Concise Minutes of the Karachi Bioethics Group (KBG) Meetings held in 2018
Date: Monday, February 12, 2018
Time: 8.00 am – 09.30 am
- Religion as a commodity – Ms. Farzana Hashmi
Ms. Farzana Hashmi led an interesting discussion on the use of religion to market healthcare services. As examples, she showed advertisements in which services had been given ‘Islamic’ connotations to sell them. For instance, there was an advertisement about ‘Islamic’ methods of choosing gender before birth and an advertisement by a clinic providing IVF procedures packaged as an invitation to a milaad for women. A third advertisement promised free medical consultation for infertile couples as a special Ramzan deal.
- Clinical ethics case discussion – Dr. Bushra Shirazi
Dr. Bushra Shirazi presented a case scenario involving a 34-year-old woman with a history of breast cancer who had been married for 15 years but was childless. She had now come for treatment at a semi-government fertility clinic run largely on public donations. The case positioned the readers as members of a committee that oversaw the disbursement of funds to the clinic through a trust and selected deserving couples for treatment.
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Date: Monday, April 9, 2018
Time: 8.00 am – 09.30 am
- Social media and physicians: exploring limits – Dr. Saima Perwaiz Iqbal
Dr. Saima Perwaiz Iqbal joined the group virtually to lead a discussion on the use of social media by physicians. The discussion centered around a recent case in which a physician from a reputable hospital in Karachi was asked to leave because of sending a Facebook friend request to a patient. This case went viral on social media because the patient was the sister of a well-known film producer, Ms. Sharmeen Obaid Chinoy, who accused the physician of harassment and of crossing boundaries.
- Clinical ethics case discussion: ‘Paternalism in a Patriarchal Society’ – Dr. Ali Lanewala
Dr. Ali Lanewala presented a case scenario involving a separated couple who had a three-month-old baby diagnosed with a posterior urethral valve which is correctable with surgery. The couple had previously lost a child due to surgery-related complications, and the father who was bearing the baby’s medical expenses categorically refused to go ahead with the surgery, as he was afraid of losing another child. This created a dilemma because the mother, who was the primary caregiver, begged the physician to go ahead with the surgery without informing the father, and do what is in the child’s best interest.
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Date: June 25, 2018
Time: 8.00 am – 09.30 am
- Who gives the final verdict? – Dr. Abdul Rehman Azam
Dr. Abdul Rehman Azam, medical resident at Patel Hospital, presented a case involving a 60-year-old unmarried patient admitted to the emergency room, who stated that he did not wish to be intubated. However, despite supportive therapy, his condition deteriorated and following a discussion with his nephew (the only family member present), the patient was placed on a ventilator. The next day, he died.
- Would you support or oppose this abortion? – Dr. Nazli Hossain
Dr. Nazli Hossain, Professor, Obstetrics & Gynecology, Dow University of Health Sciences, discussed the ethical issues raised by the case of a pregnant, married woman with three daughters, who requested an abortion when her 11-week-old fetus also turned out to be female. This created an ethical dilemma for the gynecologist because although abortion is illegal in Pakistan, she knew that the woman would be divorced if she had another female child.
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Date: Monday August 20, 2018
Time: 8.00 am – 09.30 am
- Clinical Case Discussion – Dr. Ali Lanewala (AL)
Dr. Ali Lanewala, Professor, Sindh Institute of Urology and Transplantation (SIUT), presented a case of a ninth-grade student from a religious minority background, who having missed school on several occasions has now been warned that she cannot miss her classes unless she presents a medical certificate. Failure to do so would lead to her expulsion from the school.
In order to attend a very important religious event in another city, her mother requests the family physician for medical certificate so that her absence is justified and she is not expelled from school.
- Discussion over Skype: ‘Abortion laws in Pakistan’ – Ms. Sharmeen Khan (SK)
Ms. Sharmeen Khan, a corporate lawyer and director of Compliance Africa Middle East, Turkey, Amjen, Dubai, UAE shared a presentation on the Termination of Pregnancy (ToP) laws in Pakistan. She shared a few cases on ToP, Pakistani laws related to it and the Islamic perspectives. Ms. Khan also shared Dr. Farhat Moazam’s article on the subject from “Bioethics Links” which she requested to be circulated to the group.
