29th March 2023
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29th March 2023 |
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Medical Defence Malaysia Ethics Essay 2011 Organ donation should be mandated by Law
Done by: Aravindhanraj a/l Rajoo
Organ donation is defined as the surgical process of providing one or more organs to be used for transplantation into another person. Organ donors can be deceased or living. Living donors can provide a kidney or a portion of the liver, lung or intestine, and in some instances, eyes and tissues. Deceased donors can provide six types of organs namely the kidney, pancreas, liver, lungs, heart, intestines, and tissues such as bones, skin, heart valves and veins, and corneas. 'Mandated by law' means any mandatory order or requirement under statute, by the body of rules and principles governing the affairs of a community and enforced by a political authority. In short, if organ donation is mandated by law, every citizen of the country will be required by law to donate their organs. The Deputy Minister of Health Malaysia, in a press statement on the 23rd of October 2011 revealed that as of September 2011, the number of patients waiting for organs in Malaysia is 14,037 people and the total number of Malaysians who have pledged to donate their organs are 181,534 people. It's a huge figure and could solve the woes of these patients but we have to wait for all these pledgers to die first before their organs could be donated. On the other hand, the number of deaths from road traffic accidents between 1995-2010 is approximately 6,000 deaths every year. Should organ donation be mandated by law, we would not have any patients on the waiting list for organ donation, but in fact we would have organs in abundance in which patients diagnosed with even the first stage of any organ failure would be able to have an organ transplantation. Organ donation is important in saving lives and this is why it should be made mandatory. Organ donation is very important to increase the supply of organs because the number of people who need organ transplantation is higher than the supply. The demand for organs is so high that rich patients are not willing to queue and offer high fees in return for organs from those who are willing to sell leading to the increase of underground organ trade. Hence, it is also the best way to stop illegal black market of organ trade. This way, every patient has the opportunity to receive an organ regardless of their financial status. Moving on, now we cannot deny that by mandating organ donation and by removing their organs after death is something right. Everyone has the right on themselves and their body. However, educating the public on its importance first and mandating it when the public understands the reasoning behind it, would be a better option. In Malaysia, organ donation of the deceased is something very sensitive as the main concern of the family members of the deceased revolves around various superstitions on the effects it might have on the soul and the rebirth process of the deceased, and towards the family and relatives of the deceased. However, this issue can be tackled easily because it revolves around religion and almost all religions in Malaysia are in favor of organ donation. However, it is not understood properly by anyone and that's the sole reason why Malaysians are still skeptical to the issue of organ donation. In Islam, organ donation is a deed that is not mentioned specifically in the Holy Quran or by the Prophet Muhammad's Sunna. This method of treatment is a relatively new advancement in the field of medicine. One of the Maqassid al-Syariah which means purpose of syariah is persevering life. Hence, the above matter was discussed at the National Fatwa Committee meeting back in June 1970 and the decision to allow organ donation and transplantation based on acceptable judicial principles. The first principle is 'choosing the lesser of two evils if neither can be avoided'. Since saving the life is a necessity that carries more weight than preserving the integrity of the body or the cadaver, the inflicting injury on the body of the donor is less evil compared with letting the patient die, therefore organ donation and transplantation is sanctioned. It goes without saying that the procedure should not pose any danger to the living donor as far as medically ascertainable. Here the main principle of medical ethics, primum non nocere is automatically invoked. Donation must cause no harm or a minimal increased risk to the health of the donor. The second rule is 'necessities overrule prohibitions'. Basically mutilating the human body, whether living or otherwise, is against the perceptions of Islam. However donating an organ is not an act of mutilation. Mutilation is done with malice and vengeance and serves no good purpose. Wherelse donating an organ is an act of charity and benevolence as it can save a human life. In Surah Al-Maidah, verse 32, Allah says if anyone saves a life, it will be as if he saves the life of all mankind. The third principle which supports this issue is contained in verse 