Chapter 1: Healthcare Practitioner Ethics PDF

Chapter 1: HEALTHCARE PRACTITIONER ETHICS Chapter 1: Healthcare Practitioner Ethics The following are examples of ethical standards that healthcare practitioners should demonstrate and work on developing within him/herself and among those who work with him/her; especially when he...

Chapter 1: HEALTHCARE PRACTITIONER ETHICS Chapter 1: Healthcare Practitioner Ethics The following are examples of ethical standards that healthcare practitioners should demonstrate and work on developing within him/herself and among those who work with him/her; especially when he/she recognizes that he/she is a member in a group whose members complement each other in the medical field. (A) Devotion and Feeling the Worship of Allah (SWT) Among the values a healthcare practitioner should possess is earnest devotion to Allah (SWT), perceiving His presence through sincere spiritual commitment and worship. Allah (SWT) said, )٦ َ ‫ م خ َ ٱلج‬, ) created the ‫ن ٱۡنسَ إَليعبد نَ (الذاري‬ Jinn and mankind only that they might worship Me Adh-Dhariyat, 51:56). Consequently, if Allah (SWT) did not create mankind other than to worship Him; then worship of Allah (SWT) is in all our deeds, including what we do as healthcare practitioners making it one of the most mandated duties. The messenger of Allah (PBUH) said, The reward of deeds depends upon the intentions and every person will get the reward according to his intentions. 1 Therefore, it is up to each individual Muslim healthcare practitioner to have devotion in all his/her deeds for the sake of Allah (SWT), and perceive the presence of Allah (SWT) in all his/her activities, plus understand that he/she will be judged for every small and big act he/she has done. (B) Demonstration of the Best of Manners 1. Truthfulness Truthfulness is the main trait of a faithful person, as Allah (SWT) said in the Holy Quran, )١١١ ‫ يـٓ يہ ٱلذينَ ءامن اَ ٱت اَ ٱَّ ك ن اَ معَ ٱلصـدقينَ )الت ب‬, O you who have believed, fear Allah and be with those who are true. Tawba, 9:119). Truthfulness is not only about telling the truth, it is also about truth of the intention, truth in the deed and performance as well. Thus, it includes all human relations. It is not appropriate for someone who is a role-model to others, in knowledge and honesty, to be accused of lying let alone being known as a liar. Of course, there is no doubt that the healthcare practitioner, whom people seek due to their calamities of pain and sickness with complete trust in his/her deeds and words, should not be found otherwise [a liar]. If found to be a liar, his/her knowledge and skills will not help him/her restore the lost trust. 2. Honesty and Integrity Healthcare practitioner is entrusted with human souls and bodies, thus, he/she should reflect upon it appropriately. Allah (SWT) said, describing the faithful, )٨ ‫ ٱلذينَ ه َ ۡمـنـت َ ع ده َ رٲع نَ (الم من ن‬, And who are keepers of their pledge and their covenant, Mu minun, 23:8) 3. Humbleness and Respect for Others Healthcare practitioner should be humble and never display arrogance towards his/her patients or demean them, whatever be their position. He/she has to respect all those he/she deals with, including the patients and/or their family members. This makes him/her in a more respectful status. And whoever humbles 1 Reported by Bukhari and Muslim 13  Chapter 1: HEALTHCARE PRACTITIONER ETHICS him/herself for the sake of Allah (SWT), He will raise his/her position. The messenger of Allah (PBUH) said, He, whoever has even a weight of a mustard seed of arrogance in his heart, will not enter paradise. 1 4. Patience and Forbearance The medical profession is a challenging and hard career. Healthcare practitioners deal with different types people in the community which requires a high level of patience, forbearance and tolerance. A patient healthcare practitioner tolerates the behaviour of his/her patients and excuses the annoyance of some [patients] considering their pain and illness. Healthcare practitioners should not confront the patients irritability with anger or retaliation by stopping to treat a patient who has used inappropriate language, or by dereliction in fulfilling the patient s right to full care. 5. Passion and Love Healthcare practitioners should be loving, passionate and lenient towards his/her patients as well as refrain from insulting them by saying what could make them weak or lose hope. A successful healthcare practitioner considers the psychological state of his/her patient, and uses ways that would help them get rid of illusions by delivering the truth about their illness in a considerate manner with diligence and accuracy that suits the level of the patient s understanding, intellectual and psychological abilities. 