Shamim, Muhammad Shahid

Shamim, Muhammad Shahzad

eCommons@AKU

eCommons@AKUSection of Neurosurgery Department of SurgerySeptember 2010Medical Ethics: A slow but sustained revolution inPakistan’s healthcareMuhammad Shahid ShamimDow University of Health SciencesMuhammad Shahzad ShamimAga Khan UniversityFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_surg_neurosurgPart of the Neurology Commons, and the Surgery CommonsRecommended CitationShamim, M. S., Shamim, M. S. (2010). Medical Ethics: A slow but sustained revolution in Pakistan’s healthcare. Journal of the PakistanMedical Association, 60(9), 706-707.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_surg_neurosurg/41706 J Pak Med Assoc"Change is the Measure of Time"A few decades ago, it was considered unthinkable toaccept a physician's deliberate action to hasten his/herpatient's demise. Today, it is not only legal in parts of theworld, but also considered a morally and ethically soundmethod of ending human life (assisted suicide andeuthanasia).1-3 The strong winds of change in contemporarybioethics, often arising from technically developed WesternEuropean and North American regions, eventually bringtheir effects on under-developed countries like Pakistan.Although, the rich and heavily bonding cultures augmentedby strong religious beliefs, in a "family" orientedhierarchical society like ours, provide much resistance toany change in general thinking patterns,4,5 change isnonetheless, inevitable. In Pakistan, even the uneducated, poor, andpresumably "powerless" patients have now begun toquestion their physicians for their right to know theiroptions, their planned treatment and possible complications,something unheard off a decade ago. Medical studentarguing over "Professor's" judgment on grounds of lack ofevidence in literature was considered a sin par imagination.Times have changed now. Patients are more aware of theirrights today then they were ever before. Similarly, studentsare better equipped with knowledge as well asunderstanding of clinical ethics. Moral values, physicians'capabilities and motives of providing best possible care topatients have always been in medical professionals, but therelative societal norms are changing and society in generalis moving towards increased awareness of an individual'srights.6 Information technology, in the form of electronicmedia (radio and television) and internet browsing have amajor role to play in this paradigm shift. Another important factor is the individualprofessionals, trained in bioethics, imparting thought andknowledge in different aspects of ethics to medical students,junior doctors and patients. These individuals have startedtheir ethics related activities in different areas of thecountry.7 In some places these activities have beenincorporated by Institutions, where they have beenimplemented as a part of the formal curriculum.8,9 Thesetorch bearers of bioethics are mostly trained at Centre ofBioethics and Culture (CBEC) in Karachi, the only publicsector institute providing training for award of diploma andmasters in Bioethics in Pakistan. These CBEC alumni havestarted a wave of discussions on ethical issues throughoutthe country. This dispersion is not limited to medicalstudents and junior doctors and family practitioners, but isalso enlightening postgraduate trainees, nurses,technologists, physiotherapists and school children.7,10,11Unlike previously, today's graduating doctors ofmany medical colleges of Pakistan are familiar withterminologies like informed consent, confidentiality,conflict of interest and plagiarism. Regular seminars andworkshops are now being conducted in different parts ofthe country with attendance from all over.12 Publicationsand presentations from Pakistan on ethical matters are nowoften seen on national and international forums. Ethicsreview committees are now an integral part of academichospitals and are a requirement for any substantialaccreditation. Research similarly has now formallyincorporated ethics as a mandatory consideration for allwork. Funding agencies are also aware of the importance ofethics and require that ethical issues be properly addressedfor all research work, either clinical or laboratory, prior tocommencement. The Pakistan Medical and Dental Council (PMDC)curriculum clearly advises the teaching of medical ethics tomedical students during their five year undergraduateprogramme. However, like many other topics includingdisaster, information, education and communication, medicalethics is also not formally taught in most of the medicalcolleges of the country.13 It is about time that PMDC shouldmake it mandatory for all the medical colleges to includeethics in the curriculum and also as part of the periodicalevaluation of MBBS and BDS programmes. Similarly,medical universities and colleges should take initiatives intraining their graduates and postgraduates in order to preparethem for facing and managing ethical issues in clinicalpractice, as this is the need of changing times in the country.Reference1. Fins JJ, Bancroft EA, Edwards MJ, Connor WE, Chin AE, Hedberg K,Fleming DW. Legalized Physician-Assisted Suicide in Oregon. N Engl J Med1999; 341: 212-3. 2. Back AL, Wallace JI, Starks HE, Pearlman RA. Physician-Assisted Suicideand Euthanasia in Washington State JAMA 1996; 275: 919-25.3. Tonelli MR, Lynn J, Orentlicher DN. Terminal Sedation. Engl J Med 1998;EditorialMedical Ethics: A slow but sustained revolution in Pakistan’s healthcareMuhammad Shahid Shamim,1 Muhammad Shahzad Shamim2Medical Education Cell, Dow University of Health Sciences,1 Surgical Neurology, Aga Khan University Hospital,2 Karachi.338: 1230-1.4. Abu-Nimer M. Conflict Resolution, Culture, and Religion: Toward a TrainingModel of Interreligious Peace building. J Peace Research 2001; 38: 685-704.5. Moazam F, Jafarey AM. Pakistan and Biomedical Ethics: Report from aMuslim Country. Cambridge Quarterly of Healthcare Ethics 2005; 14: 249-55.6. Khan B. Writ to Protect Your Fundamental Rights in Pakistan. (Online) Cited2009 July 9. Available from URL: http://www.hg.org/article.asp?id=5627.7. Official website: Centre of Biomedical Ethics and Culture. (Online) Cited 2009July 9. Available from URL: http://www.siut.org/bioethics/projects.html.8. Jafarey AM. Bioethics and Medical Education. Editorial, J Pak Med Assoc2003; 53: 209-10.9. Saeed N. Birth of Bioethics Group in Ziauddin University, Karachi. BioethicsLinks 2009; 5: 3.10. Siddiqui M. PGD Alumni bring Bioethics to Medical Technologists inKarachi. Bioethics Links 2009; 5: 4.11. Wajahat Y. Biomedical Ethics Teachings to Postgraduate Doctors. J MedEthics Hist Med 2009; 2: 15.12. Activity report. (Online) Cited 2009 July 9. Available from URL:http://www.issuesinmedicalethics.org/114ar135.html.13. Shirazi B, Shahzad Shamim M, Shahid Shamim M, Ahmed A. Medical ethicsin surgical wards: knowledge, attitude and practice of surgical team membersin Karachi. Indian J Med Ethics 2005; 2: 94-6.Vol. 60, No. 9, September 2010 707

Medical Ethics: A slow but sustained revolution in Pakistan’s healthcare

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Medical Ethics: A slow but sustained revolution in Pakistan’s healthcare

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