A case study from the perspective of medical ethics: refusal of treatment in an ambulance

This paper will examine a sample case encountered by ambulance staff in the context of the basic principles of medical ethics. An accident takes place on an intercity highway. Ambulance staff pick up the injured driver and medical intervention is initiated. The driver suffers from a severe stomach ache, which is also affecting his back. Evaluating the patient, the ambulance doctor suspects that he might be experiencing internal bleeding. For this reason, venous access, in the doctor's opinion, should be achieved and the patient should be quickly started on an intravenous serum. The patient, however, who has so far kept his silence, objects to the administration of the serum. The day this is taking place is within the month of Ramadan and the patient is fasting. The patient states that he is fasting and that his fast will be broken and his religious practice disrupted in the event that the serum is administered. The ambulance doctor informs him that his condition is life-threatening and that the serum must be administered immediately. The patient now takes a more vehement stand. 'If I am to die, I want to die while I am fasting. Today is Friday and I have always wanted to die on such a holy day,' he says. The ambulance physician has little time to decide. How should the patient be treated? Which type of behaviour will create the least erosion of his values?

Muslim families' understanding of, and reaction to, 'the war on terror'

In multiethnic societies, the consequences of the war on terror (WOT) for Muslim youth are still not well understood and the school's role remains to be defined. This article documents the parent-child transmission of understanding and emotional reaction to the WOT in South Asian Muslim families in Montreal, Canada. For this qualitative study, the researchers interviewed 20 families. Results indicated that the families' emotional reactions and communication about these events were interlinked with family patterns of identity assignation. The majority of parents avoided talking with their children about the WOT and felt that these issues should not be discussed at school. Most children shared their parents' feelings of helplessness and familial patterns of identity assignation. Parents reporting a greater sense of agency displayed less avoidance, had a more complex vision of self and other, and favored the school's role in helping children make sense of these events. These results suggest that school interventions in neighborhoods strained by international tensions should emphasize immigrant parents' empowerment and provide spaces where their children feel comfortable expressing their concerns.

Being hopeful and continuing to move ahead: religious coping in Iranian chemical warfare poisoned veterans, a qualitative study

There is a substantial number of Iranian war veterans, exposed to sulfur mustard, who suffer from serious long term progressive health problems involving their respiratory organs, eyes, and skin. Little is known, however, about these casualties' experiences of living with the consequences of sulfur mustard poisoning. This qualitative study aims to provide greater insight into how war veterans live with the consequences of the poisoning and involved 17 Iranian war veterans who had been poisoned by sulfur mustard during the Iran-Iraq conflict. Each participant was interviewed using a semi-structured interview schedule and the data generated through this process was analyzed using constant comparative data analysis technique. Data analysis resulted in "religious beliefs and practices" as a main category, which included two sub-categories: religious value centered life and religious support. Findings suggest that religious belief assists veterans to accept the impact of poisoning on their lives and adapt their lifestyles accordingly, to participate in religious social activities and feel socially supported, and to be hopeful about the future and live their lives as fully as possible.

A two-center study of Muslim women's views of breast cancer and breast health practices in Pakistan and the UK

Breast health awareness practices of Pakistani Muslim women in the UK and Pakistan is unknown. Focus group interviews were used to investigate the impact of culture and psychosocial issues on breast health awareness involving 44 women in Lahore and London. Women based in Lahore were more inquisitive about breast cancer and held more developed views compared with British Pakistani Muslim women. Women concurred that concise and relevant breast health education is needed irrespective of faith to improve cultural sensitivity and awareness in both Pakistani communities (both men and women).

