FAITH & MEDICAL ETHICS

Morium ChowdhuryLaurie Wilson

MUSM 2010

INTRODUCTION Consider this… you are an ER physician working at your local hospital. A 35

year old man and woman and her two young children ages 3 & 5 are involved in a motor vehicle accident. They are brought to you for care. The children suffer only minor bumps & bruises. The mother however, has been bleeding profusely and is in urgent need of a blood transfusion. The husband informs you that his wife would not wish to receive a blood transfusion because they are Jehovah’s Witnesses.

SO, as the physician what do you do? Do you ignore the patient’s wishes as expressed by her husband? Or do you abide by the patient & families wishes’ knowing those 2 children will grow up without their mother? Would your religious beliefs influence your decision in the matter?

This scenario is just one example of the ethical dilemmas we as physicians will face as we work with people from different cultures & religions.

Our work is an attempt to help us better understand the attitudes of participants in health care on issues where faith, culture, and medicine might create ethical dilemmas.

OVERVIEW

Rationale Methodology Results Limitation Future Directions

PURPOSE Develop an Instrument for Assessment

In order to become effective physicians we have to consider how the background & faith of healthcare workers, patients, and families might affect medical decisionmaking. To this end we have begun the process of developing an instrument that would objectively assess attitudes toward medical situations where faith is expected to have an influence.

WHERE DO YOU START? Literature Review Choose medical cases Semi-structured questionnaire Interview religious leaders regarding

medical cases Survey

LITERATURE REVIEW Reviewed literature broadly on faith and

medical decisionmaking Selected cases where differences would

be expected for people of different faith Based on the review, selected the

following cases: IVFAbortionEuthanasiaDelivering Bad News

LITERATURE REVIEW Is In-Vitro-Fertilization acceptable?

Judaism – YesChristianity – Yes except within Catholicism Islam - Yes

LITERATURE REVIEW

Genesis 2:18 Yahweh God said, “It is not good that the

man should be alone; I will make him a helper suitable for him.”

Genesis 2:24

Therefore a man will leave his father and his mother, and will join with his wife, and they will be one flesh.

LITERATURE REVIEW Is Abortion acceptable?

Judaism – Yes under certain circumstancesChristianity – Yes under certain

circumstances; No within Catholicism Islam – Yes under certain circumstances

LITERATURE REVIEW Exodus 21: 22-23

“And if men strive together, and hurt a woman with a child, so that her fruit depart (if she miscarries) and yet no harm follow, he shall be surely fined, according as the woman’s husband shall lay upon him; and he shall pay as the judges determine. But if any harm follow, then shalt thou give life for life……..”

LITERATURE REVIEW Is Euthanasia (Passive or Active)

permissible? JudaismChristianity Islam

Passive allowed in all three major religions (except within Catholicism)

Active forbidden within all three major religions

LITERATURE REIVEW

Quran 5:32

"On that account We ordained for the children of Israel that if anyone slay a person -unless it be for murder or spreading mischief in the land- it would be as if he slew the whole people. And if anyone saved a life, it would be as if he saved the life of the whole people"

LITERATURE REVIEW Delivering bad news

More culturally driven than faith

INTERVIEWSConstruction of Cases

-IVF -Abortion -End of Life Issues -Delivering Bad News

Semi-structured interviews 19 total interviews

-2 Catholic priests -2 Presbyterian priests -4 Baptist preachers -I Episcopalian priest -1 Russian orthodox priest -1 Pentecostal preacher -4 Hindu priests -2 Imam’s (Muslim priest) -2 Methodist priest

INTERVIEWS Mr. Joe is a 45 year old soldier in the U.S. army who is

married to a 33 year old newscaster. The couple had been happily married for 10 years and have been attempting to have children for the last 5 years. Dr. Han suggested IVF for the couple. The couple kindly asks for your opinion in making this decision. -What would you advise? -Why? -Would it make a difference if third-party gametes have to be

used? -Imagine Mr. Joe died in war. Luckily, he has frozen sperm just in

case of an event like this. Would you advise Ms. Joe to go ahead with IVF if she came to you asking if this is ok?

-What more would you like to know?

