Exprimenting on Humans

The article from the Lebanese Newspaper, Al Hayat, (Friday 24, 2009, issue no. 16821) refers to numerous experiments done on humans in prison camps. These experiments are being carried out in occupied Palestine, Iraq and other countries without patient consent. The Nuremberg War Crimes Trial and the infamous Tuskegee Experiments (among others) led to a serious reexamination of ethical standards in research and to the agreement that potential human subjects needed to be protected from being exploited as 'guinea pigs' in scientific research.
The stories revealed in the article are a clear violation of many treaties and codes of research ethics. Yet, they continue to take place and nothing is being done to stop them.

As Dante once said, “The hottest places in hell are reserved for those who in times of great moral crises maintain their neutrality”.

Click on Picture to read text in Arabic.

The Hidden Curriclum in Medical School

Physicians treat patients and medicine is a moral enterprise. We all agree to that. Well, I hope we do. In teaching hospitals, doctors teach medical students to become future physicians. Yet, teaching is not all there is to it. From what I can tell, it is basically a “do as I do, not as I say” thing. So, not matter how hard the medical programme tries to teach students to be ethical, to do the right thing, unless the hidden curriculum speaks the same language, it is a losing battle.

Many student of medicine complain that some of their teachers go into the classroom, tell them how important it is to stand up, greet the patient, comfort the patient, treat the patient as a person not a disease and, once on the floors, they see a different scenario, often by the same tutor! They are told to respect autonomy and when in the clinic, they see live scenarios where the right to decide is dismissed. They are taught to be humble and when they shadow physicians, they sense humility has no place in the equation and that their curriculum is a sham.

What do we tell these physicians-to-be? Or better, what should we do, lest we regret?

يوافق الجميع على أن مهنة الطبيب تتمحور حول معالجة المرضى وعلى أن الطب مهنة أخلاقية.

في المستشفيات الجامعيّة، يتعلم تلامذة الطب كيف يعاملون المرضى كما يتعلمّون أسس أخلاقيات الطب التي هي أساس المهنة، ولكن واقع الأمر هو أن أفعال الأساتذة وتصرفاتهم هي التي تترك أثرا على التلاميذ وليس أقوالهم. لذلك، فإن ما هو معروف "بالمنهج الخفي" هو أهم بكثير من المنهج الرسمي المقرر. كم من تلميذ جلس في الصف وتسمّر يستمع إلى المحاضر يتكلم نظريا عن التواضع وعن احترام المريض واحترام حرية قراره بينما يجد هذا التلميذ نفسه أمام ذاك المحاضر الطبيب عينه في أروقة المستشفى وهو يتصرف بعكس ما كان يحاضر. هكذا وبلحظات معدودة يلغى المنهج الرسمي ولا يبقى في ذاكرة التلميذ – طبيب المستقبل – سوى ما رآه من تصرفات الطبيب المتمرس الذي كان له المثال الأعلى.

ماذا نقول لهؤلاء التلامذة أو ماذا نفعل حيالهم كي لا نندم؟

Image above: Hugh Laurie "Everybody lies" - House MD

Access to Healthcare

The human right to health is acknowledged in several international documents. Article 25.1 of the Universal Declaration of Human Rights assert: "Everyone has the right to a standard of living adequate for the health of himself and of his family, including food, clothing, housing and medical care and necessary social services".
That health is a fundamental human right is obviously incontestable. Yet, access to healthcare is an issue that is becoming highly controversial, particularly when it is becoming tied to the financial status of the person, not to personhood itself. Those who can pay or buy private insurance can afford treatment. Those who fare lower on the scale find themselves having to plead or to remain untreated. What is the morale of the story? That poor people are not allowed to get sick? Medical care is expensive and treatment is not always available and at times is poorly available. Should we “mind the gap” as if it were an anomaly or correct the malfunctioning in the system?

