Ethics survey: End of Life Care

How much do we look after people at the end of life? What do we do when there seems to be no medical solution in sight?

The ethics survey presented the following situation:
If a person is paralyzed from the neck down, is unlikely to regain mobility, and is unable to care for him/herself without expensive life-support systems, it is best to withhold the life-support since the extra expenses are not helping anymore.

Here are the results to this question:

Almost three quarters of the church goers who took part in the survey (n=117) disagreed with the removing of life support from this person. For the remaining quarter, 1 in 7 were not sure, while 1 in 8 agreed or strongly agreed to removing the life support.
The delegates responses (n=34) largely mirrored the church-goers with two thirds disagreeing with the removing the life support from this person. A quarter where not sure, while 1 in 8 agreed or strongly agreed to removing the life support. In comparison with church members - the same proportion of delegates supported withdrawing life support, but there were more who were not sure what their stance was.

Hard decisions. Things that many of us will face - both as people who are helping others make choices - and for our selves and our loved ones.

Ethics Survey: Fraudulent certificate

What should a doctor do when asked to lie?

We asked the survey question this way:
The parents of a child come to a doctor ask for a medical certificate for two days in the previous week since they all attended a special Christian meeting on those days and the school is known not to give permission to attend such functions. The doctor should write the certificate on compassionate grounds

Here are the results:
Almost 80% of the church members surveyed (n=117) considered it wrong for the doctor to write the certificate for a child who was clearly not sick but whose parents wanted to attend a Christian meeting. It is interesting to note, however, that almost 1 in 5 church goers surveyed felt that it was right for the doctor two write out a medical certificate.

The delegates involved in health care (n=34)also followed the patern with 4 out of 5 disagreeing or strongly disagreeing with the doctor writing a fraudulent certificate. There, were almost 10%, however that agreed with the request.

We are constantly asked to tell lies - often because people want to do - or have done 'good things'.

Ethics is the challenge of being true to what God wants of us. Even if it may disappoint people who we like.

Ethics survey: Treating the poor

What do we do when a person needs treatment, but does not have the financial means to afford it?
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The Ethics survey put the following mini-case study forward:
A man on daily wages needs an emergency operation, the nearest hospital is a private charitable institution. When the man is taken to this hospital they refer him to the government hospital saying that it is very expensive for the procedure to be done at their hospital. Do you feel that this is the correct step taken by the management?
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The results are:
Just over half of the church members (n=117) felt the charitable hospital was wrong to send the patient to the government hospital for the emergency procedure. A third, however, agree with the hospital's decision.
.The delegates were stronger in stating that the emergency procedure should be done at the hospital, with a full 3/4 of them disagreeing with the hospitals decision (n=34). The remaining quarter of the delegates were split between those who agreed with the hospital managment and those who were not sure.

This question is of course a challenging one, and one that asks questions on both sides of the spectrum.

1) Should charitable hospitals have the right to refuse emergency cases? By definition, that is what they are there for, and the right to emergency care is crucial for the right to health.

2) What is the actual condition of the government emergency care? Does the government setup adequately deal with serious medical conditions?

It is interesting that more people in the general Christian public were agreed with the hospital's decision to refer to the government hospital than the Christian health care givers who attended the conference. Though the majority of both disagreed with the hospital management, would it be a small indication that the case study perhaps reflects the reality experienced by church goers?

Ethics Survey: Abortion for economic reasons

The third question in our survey probed the issue of terminating pregnancies because of socio-financial reasons - something that is legal under the MPT Act in our country.

The question was phrased in this way:

It is right to abort a foetus if the mother and father already have 3 children and do not have a job.

Here are the results:
A quarter of the church members felt that abortion was right in this case (n=117). If the ones who are not sure are included the proportion goes up to 1/3.

The conference delegates, however, had a strikingly different view (n=34). They were over-whelmingly clear that abortion in this case was wrong, with over 90% expressing this view.

This question showed the biggest gap yet between views held by church going Christians and Christians in Medical practice who were drawn to attend this conference.

There is clearly a large minority within the church for whom an extra life is seen mainly as an economic impediment and burden. This is perhaps not surprising as abortion is legalised as a form of birth control. We often confuse what is legal with what is right. Just because something is permitted in the law of the land, does not mean it pleases God.

The whole Ethics and Excellence in Medical Practice Today conference actually got its spark from a case study done 2 years ago at a church camp, where at the end of a discussion on abortion 3 Christian doctors felt threatened by the Biblical picture of the sanctity of life. It is heartening to see such a strong life-affirmation by those Christians in health care who attended this conference. The challenge now clearly remains about how to see the church take ownership of this issue too.