SK’s presentation shared views of different schools of thought of Islam, most of which allow termination of pregnancy only if the doctors declare that the continuation of pregnancy will endanger the woman’s life whereas some believe in the total permissibility of ToP before life is breathed into the fetus that is usually taken as 120 days.
SK also shared the specific provisions within the Pakistani Penal Code that relate to Termination of Pregnancy: 338-A Isqati-i-Hamal (whoever causes a woman with child whose organs have not been formed, to miscarry, if such miscarriage is not caused in good faith for the purpose of saving the life of the woman, or providing necessary treatment to her, is said to cause ‘Isqat-i-haml’) and 338-B Isqat-i-Janin (whoever causes a woman with child some of whose limbs or organs have been formed to miscarry, if such miscarriage is not caused in good faith for the purpose of saving the life of the woman, is said to cause ‘Isqat-i-janin’). A woman who causes herself to miscarry is within the meaning of both sections.
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Date: Monday October 08, 2018
Time: 8.00 am – 09.30 am
- Clinical Case Discussion – Ms. Sualeha Shekhani (SS)
Ms. Sualeha Shekhani, Lecturer, Centre of Biomedical Ethics and Culture (CBEC), Sindh Institute of Urology and Transplantation (SIUT), presented a case of a twenty-seven-year male brought into a tertiary healthcare center with renal failure. Upon examination, it was clear that a transplant was required. The medical team evaluated both parents as potential donors. On examination of both parents, it is revealed that due to multiple medical conditions, the mother is not suitable whereas the father is a complete mismatch. This leads to a query in the patient’s mind that since his father is healthy why cannot he be the donor?
- Sexual Harassment within Healthcare Organizations: ‘A Personal Narrative’ –
Ms. Erum Khan Ghazi (EKG)
Ms. Erum Khan Ghazi, Ph.D Fellow Clinical Psychology, Member American Psychological Association & Pakistan Psychological Association shared a personal experience of sexual harassment that took place with a 19-year-old female who was seeing a therapist (the accused) for about 6-8 months to better manage her stress. The accused is a middle-aged married male, practicing therapist for seven years and is associated with leading hospitals and NGOs in Karachi. The accused, without taking the patient’s consent to make her angry, purposefully violated the sacred relationship and crossed the boundaries of a therapist and a patient when he touched her multiple times in March 2018 while the patient sat quietly unresponsive. The patient shared this incident with a family member, a therapist, who eventually informed the accused therapist’s organization, filed a complaint at the Provincial Ombudsman and also met the Inspector General Police. The accused however, explaining his position said that he did this act on fatherly grounds.
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Date: Monday November 26, 2018
Time: 8.00 am – 09.30 am
- Our Collective responsibility- Case of Amal Umer – Dr. ShifaNaeem
Dr. Shifa Naeem, a psychiatrist from Karachi brought up the live scenario discussion of the sad demise of Amal Umer on 13th August, 2018. The discussion was based upon the article written in Dawn by Amal Umer’s mother, which had been circulated earlier by Dr. Naeem. Dr. Naeem facilitated the discussion on the different ways that the medical system did not respond appropriately to the incident. The group deliberated upon the various ways that the medical system can be improved.
- Moral games – Dr. Aamir Jafarey and Ms. Sualeha Siddiq
Dr. Aamir Jafarey, Professor, Centre of Biomedical Ethics and Culture (CBEC), SIUT and Ms. Sualeha Siddiq, Lecture, CBEC, SIUT at first led the group through an online game on self-driving cars in order to understand the basis for moral decisions among humans.
The group provided various reasons for sparing humans (over animals), sparing passengers of the cars (versus pedestrians), sparing more lives (versus fewer lives), sparing men (versus women), sparing the young (versus the elderly) and sparing the law-abiding citizens (versus the non-abiding ones).