Thalia Arawi

Using medical drama to teach biomedical ethics to medical students

Nowadays, clinicians are faced with multifaceted ethical concerns, and it is often argued that students of medicine should be well trained in clinical ethics and have a minimum level of ethical sensitivity and critical analysis. Consequently, most medical colleges have introduced programs in biomedical ethics. It is often pointed out that there is a gap separating ethical theories from concrete moral dilemmas. This problem became less pervasive as case-studies started being used. Nevertheless, vignettes are mostly presented as an addendum to a unit and often engage the students only “temporarily.” It is my contention that this can be remedied if students were given a venue that will allow them to appreciate as many particulars of the situation as possible, to engage in the case not merely as inactive spectators, rather to get entangled in the case just enough to be involved yet remain sufficiently detached to be able to exercise critical analysis. This is possible through medical drama which, I will argue, is a narrative genre that enhances emotional engagement, cognitive development, and moral imagination allowing for a more ethically sensitive student in training. To do that, reference will be made to the medical drama “House MD.”

Attitudes of health care professionals toward pharmacogenetic testing.

AbstractBackground: Pharmacogenetics has emerged as a new tool for the optimization of drug therapy. Although the pharmacogenetics concept was first recognized at least 50 years ago, clinical testing to determine pharmacogenetic traits is still relatively rare, and many hurdles are markedly slowing its development. There is a lot of literature and speculation about potential ethical challenges in genetic and pharmacogenetic testing, yet few researchers have actually examined the attitudes of health care professionals regarding the clinical application of these tests. Objective: In this article, we aim to review the current literature on health care professionals’ perceptions of the role of pharmacogenetic data and describe the attitudes of medical students when faced with a clinical pharmacogenetic testing scenario. Methods: A group of 59 third-year medical students from the American University of Beirut Medical Center were asked to answer a questionnaire about pharmacogenetic testing after being exposed to a clinical scenario of a patient who was diagnosed with mild Alzheimer Disease (AD) and hence was a candidate for therapy with one of the acetylcholinesterase (AChE) inhibitors. Results: The students indicated that they would respect patients’ confidentiality and inform them about the test results and therapeutic plan, but they would not be as open about bad prognoses. They did not agree on the therapeutic plan that would follow a pharmacogenetic test result and were uncertain about potential patient discrimination in insurability. Conclusion: Our and others’ findings demonstrate the existence and seriousness of several challenges pertaining to pharmacogenetic applications in the clinical setting. Further training and education are needed for health care professionals, since they are the ones who will most probably request these tests in the near future.

The Muslim physician and the ethics of medicine

Virtuous physicians seem to have become a rarity in modern day medical practice. Many patients and physicians feel that the profession of medicine is not living up to its own standards and expectations. It is the contention of the author that the Muslim physician, guided by the two primary sources of Islamic Law, the Qur’an and the Sunna, will possess the necessary character traits of a good physician. In this article I argue that the Muslim physician who abides by the Qur’an will live a contented life, will be trusted by his/her patients and community, and will be in line with the recently enacted Western principles of medical ethics.

Fair, just and compassionate: A pilot for making allocation decisions for patients requesting experimental drugs outside of clinical trials

Patients have received experimental pharmaceuticals outside of clinical trials for decades. There are no industry-wide best practices, and many companies that have granted compassionate use, or ‘preapproval’, access to their investigational products have done so without fanfare and without divulging the process or grounds on which decisions were made. The number of compassionate use requests has increased over time. Driving the demand are new treatments for serious unmet medical needs; patient advocacy groups pressing for access to emerging treatments; internet platforms enabling broad awareness of compelling cases or novel drugs and a lack of trust among some that the pharmaceutical industry and/or the FDA have patients’ best interests in mind. High-profile cases in the media have highlighted the gap between patient expectations for compassionate use and company utilisation of fair processes to adjudicate requests. With many pharmaceutical manufacturers, patient groups, healthcare providers and policy analysts unhappy with the inequities of the status quo, fairer and more ethical management of compassionate use requests was needed. This paper reports on a novel collaboration between a pharmaceutical company and an academic medical ethics department that led to the formation of the Compassionate Use Advisory Committee (CompAC). Comprising medical experts, bioethicists and patient representatives, CompAC established an ethical framework for the allocation of a scarce investigational oncology agent to single patients requesting non-trial access. This is the first account of how the committee was formed and how it built an ethical framework and put it into practice.

The Ethics of the Muslim Physician and the Legacy of Muhammad (pbuh)

DOI: http://dx.doi.org/10.5915/43-1-7124 Contemporary physicians have become entrepreneurs, and the patient is often seen as a client and medicine a commodity. As such, many patients as well as members of the healthcare team feel that medicine is not living up to its own standards. It is the contention of the author that the Muslim physician, guided by the two primary sources of Islamic Law, the Qur’an and the Sunna , will possess the necessary character traits of a good physician. In this article I argue that the Muslim physician who abides by the Sunna will develop the character traits that will help him/her develop the virtues necessary for making a good physician that will do the right thing even when no one is looking.