Social and ethical determinants of human sexuality: 1. The need to reproduce

Aims of this study was to review the many and diverse factors conditioning human sexual behavior; starting with the first and still most important: the need to reproduce and to analyse these factors and how they have changed over time in order to better understand the interplay between the major determinants of human sexuality. For this aim the authors made a literature review of relevant scientific papers and books, including religious websites. At the dawn of humanity, sexuality was focused on reproduction; this, however, did not exclude other important meanings in sexual relationships, since non-conceptive copulations have been a constant aspect of human behavior, becoming an almost unique feature of genus homo. In this respect, the characteristics of a female continuously accessible to her male set the stage for a trend towards monogamy and created the substrate for closed families. Anthropologists have justified conceptive sexuality because sexual activity is costly in terms of energy consumption; for this reason, in the early days, restricting sexual activity made sense for the survival of the species. Traditional ethical considerations and ancient norms by the three major monotheistic religions have favored conceptive sexuality, restricting sexual activity to sanctioned unions and insisting that the major scope of sexuality is procreation. In spite of this, among humans sexuality has always had a wider meaning to the point that for millennia, humans have tried to separate its unitive and procreative meanings. Today much has changed since reproduction can be achieved without intercourse, further separating it from sexual activity. In humans sexuality always possessed multiple meanings, first and foremost reproduction and the creation of a bond between a man and one or several women.

The prevalence of middle eastern extremist ideologies among some canadian offenders

The Belief Diversity Scale (BDS) was administered to 89 male Canadian offenders of different religious backgrounds. The BDS is a 33-item, sixsubscale instrument designed to quantitatively measure the religious attitudes, beliefs, and ideologies of Middle Eastern extremists on risk areas described in the literature. Results indicated that the Muslim offenders scored much higher than and significantly different from both the Christian and atheist groups on the BDS. Results also suggested the prevalence of Middle Eastern extremist ideologies among the Muslim offenders involved in this study.

[Comparison of the calcium intake during and before Ramadan in Marrakesh, Morocco]

We studied the effect of Ramadan fasting on calcium intake in 2 groups of 500 healthy subjects from Marrakesh using the colloquial Arabic version of the Fardellone questionnaire. The first group was investigated 5 months before Ramadan and the second during Ramadan. No significant difference was observed between the 2 groups. However, comparison of the pre-Ramadan and Ramadan periods for each age group showed a significant increase in calcium intake in subjects over 60 years. During Ramadan, consumption of milk was significantly higher, while consumption of other dairy products was not different. Overall, no significant difference in calcium intake was noted between pre-Ramadan and Ramadan periods.

Face-off over veils

The French government is contemplating banning the burka in public places--including hospitals. Nurses in France disagree with the proposal.

Muslim women and medical students in the clinical encounter

CONTEXT

Increasingly, male medical students report being refused by female patients, particularly in obstetrics and gynaecology, which is impacting on recruitment into the discipline. However, little has been documented in terms of Muslim patients and medical students in the clinical consultation.

METHODS

Female Emirati nationals (n = 218) attending out-patient clinics at a public hospital in Al Ain, United Arab Emirates (UAE), were interviewed by medical students. Participants were provided with four hypothetical clinical scenarios (three personal, one concerning a pre-pubertal child) and asked whether they would allow male and female students to be present at a consultation, take a history or perform an examination. They were also canvassed about their past experiences with medical students and their social responsibility to contribute towards the training of Emirati doctors.

RESULTS

Significant differences were recorded in terms of female versus male student involvement for all activities (P < 0.05-0.0005). For gynaecological and abdominal problems, patients would generally refuse male students. More than 50% of interviewees would not allow a male student to examine their face. Students of either gender could, however, examine their 8-year-old child. Although 47% of the women had had previous clinical encounters with students, in only 58% of consultations had the attending doctor asked their permission. Despite this, the women had generally felt comfortable, although satisfaction decreased with increasing age (P = 0.088). Almost 90% of the women believed that Emiratis had a social responsibility to contribute towards the training of Emirati doctors, but this decreased with increasing income (P = 0.004).

CONCLUSIONS

As many medical students will encounter Muslim patients during their training, they need to be sensitive to religious and cultural issues, particularly for personal examinations. In contexts where most patients are Muslim, alternative options (e.g. manikins, international rotations) may be required for male students. In the UAE, patient education may improve history-taking opportunities but will probably not transcend religious and cultural beliefs without intervention from religious leaders.