6. Moderation and Fairness Moderation is considered one of the basic principles which Islam calls for - no surfeit and no negligence. Allah (SWT) said, ‫كذٲل َ جع نـك َ أم َ سط لَتڪ ن اَ شہد ٓاءَ ع ى ٱلن سَ يك نَ ٱلرس ل ع يك َش يدا‬ (342 ‫ الب رة‬, Thus We have appointed you a middle nation, that you may be witnesses against mankind, and that the messenger may be a witness against you. Baqarah 2:143). Therefore, a healthcare practitioner should be fair and unbiased in treating his/her patients. This is because they submit their affairs to the healthcare practitioner, based on their trust in him/her and their need for his/her advice as well as service. It is not permissible for a healthcare practitioner to abuse this trust and look down on the patients rights, whether it is the right to appropriate medical care or in terms of financial costs that over- burden the patient, patient s guardian or employer. (C) Self-accountability Healthcare practitioners have to judge themselves before being judged by others, or having their mistakes widely publicized. Self-accountability includes everything, even the smallest of blunders and lapses. For example, to compliment some people at the expense of others (even to a small extent), irrationally give advantage or delay, be late for his/her patients appointments, or speak irresponsibly. 1 Reported by Muslim 14  Chapter 1: HEALTHCARE PRACTITIONER ETHICS (D) Avoidance of Trivialities and Pettiness It is not appropriate for a healthcare practitioner to indulge in affairs that are religiously repugnant or socially reprehensible, like backbiting, tale-bearing, talking too much, arguing, laughing too much, or saying socially unacceptable words - especially while performing his/her duties. It is also preferable for a healthcare practitioner to refrain from the demeanours of virility, though it may not be religiously prohibited, such as chewing gum while working, untidy appearance, wearing strange and socially unacceptable clothes, which may be acceptable in other countries other than the Kingdom. 15  Chapter 2: HEALTHCARE PRACTITIONER’“ DUTIE“ TOWARD“ PATIENTS Chapter 2: Duties of Healthcare Practitioner Towards 1 Patients The relation between a healthcare practitioner and his/her patient is based on mutual trust and honesty between the two. It is the duty of the healthcare practitioner to deliver comprehensive medical care to his/her patients according to their medical needs with accuracy and proficiency in order to satisfy the patient s best interests while respecting the patient s dignity, and considering the patient s rights. All of this should be within the ethical framework dictated by the Islamic Sharia and professional duty, including the following: (A) Good Treatment of Patient It is the duty of a healthcare practitioner to treat his/her patient kindly in all conditions, and this [good treatment] includes the following: 1. Being welcoming by smiling at patients. 2. Listening attentively to patient s complaints and empathising with his/her suffering. 3. Being discreet when asking a patient questions related to his/her condition by choosing the most appropriate words for the situation which does not embarrass the patient, unless needed, especially when other people or patients are near. 4. Show humility and refrain from arrogance, demeaning, mocking, sarcasm towards a patient, regardless the patient s scientific or cultural status. 5. Respect the patients points of view, understand their customs and social norms, especially in relation to their personal affairs; but this does not mean not to advise them appropriately. 6. Fairness in the treatment of all patients with no discrimination against them in the level of healthcare based on the differences of their social status or based on personal feelings towards (or against) them. 7. Gentle handling of all patients while performing physical examinations. 8. Refrain from committing religiously forbidden acts, such as unnecessary exposure of patient s private parts, staying alone with a colleague or a patient of the opposite sex, as will be detailed later. 9. Reduce the patient s physical and psychological suffering as much as possible with all the available materialistic and psychological means to make the patient feel cared for. (B) Achieving Patient’s Interest and Guarding His/Her Right The healthcare practitioner should meet the patient s interest, as explained below: 1. Limit the medical investigations, prescriptions or surgical procedures to the extent needed for the patient s condition. 2. Refrain from using diagnostic or therapeutic measures that are not recognized or scientifically proven, unless within the known scientific and regulatory restrictions. 1 See Section Two of the Law of Practicing Healthcare Professions, p. 29-34 16  Chapter 2: HEALTHCARE PRACTITIONER’“ DUTIE“ TOWARD“ PATIENTS 3. Tell the patient or whoever is acting on his/her behalf as soon as possible about the patient s health condition, its causes, its possible complications, as well as the benefits of the diagnostic and therapeutic procedures. Additionally, introduce them to appropriate alternatives in diagnoses and treatment in a clear and honest way. 4. )t is the doctor s duty to refer any patient to another doctor who is specialized in the patient s health condition, or has more effective means of treatment; if the patient s condition necessitates it [such referral]. The doctor should not delay such referral whenever it is in the patient s interest with full presentation of the information needed for the patient s treatment. 