Common medical ethical issues faced by healthcare professionals in KSA

Understanding, being, and doing of bioethics; a state-level cross-sectional study of knowledge, attitude, and practice among healthcare professionals

BACKGROUND

The field of bioethics examines the moral and ethical dilemmas that arise in the biological sciences, healthcare, and medical practices. There has been a rise in medical negligence cases, complaints against healthcare workers, and public dissatisfaction with healthcare professionals, according to reports from the Indian Medical Council and other healthcare associations. We intend to assess the level of knowledge, attitude, and practice of bioethics among the registered healthcare professionals (HCPs) of Maharashtra, India.

METHODS

A State-level online survey was conducted among the registered HCPs (n = 2143) casing all five regions of the Maharashtra state using a pre-tested self-administered questionnaire. The responses were expressed as mean, and proportions with their standard deviation and 95% CI respectively. Binary logistic regression and a multivariate logistic model were used to determine factors associated with knowledge, attitude, and practice of bioethics.

RESULTS

Of the 2143 registered HCPs in Maharashtra included in this study, most of them (65.2%) had adequate knowledge of bioethics. Adequate knowledge was associated with lower age, profession (nurses and dentists), employment in the private sector, HCPS at Marathwada and Pune, and higher educational attainment. About 3 in 5 HCPs (59.4%) had a favorable attitude towards the ethical practice of bioethics, and was associated with profession, place of work, region of practice, and work experience. The distribution of unethical bioethics practices among 10 items was proportionally high, and only 34.4% reported good/fair practice. The common unethical practices in the state were allowing patients to be examined by interns, and not informing them about professional misconduct to the regulatory bodies.

CONCLUSION

Most HCPs had adequate knowledge of bioethics, which is encouraging and would favor the laying foundation for forming a good bioethics framework. Only 3/5 HCPs demonstrated a favorable attitude, and the observed unethical practice is alarmingly common. A serious consideration to evaluate the compliance level of bioethics practice periodically and measures to educate, sensitize, and train bioethics among HCPs in Maharashtra is warranted.

Medical Ethics Knowledge and Attitude Among Dental Students from Two Universities in The Middle East

Background:

Dentists are obligated to provide patients with ethical and harmless treatment.

Objective:

This study aimed to assess the knowledge, attitude and practices of medical ethics among dental students in two dental faculties in the Middle East.

Methods:

A cross-sectional study using a validated online self-administrated questionnaire was completed by dental students who started clinical training at Mansoura University, Egypt, and from Umm Al-Qura University (UQU), Saudi Arabia. Descriptive statistics and chi-square tests were used for the statistical analysis.

Results:

Participants were 649 dental students. About 77% of Mansoura’s students were aware of the Hippocratic Oath compared to 89.6% of UQU students (p=0.000). No significant difference was found between the two faculties in the presence of ethical topics in their curriculum and the mode of teaching. About 67% of respondents reported obtaining written consent from UQU patients compared to only 10.5% of Mansoura’s patients. Nearly 86.3% and 63.3% of dental students at Mansoura and UQU, respectively, believed that they knew the best, irrespective of the patients’ opinion. In case of any wrongdoing during treatment, 88.7% of Mansoura’s and 93.9% of UQU students agreed to inform the patients. Regarding patient autonomy, only 51.2% and 65.3% of dental students at Mansoura and UQU, respectively, respected the patient’s wishes during treatment., The majority of students from both faculties had less knowledge regarding services and duties related to the ethical committee.

Conclusion:

Gaps in knowledge, attitude and practices of medical ethics were found among dental students of the two faculties, especially among Mansoura’s students. Attention should be paid to improving the present situation.

Current state of ethical challenges reported in Saudi Arabia: a systematic review & bibliometric analysis from 2010 to 2021

Background

Over the past few years, five domains of importance about the current state of bioethics in Saudi Arabia have shaped the perspective of most research: doctor-patient relationship, informed consent, do-not-resuscitate, organ donation, and transplantation, medical students’ knowledge and attitudes about medical ethics curriculum. This systematic review aimed to systematically identify, compile, describe and discuss ethical arguments and concepts in the best-studied domains of bioethics in Saudi Arabia and to present cultural, social, educational, and humane perspectives.

Methods

Six databases were searched using Boolean operators (PubMed, Embase, Web of Science, Scopus, CINAHL, Google Scholar) from December 2020–June 2021. The search and report process followed the statement and flowchart of preferred reporting items for systematic reviews and meta-analyses (PRISMA).

Resutls

The search resulted in 1651 articles, of which 82 studies were selected for a final review and assessment. There is a gradual increase in research, whereby a substantial increase was observed from 2017. Most of the published articles focused on ‘Organ Donation & Transplantation’ with 33 articles, followed by ‘Doctor-Patient Relations’ with 18 publications. Most of the published articles were from Central Province (33), followed by Western Province (16). The authorship pattern showed a collaborative approach among researchers. The thematic analysis of keywords analysis showed that ‘Saudi Arabia,’ ‘attitude PHC,’ ‘organ donation,’ ‘knowledge and education,’ and ‘donation’ have been used the most commonly.