185, Surah Al-Baqarah, 'Allah intends every facility for you, and He does not want to put you to difficulties'. Islam considers a disease as a natural phenomenon. However one should seek remedy because Allah, who causes ailments, also brings cure and redemption. Despite the unequivocal sanction for organ donation, the failure to spread the message properly has resulted in low organ donation amongst the Muslims. In Hinduism, they can donate anything that they wish, including their organs whether alive or after death. Hinduism does not prohibit their devotees from donating their organs if it can save lives. Love, compassion and charity are the practical aspects of Hinduism. The prayers of Hindus end with, 'Loka Samastha Sukino Bhavathu' which means let all the living beings be happy in the world. Therefore, a Hindu should do whatever is in his means, to eradicate sorrow and sufferings of others. Organ donation be it when alive or after death, are noble acts of charity and not against the teachings of Hinduism. Hindus believe in re-birth and their main concern of an organ donation leading to being re-born with missing organs is purely superstitious. From the Hindu religious point of view, there are no restrictions or constraints for organ donations by Hindus but people are prohibited by taboos and beliefs. These taboos, in the minds of man must be removed. They must be educated in religion and ethics. They must be made to realize their moral and ethical responsibilities to their fellow human beings. From the Buddhism point of view, the donation of organs after one's death for the purpose of restoring life of another human being clearly constitutes an act of charity, which forms the basis or foundation of a spiritual or religious way. DANA is the term for charity or generosity. The perfection of this virtue consists of its practice in three ways namely the giving or sharing of material things or worldly possessions, the offering of one's own bodily organs, and the offering of one's services for a worthy cause, even to the extent of sacrificing one's own life for the well-being and happiness of others in need The teachings of Buddha are for the purpose of reducing suffering here and now, and paving the way for the complete cessation of all forms of sufferings. The reason why Buddhists still fear organ donation lies primarily on the lack of understanding of the real nature of life and death and of life hereafter. Christianity encourages organ donation but the way it is done concerns this community. Organ donation gives Christians the opportunity to follow in the footsteps of Jesus by doing something concrete to help the blind to regain their sight and the sick to recover th use of a vital organ. The Holy Bible makes a clear distinction between the resurrected body for the next life and the earthly bodies. The earthly bodies serve as a useful purpose for this present life alone and have no relevant function in the life to come. Therefore, if the usefulness of our bodily organs can be extended beyond our own early existence for the benefit of those who remain here, we should do all we can to make this possible. The Christian Federation of Malaysia encourages all Christians to share Christ's love with those who are in grave need of replacement for their dysfunctional organs. This should become an integral part of Christian education at home and in the church. The Christian community needs to have more awareness campaigns on this matter. The government with the help of local non-governmental organizations, and religious organizations, can spread information on organ donation including the religious take on organ donations through newspaper advertisements, short regular clips played regularly on all local television channels targeting the primetime hours and not forgetting religious preachings at the worship areas on a regular basis. This is acceptable to everyone as we all live and lead our lives based on religious teachings and scriptures. Apart from the above, a parliament sitting is important to come up with an Act to make it mandatory that in the case of a death, the officials must ask the family of the deceased if they wish to donate the organs of the deceased. The current practice is organs of the deceased are only donated if the family requests it to be done by informing the authorities of their wish. In a situation of losing a loved one, family members are usually not in a sound state of mind to think of donating the organs of the deceased as they are mourning over the loss. So, by just asking and giving that option, the chances of the family saying 'yes' is there rather than a zero chance by not asking at all. Lastly, I sincerely believe organ donation is a noble act. Adequate preparation of the loved ones in terms of education and counseling before and after is essential. The more preparation there is prior to the event, the less traumatic and dignified it would be for the family. Rather than incinerating or burying our loved ones, why don't we see them living inside others? Medical Defence Malaysia Ethics Essay 2011 Should doctors lie on behalf of patients?