5. Respect the patient s wish to be referred to another healthcare practitioner, or have their information recorded in their medical record, or be given the medical report that explains his/her medical condition. The doctor should not refrain from meeting the patient s wishes and should facilitate the patient obtaining these reports and information. 6. Continue delivering the appropriate medical care to the patient over the whole duration of the patient s illness, as long as it may be. 7. In case of the absence of the directly responsible healthcare practitioner, the practitioner should make sure that the patient receives the appropriate medical care during his/her absence. 8. Continue delivering the medical care needed for the patient in emergency situations until such care is no longer needed or until transferred to another qualified doctor. 9. Educate the patient about his/her condition in particular and in general, as well as how to maintain his/her health with suitable ways and means of protection from diseases. 10. Respect the patient s scheduled times and refrain from any delay on them. (C) Patient’s Consent The adult conscious patient s permission (consent) should be sought (whether the patient is male or female), or from his/her representative in case the patient is not competent to deicide, before any medical or surgical intervention. This is because the human s body and soul are from the person s privacies that no one should deal with unless with prior permission. For a patient s consent to be considered valid; the following conditions must apply: 1. The healthcare practitioner should present enough information in a language that the patient can understand about what he/she will do, and what is required from the patient, the possible consequences of the patient s decisions, as well as potential complications and risks. 2. The patient should be able to understand and appreciate the information that he/she has been provided so that he/she decides with full consciousness, awareness and conviction. 3. The patient s consent should be made voluntarily without pressure or coercion. 4. The consent should be written at the time the healthcare practitioner will perform any intervention that includes possible risks, like surgical operations, biopsy, or similar procedures. 17  Chapter 2: HEALTHCARE PRACTITIONER’“ DUTIE“ TOWARD“ PATIENTS  Woman’s Consent The conscious adult woman has the right to give consent to any medical interventions that is related to her, including surgical operations, except for what is related to reproduction, like the use of family planning methods, hysterectomy or other procedures. In such procedures, the acceptance of the husband must be obtained too. In emergency and life-threatening conditions, the woman s consent is sufficient.1  Incompetent Patient’s Consent If the patient cannot give an informed consent, for example in case of unconsciousness, or whose consent is not usually considered valid like children,2 or the insane; his/her legal guardian should be the person to give this proxy consent, whether for surgical or alike interventional procedures. If obtaining the consent of the legal guardian was not possible, amid fears of potential loss of life or severe harm to the patient, then the healthcare practitioner can do these interventions without consent. For the non-interventional procedures on an incompetent patient, it should be sufficient to have the consent of one of the present parents or accompanying healthy person, if he/she is competent to give such a consent. (D) Reassurance of Patient The healthcare practitioner should use his/her skills to reassure the patient and alleviate his/her suffering, in accordance with the teaching of the messenger of Allah PBU( , The Prophet said, "Facilitate things to people concerning religious matters), and do not make it hard for them and give them good tidings and do not make them run away from )slam.3 This includes doing the following: 1. Look out for and explore the patients psychological needs. 2. Provide the patient with sufficient clear information about his/her condition, which would help to reassure and eliminate his/her fears. 3. Positive interaction with the patient s feelings and concerns, and to correct his/her wrong conceptions and information about his/her illness and treatment. 4. Give the patient enough time to understand what is said to him/her, and to express his/her feelings towards the disease or treatment without forcing [the patient to finish] 5. Remind the patient that the illness is a test from Allah (SWT), and that it is a chance to have his/her sins forgiven and mercy given [from Allah (SWT)], while choosing the appropriate time and place. 