Conclusion

This systematic quantitative synthesis is expected to guide researchers, stakeholders, and policymakers about the strengths and gaps in knowledge and attitudes regarding medical ethics in Saudi Arabia, both among the general public and health professionals.

Knowledge, attitude, and practice of medical ethics among health practitioners in Taif government, KSA

Objectives:

Medical ethics practice and the attitude and knowledge toward it was our concern and aim to investigate.

Methods:

A cross-sectional study was conducted on 1943 healthcare practitioners from three tertiary care hospitals. A questionnaire requesting demographic data and items related to the level of knowledge and awareness beside the real-life practice of medical ethics among healthcare providers was used. A score was given for each response and a total score was calculated.

Results:

Of the participants, 86.9% had studied medical ethics, 70.3% thought patients should know about their rights, 87.4% supported that the patient have the right to know and be informed if any malpractice happened, 61.8% never engaged in healthcare-related act on a patient without informed consent, 73% ensured that no one was present other than medical team during assessments or procedures, and 86.6% tried to give only what was necessary to the patient regarding their situation. Nursing specialists/technicians, with of 20-<30 years of practice and participants who had previous training in bioethics had significantly higher mean attitude scores than others. Females, laboratory specialists/technicians, and those who reported previous study of medical ethics had a significantly higher practice scores. A cogent positive correlation was found between the practice and attitude scores.

Conclusion:

Interduce medical ethics and insist on its importance in medical institutions will positively affect practitioners' knowledge, attitude, and practice.

Exploring medical ethics' implementation challenges: A qualitative study

BACKGROUND

Adherence to medical ethics principles by medical professionals is required to improve health-care system's quality. Recognizing medical ethics' challenges and attempting to resolve them are important in the implementation of medical ethics in practice. This study aimed to explore such challenges at Iran's medical sciences universities in 2018.

MATERIALS AND METHODS

This descriptive, qualitative study utilized a conventional content analysis approach for data analysis. This study was conducted using purposeful sampling from participants with experience in teaching or practicing of medical ethics field, and by considering maximum variety of disciplines (e.g., gynecology, internal medicine, surgery, and medical ethics). The data were gathered using semi-structured interviews. The interview guide was designed based on previous research findings by two members of the research team and contained the main interview questions and participants had the opportunity to express their perspectives in detail. Participants were chosen from clinical and ethical faculty members as well as managers. The data collection process continued until the data saturation stage, beyond which no new information or concept achieved by continuing interviews.

RESULTS

After interviewing 14 faculty members and managers, findings were classified into 4 themes, 9 categories, and 42 sub-categories; four main categories of medical ethics challenges are affected by cognitive, educational, practical, and structural factors, respectively.

CONCLUSION

This study suggested that medical ethics' cognitive and educational challenges can alleviate using educational programs intended for improving qualitative and quantitative aspects of medical ethics teaching for medical professionals ranging from students to faculty members. Medical ethics' structural and practical challenges are within policymaking and scheduling activities dealt with through future researches by health-care system's managers and planners.

Patient privacy and autonomy: a comparative analysis of cases of ethical dilemmas in China and the United States

Background

Respect for patients’ autonomy is usually considered to be an important ethical principle in Western countries; privacy is one of the implications of such respect. Healthcare professionals frequently encounter ethical dilemmas during their practice. The past few decades have seen an increased use of courts to resolve intractable ethical dilemmas across both the developed and the developing world. However, Chinese and American bioethics differ largely due to the influence of Chinese Confucianism and Western religions, respectively, and there is a dearth of comparative studies that explore cases of ethical dilemmas between China and the United States.

Methods

This paper discusses four typical cases with significant social impact. First, it compares two cases concerning patient privacy: the “Shihezi University Hospital Case”, in which a patient was used as a clinical teaching object without her permission, and the “New York-Presbyterian Hospital Case”, in which the hospital allowed the filming of a patient’s treatment without his consent. Second, it compares two cases regarding patient autonomy and potentially life-saving medical procedures: the “Case of Ms. L”, concerning a cohabitant’s refusal to sign a consent form for a pregnant woman’s caesarean, and the “Case of Mrs. V”, concerning a hospital’s insistence upon a blood transfusion for a dissenting patient. This paper introduces the supporting and opposing views for each case and discusses their social impact. It then compares and analyses the differences between China and the United States from cultural and legislative perspectives.

Conclusions

Ethical dilemmas have often occurred in China due to the late development of bioethics. However, the presence of bioethics earlier in the US than in China has not spared the US of ethical dilemmas. This paper highlights lessons and inspiration from the cases for healthcare professionals and introduces readers to the role and weight of privacy and autonomy in China and in the US from the perspectives of different cultures, religions and laws.