Muslim women and foreign prostitutes: victim discourse, subjectivity, and governance

In this article, we juxtapose the ways “Muslim women” and “foreign prostitutes” are commonly constituted as victims in media and politics. We analyze the functions of these two prototypical female victims in terms of the role they play in epitomizing “the problems of globalization” and in reinforcing the existing social and political structures. Victim discourse, when tied to the transnational proliferation of the sex industry and of (radical) Islam, has depoliticizing effects because it places nonindividual causes of victimization outside of “our” polity and society and casts the state as protector and neutral arbiter of national and global inequalities, marginalization, and social conflict.

The cultural gap delivering health care services to Arab American populations in the United States

The relationship between Middle Eastern patients and populations of Arab origin with western health care professionals are by no means free of cultural misunderstandings. The relationship is often strained by mutual cultural misunderstanding as well as communicative and linguistic hardship. Even though people from the Middle East do vary racially, they do have shared values and behavior. This can include the importance of family cohesion, and interactive attitudes toward ailments and health. Some issues and concerns in providing health care could vary from attaining adequate information to communicated suggested behavioral change by a patient. Culturally and linguistically appropriate guidelines are warranted to provide an understanding of the cultural distinctiveness of Arab Eastern patients by shortening the gap between the Arab cultures with the western medical culture thus improving their healthcare needs.

Religion, politics and gender equality in Turkey: implications of a democratic paradox?

This article examines the gendered implications of the intertwining of Islam and politics that took shape after the process of democratisation in Turkey had brought a political party with an Islamist background to power. This development revived the spectre of restrictive sex roles for women. The country is thus confronted with a democratic paradox: the expansion of religious freedoms accompanying potential and/or real threats to gender equality. The ban on the Islamic headscarf in universities has been the most visible terrain of public controversy on Islam. However, the paper argues that a more threatening development is the propagation of patriarchal religious values, sanctioning secondary roles for women through the public bureaucracy as well as through the educational system and civil society organisations.

Fatma Aliye's Stories: Ottoman marriages beyond the harem

The harem image has dominated the conceptualizations of the family and the private sphere in the Ottoman empire at the turn of the century. This essay aims to review these conceptualizations and locate family life in both public and private spheres. The main source of inquiry will be the literary writings of Fatma Aliye (1862-1936) who wrote about women, marriage, education, poverty, and slavery. In these works, she outlined common dreams for Eastern and Western women, such as the love and companionship of an honest, monogamous man. These dreams envisioned Muslim women performing a variety of roles and thus transcended the given expectations from the family and from Muslim women as a monolithic category. In this light, this essay seeks to contextualize Aliye's works within the history of the family by evaluating Aliye's views particularly on marriage.

Contested identities: gendered politics, gendered religion in Pakistan

In Pakistan, the self-serving use of Islam by more secular elements alongside politico-religious ones facilitated the latter's increasing influence and the conflation and intricate interweaving of Islam and Pakistani nationhood. A paradigm shift under Zia's martial law revamped society as much as state laws, producing both religiously defined militias and aligned civil society groups. Examining the impact on women of fusing religion and politics, this paper argues that women become symbolic markers of appropriated territory in the pursuit of state power, and that the impact of such fusing, different for differently situated women, needs to be gauged in societal terms as well as in terms of state dynamics. Questioning the positing of civil society as a self-evident progressive desideratum, the paper concludes that gender equality projects seeking reconfigurations of power cannot be effective without vigorously competing in the creation of knowledge, culture and identity.