6. The healthcare practitioner shall reassure the patient of his/her readiness to take care of him/her and stand by him/her. This should be ongoing through all the phases of the illness, even in incurable diseases. In addition, the reassurance should include: 1 “ee the Cou il of “e ior “ holars’ Resolutio No. 93 2 A child is defined as any person from birth until maturity 3 Reported by Bukhari and Muslim 18  Chapter 2: HEALTHCARE PRACTITIONER’“ DUTIE“ TOWARD“ PATIENTS  Praying for the Patient It is from the helping factors for the patient to cope with his/her illness and have his/her spirit soothed when the healthcare practitioner demonstrates the manners of the noble prophet (PBUH) in praying for his patient to be cured, as it was from his guidance PBU( that if he comes to a patient, he holds the patient s hand and says, "O Allah! The Lord of the people, the Remover of trouble! (Please) cure (Heal) (this patient), for You are the Healer. None brings about healing but You; a healing that will leave behind no ailment" and said, whoever visits a patient whose time (of death) did not come, and says near him seven times, I ask the Glorious Lord (Allah), the Lord of the glorious throne to heal (cure) you; Allah will cure him from that illness.1  Breaking Bad News There is no contradiction between reassuring the patient and telling him/her about his/her condition, even if it is serious and fatal. It is the right of the patient to know his/her health condition, illness, symptoms, and prognosis in general terms. If the patient requires more details, he/she should be answered with that [request]. Informing the patient is the duty of the treating doctor and should not be left to doctors more junior to him/her, especially if these doctors do not have sufficient experience. When breaking such news, the following should be considered: 1. Gradual approach and preparing the patient psychologically to receive the sudden undesirable news. 2. Limit [yourself to] the information that suits the patient s knowledge and understanding of his/her health condition without the minutiae that would increase his/her worry. 3. Choose a suitable time and place to tell the patient. Preferably at the time in which the patient is psychologically, physically settled and ready to receive such news. It is also preferable to inform one of the people the patient trusts after obtaining his/her consent, as this would facilitate the treating doctor s job in breaking the bad news. 4. Take enough time and attention to inform the patient, so the doctor breaks the news tranquilly using effective skills in communication. 5. Focus on the positive sides that would restore hope in the patient s soul following the messenger of Allah s (PBUH) advice, "Facilitate things for people, and do not make it hard for them and give them good tidings and do not alienate them ,2 for example, by telling stories of how others overcame their illness, and the scientific advantages in this field [of the patient s illness] in particular. 6. Continue in alleviating the patient s physical and psychological sufferings and provide the required care. Do not abandon the patient or neglect him/her so that he/she does not feel the doctor has lost hope in his/her condition. 7. The doctors should assess whether it is better telling a patient only part of the truth, and/or limit this [disclosure] to the patient s family; if the doctor sees this is in the patient s best interests. 1 Reported by Abu Dawoud 2 Reported by Bukhari 19  Chapter 2: HEALTHCARE PRACTITIONER’“ DUTIE“ TOWARD“ PATIENTS 8. The doctor and the healthcare practitioners should receive enough training on effective skills of communication for dealing with such cases. 9. The healthcare practitioner should refrain from telling the patient something he/she is not authorized to disclose. (E) Maintaining Patient’s Secrets - Confidentiality1 The Islamic Sharia has asserted the significance of keeping the patient s secrets and confidentiality. The knowledge of the health practitioner about the patient s secrets does not entitle him/her to disclose them or talking about them in a way that would lead to their disclosure, except for the following exceptional conditions: 1. )f the disclosure is to protect the patient s contacts from being infected or harmed, like contagious diseases, drug addiction, or severe psychological illnesses. In this case, disclosure should be confined to those who may become harmed. 2. If the disclosure is to achieve a dominant interest of the society or to ward off any evil from it. In this case, the disclosure should be made only to the official specialized authorities. Examples of this condition are the following: a. Reporting death resulting from a criminal act, or to prevent a crime from happening. b. Reporting of communicable or infectious diseases. c. If disclosure is requested by a judiciary authority. d. To defend a charge against a healthcare practitioner alleged by the patient or his/her family in relation to the practitioner s competence or how he/she practices his/her profession. Disclosure should be only before the official authorities. 