Done by: Subbramanian SP Palaniappan
Should doctors lie on behalf of patients? Often in Medicine, doctors are faced with difficult ethical dilemmas that stretch and question their thinking. The complexities of modern Medicine are such that the line between truth and lying are not clear-cut. When making decisions regarding truth, doctors must consider their role as professionals, their duty towards their patients, their duty towards society, as well as the prevalent laws at that time .With the information available, doctors should consider the different factors and make the best decision possible. The principle of veracity (truthfulness) is important in Medicine. It is the opposite of lying which is the 'wilful and intentional failure to tell the truth '.The principle obliges the doctor to always provide full, honest disclosure . While the principle itself is not a law, voiding it would result in a loss of credibility and respect in the medical profession . This is because medical personnel hold a position of trust within the community and they are expected to promote high standards of accountability and professionalism . However, having said this, are there times where lying on behalf of patients is acceptable? When one becomes a doctor onetakes a pledge, one line of which is, “The health of the patient will be my first consideration ”. This corresponds with the principle of beneficence,
where doctors strive to do what benefits the patient . Are there times where lying on behalf of patients can benefit them? Consider this actual example from the JAMA . A patient enters an ER and the doctor diagnoses appendicitis, but to confirm it requires a contrast-CT which requires time. The doctor believes a normal-CT would be clear enough so she neglects to mention to the radiologist that she suspects appendicitis. Adiagnosis for appendicitis is returned and the patient receives immediate surgery. In this case the 'doctor lied to get the “wrong” test for her patient, who did end up benefitting '. Here a benefit was achieved which corresponds with Jeremy Bentham's theory of 'utilitarianism ', where actions are right if they benefit the majority . In this ethical theory, lying is not immoral where the resulting consequences maximise benefit or minimise harm, such as in the case above, where lying allowed the patient to receive a quicker diagnosis and surgery. The doctor weighed out carefully the overall consequences of her actions before making a decision, a pre-requisite of utilitarianism. She reasoned that waiting for the contrast-CT would put the patient at risk because if the patient regurgitated the contrast, valuable time would have been lost. At the opposite end of the spectrum, if the regular-CT had failed, a second CT would have been required resulting in further delays which could have been serious. This could have breached the principle of 'primum non nocere' (do no harm) .However, based
View more upon the information available at the time, the doctor lied to the radiologist- who otherwise would not have done a regular-CT- to achieve the best care for her patient. There may be also be times, where doctors feel lying on behalf of their patients will benefit them in an unfair insurance-based healthcare system such as the USA. In the USA, 49.9 million are without health insurance as they do not qualify for work-based insurance or Medicare or Medicaid .Data suggests that many physicians would choose to deceive insurers for patient benefit. Statistics show that 70% of clinicians would write 'exclude cancer' to secure funds for mammography, if it was not covered . Other data showed that in a 1998 study, 39% of physicians admitted to exaggerating the severity of conditions and documenting nonexistent symptoms- to gain benefits for patients . At other times, doctors would also make the symptoms seem less aggressive by 'bending' the rules, for example by stating 'moderate reflux' rather than 'severe reflux'. Technically this would not be breaking the rules as the threshold for classification, leaves room for interpretation .Some would consider this to be deceitful, as doctors are lying by miscoding symptoms for a patient to get treatment and misrepresenting the truth. However, there is also an alternative view of
looking at it. As one frustrated blogger put it, “If my assessment results in a [correct] diagnosis...and they [insurers] don't pay on those grounds alone, who is defrauding whom ?”.Under the 2002 charter on medical professionalism, it states that 'doctors must promote justice in the healthcare system, including the fair distribution of healthcare resources ' and on a WHO report it states 'health system[s] [should have]...equal provision of care regardless of social standing or the patients' ability to pay '. In countries such as the USA, which has high levels of inequality , 'who gets treatment is effectively decided by...officials of companies providing insurance plans '. Insurance systems are considered unequal and do not provide what the community considers good and fair treatment . So in these circumstances, doctors take it upon themselves to 'assist individual patients to access healthcare [based on]...a patient's needs '. Doctors due their position and skills can now deliver justice to those who really require treatment by maximising their health gain . Thereby, their acts benefit the patient.