SURVEY Having obtained feedback from various

religious leaders in the community our original cases were modified into a multiple choice survey. This survey also inquired about the following details of the responderAgeGenderMSI-MS4, Resident Physician, Attending

PhysicianSpecialty, SubspecialtyReligionFrequency of Religious Practice

SURVEY CASE 1: IVF

A 35-year-old soldier in the U.S. Army is married to a 33-year-old woman. The couple has been happily married for 10 years and has been attempting to have children for the last five years. They approach you regarding the feasibility of In Vitro Fertilization. A medical evaluation confirms that IVF is appropriate. What would you recommend?

              A. In Vitro Fertilization with the couple’s gametes              B. Encourage further attempts to conceive naturally              C. Encourage exploration of adoption D. Others (specify)_____________________________ If medically appropriate, would you recommend the use of donor gametes? Circle one. A. Yes B. NoIf medically appropriate, would you recommend the use of a surrogate? A. Yes B. NoIf the husband died in combat and had frozen sperm, would you recommend its use for IVF? Circle

one               A. Yes     B. No

SURVEYCASE 2: ABORTION

An 18-year-old was sexually assaulted and showed up in the ER 24 hrs later. Emergency contraception (RU486) exists which would abort the embryo in the event of pregnancy. Would you offer RU486?

              A. Yes              B. NoShe does not take the pill. At six weeks following the assault, genetic testing reveals a likely severe

genetic defect. She asks you about performing an abortion. How would you advise her?A. Continue w/ the pregnancyB. Continue with the pregnancy and explore the option of placing the child up for adoptionC. Abort the fetusD. Decline to perform the abortion, but refer to a colleague who will perform the abortionE. Other (specify) ___________________________________________________

 She elects to continue the pregnancy, has an amniocentesis and ultrasound at 14 weeks, the results

of which confirm the presence of a severe congenital defect. She returns at 18 weeks to discuss the results of the test and options available to her. At this time you would recommend…A. Continue w/ the pregnancyB. Continue with the pregnancy and explore the option of placing the child up for adoptionC. Abort the fetusD. Decline to perform the abortion, but refer to a colleague who will perform the abortionE. Other (specify) ___________________________________________________

SURVEYCASE 3: END OF LIFE ISSUES A 74-year-old pedestrian is struck by a vehicle while crossing the street.  The

patient is comatose and requires life support to maintain respiration; her prognosis is poor. The patient made no end of life wishes known to her family and there is no documentation of Advance Directives/Living Will in the patient’s chart. The family has been presented with the choice between continuing or removing life support. They come to you for advice on how to proceed. How would you advise the family?

              A. Remove life support and allow the patient to die              B. Keep the patient on life support

C. Refer the case to the hospital ethics committee               D. Other specify 

SURVEYCASE 4: DELIVERING BAD NEWS  A 56-year- old patient is found to have a brain tumor. Postoperative diagnosis

indicates that the patient has less than six months to live. Having obtained permission from the patient, you deliver this news to the family first, at which time they ask you not to tell the patient anything about his prognosis. You would...

              A. Agree to the family’s wishes and not discuss the prognosis with the patient

              B. Dismiss the family’s request and speak with the patient about his prognosis

              C. Explain to the family that you will not speak with the patient about his prognosis unless the patient specifically asks you about it.

              D. Other (specify)

RESULTS Pilot test run was done on MUSM Class

of 2012 (Macon Campus) 40 students responded Single pass Chi Square & Mann Whitney U Statistical

Analysis

RESULTS

There were no statistical differences amongst religions or genders with regard to answering the survey questions

RESULT HIGHLIGHTS

IVF – 85% of responders would offer IVF Abortion

RU486- 85% of responders would offer emergency contraception

6Wks into pregnancy17/40 (43%) would decline to abort the fetus,

but refer to a colleague who would be willing to do it

7/40 (18%) would abort the fetus themselves2/40 (5%) would advice she continues with

pregnancy7/40 (18%) would advice to continue with

pregnancy and consider adoption

LIMITATIONS AND FUTURE DIRECTIONS

LimitationsSmall population sizeLimited variety within the population

sample Future Directions

Larger, more varied population E-surveyFollow up research examining outliers

SPECIAL THANKS Dr. Richard Elliott, MD, PhD Dr. Steven Williams, MD Dr. Frank Dane, PhD – Saginaw Valley

State University, MI All ministers, pastors, priests, & imams

who consented to be interviewed All students of MUSM Class of 2012 who

participated Everyone who made Summer Scholars

Possible