The utilization of pre-implantation genetic testing in the absence of governance: a real-time experience

To create a diagnostic document describing the utilization of pre‐implantation genetic testing (PGT) in the absence of monitoring and regulation. Retrospective cohort study of couples undergoing PGT between 2004 and 2007 in Lebanon. The clinical indications for 192 PGT cycles performed during the study period were gender selection (96.3%), chromosomal aneuploidy (3.1%), and balanced translocation (0.5%). When gender selection was sought, the selection of a son was desired in 94.1% of cases. Of couples undergoing PGT for sex selection, 16.2% were childless, 8.6% had one child of the opposite gender, 28.1% had two same‐gender children, 29.7% had three same‐gender children, and 11.9% had four or more. Our findings demonstrate the morally questionable consequences of self‐regulated systems in which physicians are the sole gatekeepers of norms and ethics.

Prenatally diagnosed foetal malformations and termination of pregnancy: The case of lebanon

Termination of pregnancy (TOP) is offered in many countries, for foetuses prenatally diagnosed with congenital malformations that are deemed incompatible with life or that are associated with a high morbidity. In Lebanon, a middle income country where religion plays a focal role, the law prohibits any form of TOP unless it is the only means to save the mothers life. It is the contention of the authors of this article that even if the foetus is a person, if it were medically revealed that there is a substantial risk that the newborn will suffer severe physical abnormalities that will cause it to be seriously handicapped; it is morally acceptable to terminate the pregnancy. Hence, TOP carried out for these indications is justified in the interest of the foetus and the child. Whatever the status of the foetus is, once born, it will become a full-fledged sentient being with all that this entails. When given the option of starting an existence, this person-to-be has the right to a minimum that allows him/her to enjoy a relatively good quality of life. Today, Lebanese obstetricians are confronted with the burden placed on them under the law to refuse TOP, or, when performing them, to forge records or deny having done them. This is why we strongly believe that the Lebanese policy on abortion should be amended.

When a physician and a clinical ethicist collaborate for better patient care

Bioethics is a relatively new addition to bedside medical care in Arab world which is characterized by a special culture that often makes blind adaptation of western ethics codes and principles; a challenge that has to be faced. To date, the American University of Beirut Medical Center is the only hospital that offers bedside ethics consultations in the Arab Region aiming towards better patient-centered care. This article tackles the role of the bedside clinical ethics consultant as an active member of the medical team and the impact of such consultations on decision-making and patient-centered care. Using the case of a child with multiple medical problems and a futile medical condition, we describe how the collaboration of the medical team and the clinical ethics consultant took a comprehensive approach to accompany and lead the parents and the medical team in their decision-making process and how the consultations allowed several salient issues to be addressed. This approach proved to be effective in the Arab cultural setting and indeed did lead to better patientcentered care.

Respecting patient choices: using the ’Go Wish' cards as a teaching tool

Background Individuals have different values and priorities that can have an important impact on their medical management. Understanding this concept can help physicians provide medical care that is in line with the goals of their patients. Communicating this message effectively to students is challenging. Objective To report our experience with using Go Wish cards in the medical education setting. Design A thematic analysis of student reflection papers using grounded theory. Setting/Subjects Second-year medical students participated in an activity using the Go Wish cards as part of a course module on palliative care. The activity aimed to encourage students to reflect on their own choices at the end of life and to highlight that different people have different priorities. Results Forty-two students (42%) mentioned the Go Wish activity in their reflections on the module. They reported that the activity demonstrated the different priorities at the end of life, it illustrated the importance of providing personalised care, it promoted self-discovery, it transformed their view of death and dying, and it increased their appreciation of the importance of palliative care. Conclusion Go Wish cards can be used to help illustrate the variability in priorities of patients. They can be used as an effective to teach medical students about the importance of considering patient preferences when illness progresses.

BROWnies: bioethics rounds on the wards

pants recorded the major problems they saw arising from surrogacy. Assessing how these responses changed acted as part of our evaluation. What lessons were learned? Because of the emotive nature of the letters, we expected an increase in participants’ emotional engagement with the problems of surrogacy. Our evaluation found more than this; participants made more complex ethical and legal arguments and engaged with a sophisticated moral analysis by the end of the session. Participants demonstrated an improvement in their ability to distinguish arguments, group concepts and recognise and challenge assumptions. Moreover, feedback suggested that physical interaction with the letters (the opening of the letter, a physical representation of the revealing of a story) immersed participants in the case. Despite these successes, we also saw scope to improve the session. Because our narrative was written as a dialogue between surrogate mother and commissioning couple, we were not able to explore the perspectives of other characters that may be involved, for example, doctors, lawyers, friends and family, or even religious authorities. Writing a more complex network of letters may have enhanced our results. Furthermore, asking participants to write some of the letters themselves during the workshop would be a novel way to use epistolary narrative creatively. We postulate that this would allow participants to come up with more personal conclusions about the ethical and legal issues surrounding surrogacy. Overall our results encourage the use of epistolary narratives in teaching ethics.