Medical Ethical Dilemma Case Study

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Recommended: Essay of informed consent

Medical students’ knowledge and attitude in dealing with medical ethical dilemmas

HO Ariff, AG Rasydan, N Suhaila, AR Shahrir
Kulliyyah of Medicine, International Islamic University Malaysia, 25200, Kuantan, Pahang, Malaysia

Introduction
The society’s outlook towards healthcare has changed radically over the past three decades. First, there is an increased emphasis on patient autonomy and self-determination or patient-centered medicine whereby patients are the focus of the clinical interaction. The belief that doctors know what is best for patients is fast diminishing. Secondly, there is also growing recognition that improvements in healthcare require collaboration among many different stakeholders, including patients. Thirdly, health is …show more content…

Additionally, during the two-week posting in Anesthesiology and Critical Care, in the fourth year, their understanding is strengthened during small group discussions on medical dilemmas commonly encountered in anesthesiology and critical care practice with the medical teachers. In the discussions, students analyze the medical ethical dilemma, apply the ethical principles of autonomy, beneficence, non-maleficence and justice3 and decide as to the best solution to take. They also learn to analyze the situations using the Islamic ethical principles such as the maqasid and qawaid al-shariah as complement to the conventional ethical principles, which is an essential skill when one addresses similar dilemmas involving Muslim patients. Basically, they are tasked to analyze the ethical issues and apply the conventional ethical principles and Islamic ethical theory on the case studies provided to them4. They have to prepare the discussion script of the given cases and present them during the small group discussion. Ethical issues discussed are those that are normally encountered in anesthesia and critical care practice; namely, informed consent, Do not Resuscitate, DNR, withholding and withdrawal of treatment, euthanasia, brain death, organ donation and end of life care4. It is hoped that after …show more content…

Ethical Issues Yes (%) No (%)
1 Taking consent from patients involves application of ethical principles 97.56 2.44
2 Euthanasia is not permissible in Islam 87.80 12.20
3 Withholding of life support to a dying patient = Physician Assisted Euthanasia 24.39 75.61
4 Morphine administered to a terminally ill cancer patient is not equal to indirect euthanasia 75.61 24.39
5 Withdrawal of life support to a dying patient = Euthanasia 56.10 43.90
6 Withdrawal of life support from a pt with massive stroke, CVA and never regain consciousness is permissible in Islam 73.17 26.83
7 It is permissible to withdraw life support in a ‘brain dead’ patient 92.70 7.30
8 Case 1: Perform CPR on a patient, post Acute Myocardial Infarction, AMI who came to A&E in a cyanosed state and practically dead. (Brought in dead or ‘BID’) 17.07 82.93
9 Case 2: Very ill, post MVA patient on a ventilator, IPPV – had emergency laparotomy for intra-abdominal injury (open and close; abdominal pack); on triple inotropes; severe hypovolemic shock. Deteriorating general condition. Would you do a CPR should she develop a cardiac arrest?
43.9
56.10
10 Observe any doctor resolve ethical situation in the ward 31.71

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