot generalize the statement.
One should take critical look on this ethical dilemma of substitute
decision making. The subject of substitute decision making requires
extensive studies and discussion. Hopefully, such studies would result in
most appropriate decisions made by the decision makers.
I read Robert Card's recent paper entitled "Is there no alternative? Conscientious objection by medical students" with great interest.1 That Muslim students in America are able to conscientiously object (and this was entertained) to the cross-gender consultation is somewhat startling. I have just left the Middle East, where I worked as a medical educator for five and half years (2006-2011), and, to the best of my knowledg...
I think it's safe to say from the article that organ donations are lacking and it is obvious that this is a major problem, not only because people die as a result, but because of the lengths that people will go to obtain an organ. In foreign countries organs can be bought; this is illegal in the United Kingdom. People will go out to foreign countries to have the surgery and we are left to question the safety risks, the...
In their recent paper "Informed consent for clinical trials of deep brain stimulation in psychiatric disease: challenges and implications for trial design",[1] Lipsman et al. discuss important factors that influence informed consent for deep brain stimulation when applied in clinical trials concerning psychiatric diseases. Undoubtedly the issue of informed consent to DBS and its ethical implications hardly can be overest...
Dear Editor,
The topic that Professor Hon has raised is quite interesting. How should the dignity of a person after death is protected. We have to draw a delicate balance between the dignity of a person after death and the educational value of the corpse to the archeologists and general public. I would tend to feel that the corpse does not have a soul and a lot of people will benefit after seeing a corpse in the...
Dear Editor,
I agree with the author that immunisation should not be given by lottery in face of influenza pandemic.
There are several professions that are vital to the continuation of public healthcare in an influenza pandemic, including police, doctors, nurses and other workers in the hospitals. As their survival is important for the control of influenza and reduction of mortality in the general public, the...
The perception of prostitution as something intrinsically immoral is, in and of itself, harmful. Indeed, Yolanda Estes , the former prostitute who is a philosophy professor at Missippi University, is quoted in the article stating clearly that her job prospects would have been harmed had she mentioned her previous career.
Moreover, users of prostitutes are also harmed because they pay for sex. The variety of ster...
Dear sir
I believe all the commentaries on the piece by Sinnott-Armstrong and Miller miss a really fundamental problem with their account of the wrongness of killing. Sinnott-Armstrong and Miller claim that what makes killing wrong is that it totally and irreversibly disables the person killed. They then infer from this that, if someone is universally and irreversibly disabled, they cannot be wronged if they ar...
To the Editor:
We read with interest the report by Anthony-Pillai (1) and we largely agree with her. Self-determination always involves a choice of the individual, but individual choice is not necessarily synonymous with loneliness, while its opposite almost always does. The choice of a patient at the end-of-life must be open to the advice of others, their critics, their offers of aid, their requests to reconside...
Dear Editor,
I laud authors for attempting to understand the substitute decision making. The study may probably not be conclusive but, one can understand the differences between the patient's substitute decision maker to that of others. Respect for patient's autonomy is considered to be the fundamental principle in medical ethics, where competent patient has a right to accept or reject medical intervention. However, t...
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