SALINE, Michigan — In the United States, the American Medical Association provides a lengthy code of ethics outlining the proper conduct of a physician with his or her patients, colleagues and professional community.
Lines are clearly drawn to protect the patient from harm and to set boundaries for physician-patient relationships. However, in developing countries where the health care systems are often weak, are medical ethics considered?
Medical ethics should be strictly enforced during medical school, says Dr. Elhadi Aburawi of United Arab Emirates University.
Dr. Aburawi believes that a major issue in developing nations is that “the rules of medical ethics may not be applied to govern the relation between doctors and their patients.” He cites Libya as one offender.
In the Libyan Journal of Medicine, Dr. Elmahdi Elkhammas admits, “In our culture we tend not to inform the patient about the seriousness of his or her illness especially if the case is terminal.” In addition to this infraction, he states that patient confidentiality is not prioritized. A distinct lack of professionalism and patient respect is rampant.
Both Dr. Aburawi and Dr. Elkhammas indicate that religious and cultural factors are fundamental in interpreting what is and is not ethical. However, they also firmly believe that an ethical standard should be enforced during medical education and should not be left up to one’s personal understanding. “No courses on medical humanity and ethics were taught as part of medical school curriculum,” says Dr. Elkhammas of his own experience.
When it comes to practically teaching medical ethics in developing countries, challenges abound. Poor healthcare systems, insufficient resources and understaffed facilities all put a massive strain on the medical community and, as a result, ethics are neglected. However, improving ethics as developing countries build their healthcare systems would make them stronger and reduce future patient-physician controversies.
Medical research ethics are another highly scrutinized aspect of healthcare in the developing world. The University of North Carolina Institute for Global Health and Infectious Diseases released a story on research ethics in Africa, expressing concern about “the potential for exploitation of vulnerable populations” during the testing of new drugs.
UNC states that there are benefits to conducting research in developing countries (predominately in Africa), as certain drugs and healthcare initiatives would be put to good use in those communities.
However, not all aspects of research are meant to explicitly benefit participants. For example, many trials have been conducted abroad simply because it’s cheaper. Additionally, such populations are also “drug naïve,” meaning the participants are “not already taking medications that would potentially muddy study results.”
Additionally, many subjects choose to be a part of testing because they want some sort of medical treatment. Participants often do not understand that they may only receive a placebo instead of potentially helpful drugs. Researchers find it challenging to inform participants without compromising the study.
Developing countries must strive for more clarity in research ethics and physician-patient medical ethics alike. Without clear guidelines to define moral practices, doctors and researchers will fail to provide the best possible care for their patients.
– Bridget Tobin
Sources: UAE University, Libyan Journal of Medicine, AMA, UNC