3. If the disclosure to the patient s family or others is useful for the treatment, then there is no objection to such disclosure after seeking the patient s consent. 4. The healthcare practitioner can disclose some of his/her patient s secrets when needed for the education of other healthcare team members. This should be limited to the purposes of education only and to refrain from disclosing what could lead to the identification of the patient and his/her identity. (F) Photographing Patients and Recording Their Voices The rule is that patients should not be photographed in whole or in part of their bodies except for a need or a necessity required for the purpose of their care, or for the purposes of health (medical) education, or to undertake health research. When there is such a need, the following regulations should be followed: 1. Inform the patient with the significance of this imaging, its importance and purpose before imaging or recording, and tell the patient how and where it (i.e. the image or the record) will be used 2. Obtain the consent from the patient or the patient s proxy decision maker before photographing or recording. 1 Secrets here refer to any information that the patient considers as confidential about him/her. [translator] 20  Chapter 2: HEALTHCARE PRACTITIONER’“ DUTIE“ TOWARD“ PATIENTS 3. Never put any pressure on the patient to have such photograph (imaging) or recording and never coerce the patient to accept. 4. Ensure that the imaging or recording is used for important and necessary purposes like healthcare, medical education, and scientific research. 5. The patient has the right to withdraw his approval even after the imaging or recording has taken place. 6. If the patient is unconscious or a minor, the consent of the legal guardian should be obtained. If the patient becomes conscious, he/she has the right to withdraw the consent at any time. 7. It is not permissible to publish the patients images in the media, including the new media,1 unless with written permission from them. Such publication should not have anything that could identify the patient s identity. )f there is a need to publish a photo of the face, then the eyes should be covered, unless there is a scientific need. All of that should be in compliance with the legislative rulings and regulations followed in the Kingdom of Saudi Arabia. 8. The following are exclusively the parts that could be photographed and kept without the need of the patients consent: a) Photograph of internal organs of the body. b) Histology (human tissues) slides. c) Endoscopic photographs. d) Diagnostic imaging in any of its forms. (G) Dealing with Patients Who Refuse a Medical Procedure In case a patient refuses a medical procedure, the healthcare practitioner should consider the following: 1. Make sure that the patient is aware of the consequences of his/her decision to refuse the medical procedure. 2. Listen to the patient s point of view and respect his/her wish. 3. Explain the importance of the medical procedure, and the consequences of not having the procedure honestly and without exaggeration. 4. If the healthcare practitioner is not the treating doctor, and the patient refuses the medical procedure, the healthcare practitioner should refer the patient back to his/her treating doctor. The treating doctor should do whatever is possible to convince the patient as well as make him/her aware of the alternatives, and then to make the appropriate decisions after that. 5. Document the patient s refusal in writing so that the healthcare practitioner disclaims any liability. (H) Conscientious Objection to Refrain from Treating a Patient2 The healthcare practitioner can - in a non-emergency situation, refrain from treating a patient for personal or professional reasons that would jeopardize the quality of care provided by the healthcare practitioner to the patient, on condition that this [refrain] does not harm the patient s health, and that there is another practitioner who is capable of treating the patient instead of him/her. 1 The authors most probably refer to the so- alled e so ial edia , like YouTu e, Fa e ook, Twitter, etc. [translator] 2 See Article 27 in the Law of Practicing Healthcare Professions, p. 19 21  Chapter 1: HEALTHCARE PRACTITIONER’“ DUTIE“ TOWARD“ THE COMMUNITY Chapter 3: Healthcare Practitioner’s Duties Towards the 1 Community The healthcare practitioner enjoys a noble status in the community. The community has positioned the healthcare practitioner in a special social status that is not available to other members of the society. In return, the community expects the healthcare practitioner to use this position in the service of the patient and show commitment to the highest moral standards through his/her manners. The healthcare practitioner should contribute to the community service through his/her profession, and with all possible resources required for the public s interest. This could be reflected in the following: 1. Become a role model for the community members through his/her faith and maintaining human affairs away from suspicions.2 The healthcare practitioner is a member of the community, and the position that he/she holds enables him/her to have a leading role in any community reform. The healthcare practitioner who lacks moral values in his/her personal life cannot pretend to have them in his/her professional practice, even if he/she holds the highest academic qualifications. The healthcare practitioner is an effective member in his/her community and interacts with its local and public issues. Thus, he/she should not live in his/her ivory tower away from the problems and issues of the community. 