On the bodies of women: the common ground between Islam and Christianity in Nigeria

This article explores the common ideological ground between Islam and Christianity in Nigeria, in the ways in which gender and sexuality are configured in relation to women's bodies. The latter constitute key sites for the inscription of social norms and practices inherent in particular interpretations of religion. We proceed by examining the interplay between religion and politics in historical context and in specific concrete instances. While the religious right among Muslims and Christians share the view that women's bodies are sexually corrupting and therefore in need of control, this perspective is also found in secular institutions. At the same time Christians and Muslims are strongly opposed to controls on women's bodies that may lead to either religious group being identified as 'the other'. The linkage made between women's bodies and 'public morality' produces diverse forms of gender inequality. The moralising of political economy that these processes entail complicates the terrain on which challenges to the politicisation of religion and its gender politics need to be sustained.

Books vs bombs? Humanitarian development and the narrative of terror in Northern Pakistan

This article examines the role of humanitarian discourse and development in reconfiguring the contemporary culture of empire and its war on terror. It takes as its point of entry the immensely popular biographical tale, Three Cups of Tea, which details how the American mountaineer Greg Mortenson has struggled to counter terrorism in Northern Pakistan through the creation of schools. Even as this text appears to provide a self-critical and humane perspective on terrorism, the article argues that it constructs a misleading narrative of terror in which the realities of Northern Pakistan and Muslim life-worlds are distorted through simplistic tropes of ignorance, backwardness and extremism, while histories of US geopolitics and violence are erased. The text has further facilitated the emergence of a participatory militarism, whereby humanitarian work helps to reinvent the military as a culturally sensitive and caring institution in order to justify and service the project of empire.

The post-colonial state and minorities: ethnocide in the Chittagong Hill Tracts, Bangladesh

This paper argues that ethnocide in post-colonial states can be located in the interplay of three processes: (1) nation-building and development visions of the bureaucratic state; (2) the struggle for autonomy by the minorities; and (3) militarised pursuit of national security agenda by the bureaucratic state. The bureaucratic, political, economic, cultural and military penetration of the state into the territories of the indigenous communities often results in the marginalisation of those communities and destruction of their cultures and identity. It leads to demand for autonomy by the minorities. The state reacts to the struggle for autonomy by pursuing a militarised security agenda. Ethnocide in the post-colonial state occurs against the vortex of these processes. The Chittagong Hill Tracts of Bangladesh is an interesting case of ethnocide in the above context.

Islamic politics and women's quest for gender equality in Iran

The unification of a strong and authoritarian state with religious laws and institutions after the 1979 revolution in Iran has resulted in the creation of a dualistic state structure in which non-elected and non-accountable state authorities and institutions-the majority of whom have not accepted either the primacy of democracy nor the premise of equality between men and women (or Muslims and non-Muslims)-are able to oversee the elected authorities and institutions. The central question posed by this paper is whether a religious state would be capable of democratising society and delivering gender equality. By analysing the regime's gender policies and political development, the paper suggests that, at least in the case of Iran and Shi'ism, the larger obstacle to gender (and minorities') equality has more to do with the undemocratic state-society relations that persist in Iran and less to do with the actual or potential compatibility (or lack thereof) of religious traditions or practices with democratic principles.

A multiculturalism-feminism dispute: Muslim women and the Sharia debate in Canada and Australia

Canadian Muslim women, as opposed to their Australian counterparts, have attained prominent social status not only in terms of their contribution to electoral politics but also in other political spheres. With its focus on the Sharia debate, this paper investigates one potential explanation for this difference. Challenging Okin's feminist perspective, which claims that multiculturalism is an undesirable policy for emancipation, it is argued that multiculturalism facilitates agency of female members of Muslim communities. A comparative examination of the Sharia debate between the two secular countries of Canada and Australia demonstrates that the former's more robust multicultural polity in terms of responding to requests to adopt the Sharia have not only culminated in Muslim women's empowerment but have enhanced their political representation. In contrast, Australian Muslim women have neither had the opportunity to articulate their position with regard to Sharia nor to contribute to an important issue that could have empowered them.

Medical chaperoning at a tertiary care hospital in Saudi Arabia: survey of physicians

BACKGROUND

Medical chaperones (MC) are underutilised. The influence of Islamic culture on the use of MC is not known.

AIM

To examine physicians' use and perception of MC in Islamic culture.

