Firoz Abdul Hamid's Blog

What Drives The Conscience When Mortality Is At Stake?

October 8, 2013
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Soap operas – excite most people. Mostly because it is consoling to know others have imperfect lives too. Soaps ascend many to escape the monotony of life largely but more importantly people watch these soap operas hoping to relate at some level their life’s’ many issues with the imageries on television. The medical soap series have always been riveting. Doctors clashing with nurses - - running to emergency rooms, lives on the brink are resuscitated, doctors confronted by questions of principles and ideologies. Most of us would remember the ER, Chicago Hope, SCRUB and then of course the Grey’s Anatomy.

 

But one thing always struck me in the medical business (not least some of these medical series I once watched). Is it a business of saving lives or is it a business, period? You may ask what the difference is. This cannot be better demonstrated by the shutdown in the USA last week. How the seemingly most powerful nation in the world that issues global currency is searching its souls on whether healthcare should be free for its people. As imperfect as the systems may be, how can countries like Malaysia, United Kingdom amongst many make healthcare available and accessible for their people yet capitalism curbs this access in some countries in the name of rights and responsibilities?

 

Whose rights and whose responsibilities do we debate and preserve when it comes to defining and honouring the basics of human dignity like access to education and healthcare for all? What is left of dignity of man without access to either of these services?

 

The famous Hippocratic Oath which dates back to the Ionic Greek times in the 5 BC, was historically taken by physicians and other healthcare professionals swearing to practice medicine honestly. Although amended and revised over the years, one poignant commitment in this oath is, “That I will not withdraw from my patients in their time of need”.

 

How does one serving this field reconcile withdrawing from patients in their times of need – when the argument is – there is no budget, no resources. How do physicians reconcile with this oath when their fundamental responsibilities are circumvented by the fundamentals of business and politics. Indeed can we view clinical ethics in isolation to business ethics when discussing the medical industry? James MacGregor Burns, a presidential biographer, and authority on leadership studies said, “Divorced from ethics, leadership is reduced to management and politics to mere technique.”

 

Today, there are such questions like – is force feeding ethical medically. This debate came to the fore during the recent hunger strike by Guantanamo Bay inmates . Is mercy killing unethical? Is surrogate mothering ethical? Who decides this – a faith, a belief, a conviction or how high your stocks may rise for the week? Indeed what are the determinants to these continued medical ethics debates? Is it a business decision at the end of the day? Or is it a clinical decision? Or a political decision?

 

When faced with a failing organ, what if your most trusted clergy says transplant is sinful and another says it is not and you are no expert in discernment of the faith’s traditions? What do you go by? Your heart; Your instincts; Your conscience; Your doctor; Or your clergymen’s contradicting rulings?

 

How would you react when the doctor tells you that there is this thing called medical”cannabis” that will heal you? Cannabis? Yes weed! What drives your conscience to taking that leap of faith when your only child is facing leukaemia and the only cure (hypothetically) is weed? What moves your heart when you are told your partner has debilitating illness? Which “God” does one ultimately surrender to – the doctor, the system, the business, the industry of the faith itself?

 

Who do you listen to when faced with your own mortality?

 

What do you tell a 10 year old girl in a war torn country who has been multiply raped only to she find out she is pregnant? When she finds out she may have AIDs because of this rape? When she is faced with deep religious taboos and traditions of both rape and abortion? Sitting in the pulpits of judgement is so easy in such instances, yet the reality of raising a child under those circumstances of rape and disease; you wonder what sort of parent one can become. We see parents with such privileges in life struggle to raise well balanced children, what more those who conceive a child under these circumstances. The movie “We Must Talk About Kevin” with Tilda Swinton struck a real chord with me. In such privilege you find such carnage in a child’s mind. This story is played out in its true form today in some places.

 

In his acclaimed book, The Nicomachean Ethics Aristotle wrote “For the things we have to learn before we can do them, we learn by doing them.” One cannot continue to debate Clinical Ethics without seeing it in the realms of Business Ethics. Everything we do today is a business for someone somewhere. Everything we claim to do in the name of ethics is confronted by detractors who also claim to be doing so in the name of their conscience. Yet we struggle to find the line between right and wrong, black and white when faced with our own mortality. Only when faced with the fragility of our own lives do we stand down from the benches of judgement and censures to the fields of mortality that would serve and save our own lives.

 

Professor Tariq Ramadan of University of Oxford wrote a piece on medical ethics in his book, “The Radical Reform”, ‘It has appeared, however, as it grew more specialised, reflection sometimes became technical and formal, losing touch with the complexity of the world and of day-to-day realities. It is as if, while gaining effective specificity, legal councils had lost ground in terms of global vision and social, political, and economic consideration. As if, once again, medicine – whose specific complexity has been acknowledged – was practiced abstracted from the complexity of societies and economic issues’.

 

Perhaps why Jalaluddin Rumi said, “Beyond right and wrong, there is a field. I will meet you there”.

 

Finally, for the first time KPJ Healthcare, largest private medical center in Malaysia, will be debating the subject of Clinical Ethics from the sphere of Business Ethics in its annual convention this year. I hope to be moderating this exciting session which comprise both medical and non medical panellists.

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