2. Recognize that the community and environment are important factors in the health of individuals by helping the community to deal with the social and environmental determinants of diseases. 3. Practice the profession with the highest attainable level of knowledge, efficiency, trustworthiness, and integrity while keeping updated with the advances of his/her specialty. 4. Recognize his/her responsibilities in the empowerment of justice among the community members in the utilization of health resources. 5. Recognize his/her responsibility for the maintenance of health resources and utilizing them in the most appropriate way. Therefore, he/she has to avoid requesting investigations, consultations or prescribing medications that are unnecessary for his/her patients. 6. Strive hard through the use of his/her skills, knowledge and expertise to improve the standards and quality of health services available in the community, whether in the work place or in general. 7. Recognize his/her role in the development of health policies through positive opinion contributions, either individually or through the professional associations. The healthcare practitioner should, and especially those in an authoritative position, never hesitate in their positive and constructive contribution to the enactment of laws, or the development of health policies. 1 Arti le i the La of Pra ti i g Health are Professio s states that, Health are professio als shall serve the best interest of individuals and society within the framework of respecting human right to life, safet a d dig it... 2 For example, many of the community members seek excuses for their smoking stating that there are doctors who smoke. 22  Chapter 1: HEALTHCARE PRACTITIONER’“ DUTIE“ TOWARD“ THE COMMUNITY 8. Consider public health through health education that is suitable for the practitioner s area of influence, to endorse or contribute to the preventive programs, and the protection of the environment. 9. Take into account interaction with media for the sake of providing the correct information to the community. 10. When the scientific information is presented to the community, the health practitioner should recognize his/her responsibility in presenting the authentic options that are professionally acceptable, and should clarify for the beneficiaries if he/she is presenting personal opinions or opinions that could be deviating from what is professionally acceptable. 11. Contribute, as much as possible towards the study of health problems at the community level and suggest suitable solutions for them, like smoking, illegal drug abuse, traffic accidents, infectious diseases and others. 12. Commit to helping specialized authorities in performing their duties to preserve health [for example] by reporting communicable diseases and epidemics, and preserve public safety through reporting criminal incidents. 13. Being a medical witness, especially if the specialists, or experts among them, could be important for the judiciary in order to understand a patient s condition or the treatment given to him/her. In this case, the healthcare practitioner should deliver an honest and objective explanation of the medical facts. And in the case of presenting evidence to the judiciary, the healthcare practitioner should recognize his/her responsibility to help the judiciary achieve truth and justice. 14. Refrain from any practices that could harm the community, and refuse to participate in or support any practice that violates the basic human rights in the Islamic Sharia. 15. The healthcare practitioner should not be used in any way as a tool to weaken the intellectual or bodily resistance of a human. He/She should also not condone, support or participate in any act of torture, or any other practice that includes the humiliation of any member of the community; regardless of the crime that this person was suspected, accused, or convicted of having committed. The healthcare practitioner should not participate in executing any punishment unless for what was approved by the Islamic Sharia, and with a ruling from the religious judiciary. 