SETTING

A major tertiary care hospital in Saudi Arabia.

METHODS

315 self-administered questionnaires were distributed to attendees of grand rounds of 13 departments.

RESULTS

186 (59%) questionnaires were completed. 64.5% of the respondents were 30-49 years old, 75.8% were men and 31.2% were in training; 79% had a clinic load of under 50 patients per week and 47.8% had postgraduate training (PGT) in an Islamic country. MC were reported to be infrequently (< or =25% of the time) used by 44.1% (69.2% female vs 39% male physicians, p = 0.001; 58.6% in training vs 36.8% attending, p = 0.007; 52.1% PGT in Islamic vs 35.6% in western countries, p = 0.027), offered by 52.7% (78.9% female vs 46.8% male physicians, p<0.001) and requested by 79% of patients. MC were reported to be commonly (>75% of the time) used, offered by physicians and requested by patients by 38.2%, 29% and 7.5% of respondents, respectively. The most frequently cited reasons for not using MC were privacy/confidentiality (36.6%) and understaffing (30.5%). Equal numbers of respondents perceived MC use as a protection for physicians or patients (67.7% and 65.6%, respectively).

CONCLUSIONS

MC are underutilised even in Islamic culture, especially among female physicians. Training in western countries is favourably associated with MC use. Underutilisation appears to be related to privacy/confidentiality, understaffing and failure of patients to request a MC.

[Dietary modifications, in young Muslims engaged in Ramadan fasting]

The practice of the Islamic precept of Ramadan (R) imposes to those who practice it important physiological and psychological changes due to the water and dietary restrictions they are subjected to, which has a particular impact on the Muslim students' physical and psychological performances, particularly in multicultural Western societies, where there are no schedule adjustments in daily activities. Among the changes in lifestyle, consequently, the dietary changes are stressed, both qualitative and quantitative. Due to the importance of this issue and facing the limited knowledge the Muslim teenagers who live in non-Islamic societies have about the effects of Ramadan, it is suggested as main objective of this study the analysis of changes in nutrients during R in a group of Muslim students of both sexes, in order to solve and prevent some of the problems shown in this period.

MATERIALS AND METHODS

55 Muslim youngsters were selected (24 men and 31 women) aged between 15 and 18, who practise R; and the diet was analysed by inventory over 3 days, one week before fasting and in the second week during it.

RESULTS

In R there are no relevant changes in caloric intake. The consumption of carbohydrates and proteins is increased, and that of fat is decreased.

DISCUSSION

the changes in R lead to a diet more regulated to nutritional recommendations; and to this seems to have contributed the fact that the participants took their meals at home, where, in spite of the Western cut of the population, it is felt an important influence of North African traditions and habits, due to its border contact with Morocco.

Influences of religion and culture on continuing bonds in a sample of British Muslims of Pakistani origin

This study considered the nature of continuing bonds with deceased relatives in a sample of Pakistani Muslims living in the United Kingdom. Ten participants were interviewed following a cultural psychology approach and transcripts were analyzed using grounded theory methodology. Dreaming, talking with others about the deceased, following the deceased's example, keeping memories and mementos, and doing actions thought to help the deceased were forms of continued relationship found. These were intertwined with the process of grieving and were influenced by the family, culture, and religion. Religion was a strong influence on the prominence given by participants to finishing well and on the notion of doing actions thought to help the deceased. Cultural mores, such as the community, and collectivist ethos and the expectation that emotion would be expressed around the time of death, were found to be supportive for some but sources of tension for other participants. Expressing a continuing bond through following the deceased's example so as to make them proud or happy seemed to be reinforced by cultural roots in respect for elders. Participants gave instances of tensions in areas such as expression of emotion and communality versus individualism that arose as a result of their position between two cultural frameworks, some illustrating how assimilation into the host culture set up conflict with the expected norms of their family/ancestral culture. The study highlights how understanding different cultural and religious influences may enrich the concept of continuing bonds.