Ethics survey: Bible Relevance?

What place does the Bible have for medical practice today?

Our second question in the ethics survey asked this - using a slightly round about way. Participants were asked to respond to the following statement:

The Bible is primarily a spiritual book which does not have much relevance to modern medical practice

The results were interesting: While the majority of church goers (n=117) disagreed with the statement, an interesting minority did not. One in five church members felt that the Bible was not relevant for medical practice. When the people who are not sure are added to this number, we see that almost a third of the members feel the Bible is not relevant for medical issues.

The conference delegates (n=34), on the other hand overwhelmingly affirmed that they saw the Bible as key to their medical work. Only a single person was not sure of this with 97% of the delegates affirming their view the scripture is important for medical practice.

Two interesting thoughts come out of this:

1) Given that many church goers do not see the Bible as being important - is this a product of their own churches and faith journey, or is it because of the dominant humanistic environment we are in?

2) While all the participants professed that the Bible was important for them and their medical practice - is this really seen in the day-to-day actions?

What do you think?

An Evening with Prof. C.W. Imrie

The Evangelical Medical Fellowship of India – Greater Mumbai Network

and

the Bethany Trust, Thane

invite you to another opportunity of Following the Master Physician’s Heart

Please join other Christian doctors for

an Evening with Professor C.W. Imrie

Dr. Imrie will be sharing about his experiences in pancreatic surgery and research
With special reference to what it means to follow Christ in a climate of competitive excellence

Venue:
Dr. Stephen Alfred’s residence
House No. 17, Vasant Vihar Row Houses, Vasant Vihar, Thane (W) 400610

Date: Saturday 23rd February 2008 Time: 5 PM – 8 PM

R.S.V.P. to Andi Eicher 9323712065

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Professor C W Imrie

CWI was educated at Glasgow University, and started his surgical training at Glasgow Royal Infirmary in 1967. He worked in London with Lord Rodney Smith in 1973, before spending 4 years with Professor Leslie Blumgart in the Royal Infirmary. He became a Consultant Surgeon at Glasgow Royal Infirmary in 1977. Prospective studies in acute pancreatitis were started in 1971, and has published extensively on most aspects of pancreatic disease. Over the last 15years he has been the President of the European Pancreatic Club (1989), The Pancreatic Society of Great Britain and Ireland (1991) and the International Association of Pancreatology (1994-1996). A personal chair in Surgery was awarded in 1996 by the University of Glasgow. Currently he co-edits Pancreatology, one of the main international journals in pancreatic disease.

Ethics Survey: Intro & Truth-telling Question

We organised a small ethics survey in preparation for the Ethics and Excellence in Medical Practice Today Conference on the 26th of Jan 2008.

A simple 7 question survey was administered to two groups:

• A set of local churches - during the first 2 weeks of January 08
• The participants of the conference - at the time of their registration

We had a total of 117 church members take the survey - and 34 conference delegates.

The church members represented 7 different congregations in the Thane and Mumbai area. 60% of the participants were women (n=99) and the average age was 37.8 (n=83). 61% of the respondents filled up the Hindi version, while the rest did it in English (n=117).

The conference delegatesfilling the survey included 21 doctors and 13 others involved in health care (n=34) . There were slightly more men (53%) than women participants (n=32), and the average age was 41.3 years. All the delegates were given the English version of the survey.

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The first question of the survey was a inquiry into whether a doctor should communicate "bad news" to a patient against the wishes of the patients relatives.

The question was phrased like this:

A patient is diagnosed with an aggressive cancer. The relatives of the patient ask the doctor not to tell the patient what his real condition is and just say that he is sick and will get better. The doctor does not do this, but explains the situation to the patient. Did the doctor do the right thing?

The results were as follows:

Church members generally felt that the Doctor was right to communicate the truth to the patient, with three quarters of them agreeing or strongly agreeing with the stand.

It is interesting to note, however, that almost 1 in 5 felt that the doctor should do as the relatives request and hide the truth from the patient about their condition.

When compared with the church member responses, the delegates to the conference (n=34) mirrored the opinions of the church members (n=117). Two thirds agreed with the doctor's step, and just over 1 in 5 disagreed.

We can see from the question, most agreed that the doctor was right to communicate difficult news to the patient - even though the relatives had requested otherwise.

Some thoughts:

How much value do we place on truth? How do we communicate difficult issues? When do we over-ride what the care-givers desire?

What the question does not capture is how the news is communicated. Hard facts can be shared in loving ways. The Christ-following doctor and health-care worker have tremendous opportunities to speak truth in love.