Kuwait Health Initiative
Promoting Health Sector Reform in Kuwait
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Ethics in medicine
Welcome to our page dedicated to ethics in health care.
We will address various aspects of the patient-provider relationship, including why culture and social status play such an important role in explaining the current trends seen in the way health care workers interact with their patients and how we believe standards should be established in such a tumultuous health care environment.
July 12, 2007 at 11:55
I am very much interested in ethical issues when it comes to medicine. Hope to read more about it on Kuwait Health.
July 14, 2007 at 9:32
Dear Sara,
Thanks for your comment. As we develop this section of the site, we plan to discuss the wrong-doings related to work ethics in health care which many have witnessed and continue to experience and which, we believe, stem from the Kuwaiti/non-Kuwaiti distinction, the lack of foresight of our providers, the laxity in the laws regulating work ethics, and the deficits in medical education. Of course, it is far more complex than I could possibly explain in this response so please stay tuned for more in the near-future.
Also, don’t hesitate to contact us with ideas, suggestions, concerns… any thing.
Best of luck!
February 26, 2008 at 14:14
Salam all,
Lovin’ this blog, need more time to go through it, but allow me please to point out an observation I found in Kuwait, that is the absolute ignorance of law mong doctors (incl. me)!
I just came to know that in the law of Kuwait to do a procedure you need the consent to be signed by the patient if unable the right goes to the FATHER, then GRAND FATHER, then ELDER BROTHER, then the DOCTOR!! those are known as (ولي النفس) note that there is no mensioning of HUSBAND or CHILDREN.. who obviously should have no right (ولاية نفس) upon parents or spouse!!
This is just an example.. But the question is WHY WASN’T I INFORMED OR EDUCATED!!
Good luck on the blog..
Truly,
Khaldoon Al-Humood
February 27, 2008 at 2:28
Your comment has been the topic of many conversations I have had with both lawyers as well as members of the medical community, and for many years Khaldoon. It’s great to see more and more people are aware of the magnitude of the problem. The lack of any written objectives to protect the interests of the general public in their interactions with registered medical practitioners is a significant pitfall in the Kuwaiti medical body.
Medical councils and similar professional governing bodies around the world, and as part of their core role, is to educate both their members as well as the public of their locally existing rules and regulations pertaining to ethical conduct and behavior as sat by their regulating assemblies. We in Kuwait not only lack any medical ethical conduct and behavior educational structure to clinicians, but also have major missing holes in the existing regulations that govern our practices. And as you may well be aware, there are major breaches in that department, both of ethical and of legal implications. This topic has been planned to be the focus of an extended article that I anticipate to come together sometime this summer. We hope to have your views and comments upon the maturity of that article.
March 7, 2008 at 5:30
Salam all,
I have read the comments written by Khaldoun and Raed regarding the ethical and legal issues in the MOH. I agreed completely with them. I am not surprised that many physicians are unaware of their ethical and legal rights and obligations especially with coming to issues such as substitutes for decision-making and end-of-life issues. Part of blame relies on the MOH for not providing obligatory educational courses for the physicians. On the other hand, we should not forget that physicians are also to to blamed for not undertaking seminar, courses or even attending conferences to enhance their abilities in ethical decisions. Far more important, is the public awareness and education, we can not pretend that all patients know how to deal with such situations especially under the stress of the disease and bad news.
The medical-law rules were revised recently by MOH which was done under the supervision of one of the academic lawyer in Kuwait University. Actually, i have read his remarks and the proposed agenda for the revision in 2004. I expressed deep concerns of his approach especially since no physicians were involved and was mostly under the legal prospectives. I discussed with him many aspects especially, end-of-life issues and brain-death diagnosis in Kuwait. I was surprised that he is not aware of recent advances in palliative care and brain-death documentation/diagnosis and the need for transplant donors in these settings beside the lack of awareness of many specific disease entities for which he issued major remarks.
The medical law is a separate specialty and i believe that MOH should seek major advice from others who have more experience in this setting, not necessarily from Europe or North America since cultural differences may operate with these issues.
Raed, i am really interested to be involved in such conduct or research although the work should be extended to involve multi-levels (physicians, administration, public, legal representative, etc.)
Again, thanks for this forum to let us share our opinions and possibly drive us to improve and change the current ethical and medical status in Kuwait.
Raed Alroughani,
Vancouver
March 7, 2008 at 20:54
I hope we can also address formal capacity evaluation (if questioned) for admission, discharge and medical procedures. This should be a step in assessing whether someone else should be taking the decision for the patient. The last time I worked in Kuwait there was no such system. However, there is some sort of capacity evaluation done in the psychiatric hospital mostly mandated by court.
The high awareness between medical professionals to the necessity of such evaluation is motivated by the strongly enforced regulations and fear of legal consequences. Providing education about the policies without really enforcing them may not give you the desired outcome as it will be subject to individual choice. That is why the roles of the legal and health system should be overlapping not complementary.
March 8, 2008 at 4:31
There are lots of ethical issues to be addressed in our health and legal systems. I agree both systems should be overlapping but the big question relies on who would take the initiative in facilitating this. We have a strong legal advocates in Kuwait who are trying to isolate their ideas from the medical system and trying to use their influential power to move the ethical system towards being a pure legal rather than being a medico-legal system.
Examples of some of the ethical projects that need to be addressed in our health care system are:
1. Professional conduct and Confidentiality
2. Consent: involves disclosure, capacity and voluntariness
3. Substitute-Decision making
4. Research ethics
5. Futility: Appropriate use of life-support sustaining treatment
6. Resource allocation especially in the ICU and ER settings
7. Conflict of interest: i have seen physicians in Kuwait try to force the use of specific medications because of their relationship with the pharmaceutical companies and some financial gain.
Talking and discussion are probably the first and easy part, but setting the regulations & implementation are the most difficult task in Kuwait. Although, we have many sub-committees in MOH and parliament, the majorities are working under a political, personal and financial agenda ignoring their obligations in advancing the health system forward for the benefit of our people and the reputation of our country.
Raed
March 11, 2008 at 3:28
It is needless to say that we severely miss a civil society infra structure, and at almost all levels, among which is modern medical issues, and of more concern here is both the medico legal aspect as well as the ethical conduct one. Medico legal which involves manuscriting, final drafting, lobbying to legislate, endorse, educate the concerned parties in order to create a culture that respects those basis, and a final step to be able to implement those rules and regulations. That and the ethical part, which requires primarily setting up a regionally, demographically, and culturally acceptable ethical code of conduct, which can only be drafted by the medical body and it’s institutions, followed by a road map to promote, market, educate and implement those ethical codes, emphasizing to practitioners it’s paramount value that in no more circumstances can be taken lightly.
Raed, getting through your comments, I think you would be a great asset to any future movement in that direction.
March 11, 2008 at 21:04
Raed, thanks for your comments. I am sure that you and the rest of the group members will be valuable in initiating and setting the cornerstone for such movement.