. تعترف مجموعة من الاتفاقات الدولية بحق الانسان بالرعاية الصحية.
فالمادة 25,1 من شرعة حقوق الانسان مثلا تنص على ان لكل انسان الحق بمستوى معيشي يضمن صحته وصحة عائلته بما يشمل الطعام والملبس والسكن والرعاية الطبية والخدمات الاجتماعية اللازمة
ما من شك ان الصحة من أسس حقوق الانسان , لكن الحصول على الرعاية الصحية اصبح امراً قابلاً للجدل وغير مضمون خاصة مع إرتباطه بالوضع المادي للمرء وليس بشخصه فحسب. فقط اذا كان باستطاعتك شراء بوليصة تأمين خاصة بالرعاية الطبية تحصل عليها. والاّ فإنك تُحرم المعالجة الطبية وتضطر الى التوسل في طلبها. هل المقصود هنا ان ليس للفقراء الحق بأن يمرضوا لأن الرعاية الطبية مكلفة وغير متوفرة للجميع ؟ وهل علينا مسؤوليته تصحيح الخلل في نظامنا ام ان نرضخ للواقع؟

Getting physicians to listen and talk to patients

Listening and talking to patients is one detail that physicians, residents, interns, nurses and everyone involved in health care should start taking to heart. Surveys all over have revealed patients’ lack of satisfaction with the interpersonal skills of healthcare practitioners. When the patient is a ‘chronic case’, a ‘juvenile diabetes’, a ‘muscular dystrophy in room 205’ instead of a person with a name, with a private history, with a personal narrative,

communication skills are not necessary. When the illness is added to the person instead of taking over the individual, then, communication skills become paramount. So? So perhaps it all boils down to a matter of perception. How do we perceive the patients with ‘juvenile diabetes’ or ‘muscular dystrophy in room 205’?
We were having dinner yesterday night, my friends and, very nice restaurant and very good food. But dinner was ruined by the stories of physicians who tarnished their professions by the lack of their communication or humane skills. Why would a doctor tell a man not to bother spending much money treating his mother because she is old and will inevitably die soon? This was a message delivered during a clinical encounter. His mother is not suffering from any terminal illness (which would not have justified the declaration either).
Then another one added: My doctor does not bother to greet me when I come in; his arrogance is one that leaves a lot to be desired. If I can g to another physician I would. But I am stuck. She hates having to see that physician who exemplifies the characteristics of condescension. Then came the closure: a unanimous agreement that physicians these days do not bother to spend more than a few minutes with the patient whom they treat as an illness to undo. Adieu the good old days!
In my opinion, something is wrong in the system. Medicine is a moral enterprise and the most humane of the sciences. Many physicians still live up to that ideal. If others are not, there must be something that can be done about it. Part of the responsibility lies on the patients themselves. They should know their rights and not allow healthcare workers to treat them as illnesses or numbers. Patients should demand explanations and time. Until this is done, there will always be physicians who will discredit the profession.

Painting above of Egyptian Physician by H.M Herget

Hippocrates stricken in Gaza

The Hippocratic Oath states: "I solemnly pledge myself to consecrate my life to the service of humanity. I will practice my profession with conscience and dignity. The health and life of my patient will be my first consideration. I will cure all patients with the same diligence and commitment. I will not permit considerations of religion, nationality, race, party politics, or social standing to intervene between my duty and my patient."

In Gaza, doctors and nurses where killed, hospitals and ambulances targeted. Those who dedicate their lives to heal are attacked because they were trying to live up to the oath.
UN, WHO, WMA, Geneva conventions. IHL.. words and acronyms that do not hear the cries of agonizing heroes nor smell the odor of putrid bodies of innocent heroes.

Picture: Palestinian doctors send the wounded babies to a hospital in Gaza City on Monday morinng. Israeli warplanes pounded the building of Palestinian Foreign Ministry on Sunday night which is the second attack against Palestinian government building within one week.

Doctor-patient relationship

"The message I want to convey in this painting is most of all the relation of trust, a bond that can and must be built between the physician and the patient. The scene resembles a powerful womb where you can 'pass out' as a result of the anesthesia one takes. Yet, knowing that one is in trustworthy hands makes all the difference. This is so on the scientific, the psychological and the moral levels. After all, physicians are human beings with whom we share the same fate and the same human condition." Exclusively for our blog by Mimoza - the painter of Between Blue and Green.

Many patients are complaining about the physician-patient relationship. Doctors, they say, are skilled people who know the science of medicine quite well. Yet, when we are in their presence, we are reduced to an illness, a disease. What is lacking is a physician-patient relationship that makes the patient feels that he/she is a person cared for, not an illness to be treated.
Why has this happened and what can be done to remedy the vision of the old medical practitioner as 'healer'?

Bioethics Matters