Sometimes withholding information on a patient's request does not always undermine veracity . For example a young female, presents to a doctor complaining of bleeding from her vagina. After investigation it is discovered that she has cervical cancer. She requests you not to inform the parents. Respecting these wishes and lying to her parents, violates no ethical principles, as the principle of autonomy (self-determination), truth (full disclosure) and beneficence (primary consideration of welfare) are maintained . The doctor's duty is to the patient and not to her immediate family members, so when he fails to disclose the patient's information, he is merely following her wishes. He is under no ethical or legal requirements. However, if the patient were to enter a critical situation, where her life was in danger, the doctor would be obliged to break his confidentiality, so that the immediate family members could decide on the best way to treat the patient . Despite all the points in support of lying on behalf of patients, if we consider it from the opposite view, we would find points supporting the idea that doctors should not lie on behalf of patients. For example, let us reconsider the example where the doctor lied with regards to the CT-scan. Let us consider her actions against ethical codes. For example in the SMC Ethics Code it states, 'Be open, truthful, factual...in communications with the other members of the profession .' Furthermore, the 'Principles of Medical Ethics' published by the American
Medical Association states, 'A physician shall deal honestly with... colleagues ”. We can see that the doctor broke these ethical codes by excluding her suspected diagnosis of appendicitis, and in doing so was not truthful to her colleagues. Whereas before, the doctor's actions corresponded with 'Utilitarianism', one could now criticise it for being flawed. One pre-requisite of Utilitarianism is that one considers the consequences of their actions. If the doctor had misjudged the consequences of her actions or ignored the harmful consequences that her lies could have caused, it could have ended more tragically . Even if the doctor's actions were done with the best intentions, she would not definitively have been able to know whether her lie would have brought more good than the actual truth. Her objectivity would be flawed as she has a vested interest in lying, in that she believes that lying in that instant would have made the patient's world better . For this reason, critics say lying is wrong as we cannot accurately measure the benefits and harms of lying. Furthermore, by lying in that situation, it could be argued that the doctor brought the medical profession into disrepute. In the medical profession, truthfulness is essential to bring about a correct diagnosis. So when doctors lie, it damages the climate of trust within the profession and the individual's and the profession's integrity is lost . If doctors continually lie, the loss of honesty in medical practice means the end of Medicine as a profession . It is important to remember, the strength of the doctor lies in their truthfulness and integrity .
Secondly, as stated before some would consider doctors miscoding symptoms for patients as fraud and deceit. Some would argue that doctors have a responsibility to act for insurers to preserve the integrity of the system and to protect patients from unfair treatment . By deliberately miscoding information on a patient's records, the doctor 'violates the rights of other patients within the system and fails to defend openly the patient's need for the procedure '. It could be argued that due to the position doctor's hold, they should not lie to correct injustices in the healthcare system; rather they should fight them openly for the good of all patients. Also by attempting to lie to insurers, one is actually increasing the cost of insurance fraud. It is estimated that in the USA, 25% of all healthcare payouts are lost to fraud and in countries like the UK, fraud results in losses of £2 billion a year . So to recoup these costs, insurers would raise premiums and this would result in higher costs for the patient, leaving them even worse off. Also if a doctor miscodes information wilfully and the patient were to die, the patient's records would indicate this. In an attempt to save himself, the doctor may return to the records and alter themto save himself from arrest. He has thereby contravened ethical codes and committed a serious criminal offence by altering the patient's records. His negligence and the failure of his duty of care towards his patient, leaves him in an untenable position. From then on, this leads to a 'slippery slope', because the doctor would continually lie to save himself from prosecution.
Finally, sometimes lying on a patient's behalf can have drastic consequences. Consider an elderly man coming for a consultation. He tells you that he has been experiencing blurred vision and constant headaches. He asks that you do not inform the police, as he does not wish to lose his driving license. You as a doctor are faced with an ethical dilemma. You know that the patient is unfit to drive and that he could seriously injure or kill himself or others, but at the same time, as his doctor you are obliged to protect his confidentiality. The doctors must decide, does he work for the individual or does he work for society? In this situation if the doctor lied on behalf of the patient, the danger to public would be great as the chance of injury/death is high due to the driver's impaired conditions. So he must err on the side of disclosure. Legislation in countries such as the UK, would allow doctors to break confidentiality and to report the patient to the police for being unfit to drive . This legislation would allow the doctor to disclose information that would only be relevant to the risk-not anything else - thereby in some way still maintaining confidentiality. In conclusion, as the recession continues and state-run healthcare systems like the NHS struggle , it is likely that health systems will soon have more of an insurance-based approach. This could mean doctors worldwide having to deal with insurers daily and fighting for the rights of their patients. In these changing circumstances, doctors must be convinced that lying is the best clinical option and that it would substantially benefit the patient. The doctor must also consider the benefits of lying, gained by the patient as compared to the grave consequences that lying can bring. Doctors must also consider their roles as professionals and administrators of 'distributive justice'. Based upon all these factors and
the doctor's judgement, they alone should decide whether lying would be acceptable in the circumstances of the case. References Books
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