VALUES, COMPETENCE, AND RESPONSIBILITY
is based on brotherhood. The physician must maintain the highest standards of justice. He should also follow the following
guidelines from the sunnat: good intentions, avoiding doubtful things, leaving alone matters that do not concern him, loving
for others, causing no harm, giving sincere advice, avoiding the prohibited, doing the enjoined acts, , renouncing greed,
avoiding sterile arguments, respect for life, basing decisions and actions on evidence, following the dictates of conscience,
righteous acts, quality work, guarding the tongue, avoiding anger and rage, respecting transgressing Allah’s limits,
consciousness of Allah in all circumstances, performing good acts to wipe out bad ones, treating people with the best of manners,
restraint and modesty, maintaining objectivity, seeking help from Allah, and avoiding oppression or transgression against
others. The physician should be professionally competent (itiqan & ihsaan), balanced (tawazun), have responsibility
(amanat) and accountability (muhasabat). He must work for the benefit of the patients and the community (maslahat).
procedures can be carried out without informed consent of the patient except in cases of legal incompetence. The patient has
the purest intentions in decisions in the best interests of his or her life. Others may have bias their decision-making. The
patient must be free and capable of giving informed consent. Informed consent requires disclosure by the physician, understanding
by the patient, voluntariness of the decision, legal competence of the patient, recommendation of the physician on the best
course of action, decision by the patient, and authorization by the patient to carry out the procedures. The patient is free
to male decisions regarding choice of physicians and choice of treatments. Consent can be by proxy in the form of the patient
delegating decision making or by means of a living will.
consent must be voluntary, informed, and by a person with capacity to consent. It involves explaining the procedure contemplated,
making sure the patient understands, and offering the patient a choice. Consent is limited to what was explained to the patient
except in an emergency. Refusal to consent must be an informed refusal (patient understands what he is doing). Refusal to
consent by a competent adult even if irrational is conclusive and treatment can only be given by permission of the court.
Doubts about consent are resolved in favor of preserving life. Spouses and family members do not have an automatic right to
consent. A spouse cannot overrule the patient’s choice.
directives, proxy informed consent by the family are made for the unconscious terminal patient on withholding or withdrawal
of treatment. Physician assisted suicide, active euthanasia, and voluntary euthanasia are illegal. A do not resuscitate order
(DNR) by a physician could create legal complications. The living will has the following advantages: (a) reassuring the patient
that terminal care will be carried out as he or she desires (b) providing guidance and legal protection and thus relieving
the physicians of the burden of decision making and legal liabilities (c) relieving the family of the mental stress involved
in making decisions about terminal care. The disadvantage of a living will is that it may not anticipate all developments
of the future thus limiting the options available to the physicians and the family.
of the power of attorney can be used instead of the living will or advance directive. Decision by a proxy can work in two
ways: (a) decide what the patient would have decided if able (b) decide in the best interests of the patient. Informed consent
is still required for physicians in special practices such as a ship’s doctor, prison doctor, doctors in armed forces.
Police surgeons may have to carry out examinations on suspects without informed consent.
OF THE INCOMPETENT
children can consent to treatment but cannot refuse treatment. The consent of one parent is sufficient if the 2 disagree.
Parental choice takes precedence over the child’s choice. Courts can overrule parents. Life-saving treatment of minors
is given even if parents refuse. Parental choice is final in therapeutic or non-therapeutic research on children. Mental patients
cannot consent to treatment, research, or sterilization because of their intellectual incompetence. They are admitted, detained,
and treated voluntarily or involuntarily for their own benefit, in emergencies, for purposes of assessment, if they are a
danger to themselves, or on a court order. Suicidal patients tend to refuse treatment because they want to die. Nutrition,
hydration, and treatment can be withdrawn in a persistent vegetative state since the chance of recovery is low. There is no
moral difference between withholding and withdrawing futile treatment. Labor and delivery are emergencies that require immediate
decisions but the woman may not be competent and proxies are used. Forced medical intervention and ceserian section may be
ordered in the fetal interest. Birth plans can be treated as an advance directive.
of the professional contract between the physician and the patient, the physician must tell the whole truth. Patients have
the right to know the risks and benefits of medical procedure in order for them to make an autonomous informed consent. Deception
violates fidelity. If disclosure will cause harm it is not obligatory. Partial disclosure and white or technical lies are
permissible under necessity. Disclosure to the family and other professionals is allowed if it is necessary for treatment
purposes. Physicians must use their judgment in disclosure of bad news to the patient.
and confidentiality are often confused. Privacy is the right to make decisions about personal or private matters and blocking
access to private information. The patient voluntarily allows the physician access to private information in the trust that
it will not be disclosed to others. This confidentiality must be maintained within the confines of the Law even after death
of the patient. In routine hospital practice many persons have access to confidential information but all are enjoined to
keep such information confidential. Confidentiality includes medical records of any form. The patient should not make unnecessary
revelation of negative things about himself or herself. The physician can not disclose confidential information to a third
party without the consent of the patient. Information can be released without the consent of the patient for purposes of medical
care, for criminal investigations, and in the public interest. Release is not justified without patient consent for the following
purposes: education, research, medical audit, employment ofr insurance.
of fidelity requires that physicians be faithful to their patients. It includes: acting in faith, fulfilling agreements, maintaining
relations, and fiduciary responsibilities (trust and confidence). It is not based on a written contract. Abandoning the patient
at any stage of treatment without alternative arrangements is a violation of fidelity. The fidelity obligation may conflict
with the obligation to protect third parties by disclosing contagious disease or dangerous behavior of the patient. The physician
may find himself in a situation of divided loyalty between the interests of the patient and the interests of the institution.
The conflict may be between two patients of the physician such as when maternal and fetal interests conflict. Physicians involved
in clinical trials have conflicting dual roles of physicians and investigators.