Medical ethics in Kurdistan

By Amina Shadab and Tara Fatehi:

Anyone working in the healthcare sector should have a clear understanding of ethics and the part they play in medical diagnosis. 80 per cent of good medical practice derives from the ethics used which will then, in essence, lead to good patient care. Unfortunately, the quality of patient care in the Kurdistan Region is unsatisfactory. The healthcare system has been left behind, unable to sustain the demands of a growing population.

These are some of the major healthcare issues in Kurdistan – and the reasons why they need to be rectified:

Our doctors today still rely on the ‘old ways’, by having an outdated perception of medical ethics that has not developed or changed to keep up with modern times. As a result it is common for many patients in Kurdistan to experience discrimination.

Within Kurdistan there are many small hospitals that have to deal with an extremely large number of patients and this has negative consequences. Instantly, you can imagine that the healthcare provided is not to its full potential. However, this is not always the fault of healthcare professionals and especially doctors, as most, if not all, are aware of this situation. Many Kurdish doctors complain that their shifts are too short and it is not possible for them to see all the patients or effectively treat them within the time allowed. Hospital doctors need to be allowed to work longer shifts. They need to spend a minimum of 10 minutes with each individual patient, taking a basic clinical history and determining the correct treatment to follow. There must also be a more diversified training of doctors in a full range of specialties.

The limited time spent on each patient is a major cause of human error in treatment. This is bad medical practice and it can put a patient in danger, although perhaps this is not intentionally caused by healthcare professionals but rather it is due to the lack of time which can result in crucial mistakes that can further damage patients’ health or even result in their death.

These errors happen from management level through to junior doctors and nurses: patients are seen en masse, four to eight at a time, rather than individually. We understand that we live in a collectivist culture but, really, four if not more at a time is simply bad patient care and it can/will result in wrong diagnosis. And then there is the issue of confidentiality, which is extremely important in the world of medicine, especially patient to doctor: How can this be maintained if patients are seen in multiple numbers? How will our future healthcare professionals deal with the impact of increasing epidemics, such as AIDS and cancers? We must bear in mind that these are very sensitive issues faced by an individual.

Good communication is essential. The first thing for a doctor to notice is the best way to communicate so you can diagnose and create a prognosis for a patient who is putting their trust in you. But, instead, our doctors are sometimes too quick to show off and speak in a completely different language, i.e. English, when the patient is obviously Kurdish. This is more than bad communication: it is extremely poor ethics which must be resolved.

Through this widespread combination of poor ethics and a shortage of time it’s as if the government is giving doctors permission to kill without realising this.

 How can doctors act ethically to resolve the issues highlighted?

• Consider first the well-being of your patient.
• Treat your patient with compassion and respect.
• Approach healthcare as a collaboration between doctor and patient.
• Maintain accurate, contemporaneous clinical records.
• Ensure that doctors and other healthcare professionals that you call on to assist in the care of your patients are appropriately qualified.
• Make sure you do not exploit your patient for any reason.
• Refrain from denying treatment to your patient because of a judgement based on discrimination.
• Respect your patient’s right to choose their doctor freely, to accept or reject advice and to make their own decisions about treatment or procedures.
• Maintain your patient’s confidentiality. Exceptions to this must be taken very seriously. These may include where there is a serious risk to the patient or another person, where it is required by law, where it is part of approved research or where there are overwhelming societal interests.
• On request by your patient, make a report of your findings and treatment available to another doctor (this relates to the issue of clinical records).
• Recognise that an established therapeutic relationship between doctor and patient must be respected.
• Having initiated care in an emergency setting, continue to provide that care until your services are no longer required.
• When a personal moral judgement or religious belief alone prevents you from recommending some form of therapy, inform your patient so that they may seek care elsewhere.
• Recognise that you may decline to continue a therapeutic relationship. Under such circumstances, you can discontinue the relationship only if an alternative healthcare provider is available and the situation is not an emergency one. You must inform your patient so that they may seek care elsewhere.
• Recognise your professional limitations and be prepared to refer to others as appropriate.
• Place an appropriate value on your services when determining any fee. Consider the time, skill, and experience involved in the performance of those services, together with any special circumstances.
• Ensure that your patient is aware of your fees where possible. Encourage open discussion of healthcare costs.
• When referring your patient to institutions or services in which you have a direct financial interest, provide full disclosure of such interest.
• If you work in a practice or institution, place your professional duties and responsibilities to your patients above the commercial interests of the owners or others who work within these practices - pharmaceutical companies in particular.
• Ensure security of storage, access and utilisation of patient information (Clinical Records).
• Protect the right of doctors to prescribe and any patient to receive any new treatment, the demonstrated safety and efficacy of which offer hope of saving life, restoring health or alleviating suffering. In all such cases, fully inform the patient about the treatment, including its new or unorthodox nature, where applicable.
• During any treatment and/or surgical procedure, patients must be made fully aware of risks at an appropriate and honest level.
• Communication within the health industry must be improved to promote improved patient care. From the health minister through to hospitals, doctors, nurses, chemists and researchers, clear channels of communication are vital. I would suggest an online database where comprehensive information is readily available to all health professionals about all health-related topics, from new research to new drugs on the market.
• A competitive scheme for pharmaceutical goods must be put in place so that patients can afford their prescribed medicine and to maintain a feeling of trust between doctors and patients. (If patients can’t afford their treatment they will not return to the doctors).