Religion and spirituality have always played a major and intervening role in a person's life and health matters. With the influential development of patient autonomy and the right to self-determination, a patient's religious affiliation constitutes a key component in medical decision making. This is particularly pertinent in issues involving end-of-life decisions such as withdrawing and withholding treatment, medical futility, nutritional feeding and do-not-resuscitate orders. These issues affect not only the patient's values and beliefs, but also the family unit and members of the medical profession. The law also plays an intervening role in resolving conflicts between the sanctity of life and quality of life that are very much pronounced in this aspect of healthcare. Thus, the medical profession in dealing with the inherent ethical and legal dilemmas needs to be sensitive not only to patients' varying religious beliefs and cultural values, but also to the developing legal and ethical standards as well. There is a need for the medical profession to be guided on the ethical obligations, legal demands and religious expectations prior to handling difficult end-of-life decisions. The development of comprehensive ethical codes in congruence with developing legal standards may offer clear guidance to the medical profession in making sound medical decisions.
This article presents the Islamic bioethical deliberation on the issue of sex assignment surgery (SAS) for infants with disorders of sex development (DSD) or intersexed as a case study. The main objective of this study is to present a different approach in assessing a biomedical issue within the medium of the Maqasid al-Shari'ah. Within the framework of the maqasidic scheme of benefits and harms, any practice where benefits are substantial is considered permissible, while those promoting harms are prohibited. The concept of Maqasid al-Shari'ah which is the mechanistic interpretation of Qur'an and Hadith presents the holistic attention of Islam on many life activities, including healthcare. Indeed, this concept encompasses many aspects of worldly life, both for the human individual and collectively for the whole society. In healthcare, the practice of SAS on DSD newborns has presented an assortment of implications on the future livelihood of the affected individual. The process of decision-making seems to be very multifaceted since every element such as the determination of the 'correct' sex and the urgency of early surgery must consider the benefits and harms, as well as the child's rights and best interest. The application of the concept of Maqasid al-Shari'ah, would convey a pragmatic approach that is often disregarded in Western medicine. This approach considers the right of the individual to live life optimally, individually and socially and practice his faith, precisely, in accordance with the assigned gender.
Scientists and policy makers issuing predictions and warnings of impending natural disaster are faced with two major challenges, that is, failure to warn and issuing a false alarm. The consequences of failure to warn can be serious for society overall, for example, significant economic losses, heavy infrastructure and environmental damage, large number of human casualties, and social disruption. Failure to warn can also have serious for specific individuals, for example, legal proceedings against disaster research scientists, as in the L'Aquila earthquake affair. The consequences of false alarms may be less serious. Nevertheless, false alarms may violate the principle of nonmaleficence (do no harm), affect individual autonomy (eg, mandatory evacuations), and may result in the "cry wolf" effect. Other ethical issues associated with natural disasters include the promotion of global justice through international predisaster technical assistance and postdisaster aid. Social justice within a particular country is promoted through greater postdisaster aid allocation to the less privileged.
This paper reports the findings of a comparative study in which students' perceived attainment of the objectives of an engineering ethics education and their attitude towards engineering ethics were investigated and compared. The investigation was carried out in Japan and Malaysia, involving 163 and 108 engineering undergraduates respectively. The research method used was based on a survey in which respondents were sent a questionnaire to elicit relevant data. Both descriptive and inferential statistical analyses were performed on the data. The results of the analyses showed that the attainment of the objectives of engineering ethics education and students' attitude towards socio-ethical issues in engineering were significantly higher and positive among Japanese engineering students compared to Malaysian engineering students. Such findings suggest that a well-structured, integrated, and innovative pedagogy for teaching ethics will have an impact on the students' attainment of ethics education objectives and their attitude towards engineering ethics. As such, the research findings serve as a cornerstone to which the current practice of teaching and learning of engineering ethics education can be examined more critically, such that further improvements can be made to the existing curriculum that can help produce engineers that have strong moral and ethical characters.
Background Pharmacists as highly qualified professionals face ethical dilemmas and conflicts in their daily practice. These issues manifest themselves in the daily practice of pharmacists, which require pharmacists to have the competencies to manage these dilemmas but there is limited formal training in ethical decision making during undergraduate pharmacy education. Objective To describe the implementation and evaluation of a methodological approach to managing ethical dilemma workshop for community pharmacists in Malaysia. Setting Community pharmacists in Klang Valley, Malaysia. Method During the workshop, pharmacists were provided insights into how they could use and apply a methodological approach towards managing a dilemma, followed by a case study and panel discussion. All participants were invited to complete a pre- and post-workshop questionnaire Main outcome measure Number and proportion of respondents answering questions related to practice of ethics and workshop effectiveness Results A total of 37 participants attended the workshop. Most of the participants reported that they had no formal training in professional ethics and often used their own approach to solve an ethical issue. Some of the most common issues mentioned include changing medication to generic. More than three quarter of participants agreed and strongly agreed the content was relevant to their job and they will be able to use what they learned in the program. Conclusion The evidence suggests that a module in ethical decision making should be introduced to community pharmacists in Malaysia. This module can be easily adapted for use in other countries and will help ensure that pharmacist can make a good professional judgement and deliver the deeds of beneficence to all their patients.
The aim of this study was to investigate the use of a newly developed design game called BLOCKS to stimulate awareness of ethical responsibilities amongst engineering students. The design game was played by seventeen teams of chemical engineering students, with each team having to arrange pieces of colored paper to produce two letters each. Before the end of the game, additional constraints were introduced to the teams such that they faced similar ambiguity in the technical facts that the engineers involved in the Challenger disaster had faced prior to the space shuttle launch. At this stage, the teams had to decide whether to continue with their original design or to develop alternative solutions. After the teams had made their decisions, a video of the Challenger explosion was shown followed by a post-game discussion. The students' opinion on five Statements on ethics was tracked via a Five-Item Likert survey which was administered three times, before and after the ethical scenario was introduced, and after the video and post-game discussion. The results from this study indicated that the combination of the game and the real-life incident from the video had generally strengthened the students' opinions of the Statements.
Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient-centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision-making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end-of-life care.