16. The healthcare practitioner should be truthful and honest when issuing any certificates or documents such as certificates of proof of presence, sick leaves, or others. The healthcare practitioner is a witness who should be fair in his/her witnessing, and should not be taken by the desires of kinship, passion, or desire of benefit and should fear presenting a medical report that is at variance from the truth; as he/she (the healthcare practitioner) knows that the unjustified absence of an employee from his/her job may be crippling for the community s interests. 23  Chapter 8: HEALTHCARE PRACTITIONER’“ DUTIE“ TOWARD“ PROFESSIONAL COLLEAGUES Chapter 4: Healthcare Practitioner’s Duties Towards Professional Colleagues The relation between a healthcare practitioner and his/her colleagues with their different specialties should be based on solidarity, passion, and respect.1 Healthcare practitioners complement each other in the provision of healthcare to the community in their different health specialities. One team works in prevention, and another in treatment. So, the healthcare practitioner is an addition, and cooperation with his/her professional colleagues for the patient s best interests. This necessitates consideration of the following: 1. Behave well with his/her colleagues and treat them the way he/she would like them to treat him/her. 2. Do not indulge in their private issues, and eat their fleshes2 to seek their shames. 3. Avoid direct criticism of a colleague in front of patients, especially if this was done with the intention of making the people disregard him/her (i.e. the colleague) or out of evil envy. Honest scientific methodological critique should not be done in front of the patients, but in scientific meetings, medical conferences, and medical journals. 4. Doing his/her best in teaching healthcare practitioners who work in his/her medical team or are his/her trainees, and be keen to benefit them with the experience, knowledge and skills he/she has, in addition to giving them the chance to be trained and develop their skills; as will be detailed later in the chapter entitled, Ethics of Teaching and Learning on Patients. 5. The healthcare practitioner should envisage the precision and integrity of his/her evaluation on the performance of those working or being trained under his/her supervision and should not undervalue the right of anyone, while avoiding equalizing the hard working with the uncommitted. 6. The healthcare practitioner should avoid religious standards when dealing with his/her colleagues, such as avoiding being along with foreign women.3 7. The healthcare practitioner should not find it difficult to stop at the limit of his/her abilities and request help from his/her professional colleagues whenever needed. 8. The healthcare practitioner should be ready to peer-review the professional performances of his/her colleagues, and accept that peer-review on him/herself, and strive hard not to make professional or personal relationships affect evaluation positively or negatively. 1 Article 24 of the Law of Practicing Healthcare Professions states that, The relatio ship et ee health are professio als shall e ased o ooperatio a d utual trust. p. 1. 2 This refers to the verse in the Quran that relates a k iti g to eati g so eo e’s flesh. Allah (SWT) says, َ ‫ََيغت َبعضك َبعضََۚأيح‬ َ ََ‫ََتجسس ا‬ َ ََۖ ‫ضَٱلظنََإث‬ َ ‫َ يـٓ يہ َٱل‬ َ ‫ذينَءامن َاَٱجتنب اََكثيراَمنََٱلظنََإ‬ َ ‫نَبع‬ َ ‫نَٱََّت ا ََرَحي‬ َ ‫ٱََّإ‬ ۚ َ‫) أحدڪ ََأنَي ڪلََلح ََأخيهََميت َفكرهتم هََۚ ٱت َا‬32َ ‫(الحجرا‬, O ou ho ha e elie ed, avoid much [negative] assumption. Indeed, some assumption is sin. And do not spy or backbite each other. Would one of you like to eat the flesh of his brother when dead? You would detest it. And fear Allah; i deed, Allah is A epti g of repe ta e a d Mer iful. )Al Hujurat 49:12). [translator] 3 A foreign woman is any woman that the man can ask for marriage; i.e. any woman except his sister, mother, aunt. [translator] 24  Chapter 8: HEALTHCARE PRACTITIONER’“ DUTIE“ TOWARD“ PROFESSIONAL COLLEAGUES 9. If the healthcare practitioner comes to know that the condition of one of his/her colleagues would affect the safety of any medical procedure, or thinks that this condition would most probably inflict harm to the patient; then he/she should report it to the responsible authority to investigate the situation and take appropriate action. 10. If a healthcare practitioner, especially doctors, is called to see a patient treated by another colleague, he/she should abide by the following rules: a. If the call is from the treating practitioner, he/she should respond the consultation request, even if he/she doesn t see any justification for it. b. Be cautious about any word or gesture that could be interpreted as devaluing to the colleague s position or as a sign of underestimating the effort made (by the treating doctor) in front of the patient. This is particularly more important when the healthcare practitioner has a different point of view from that of the treating practitioner. c. Reassure the patient and minimize his/her worries, and use wisdom in determining what he/she should let the patient know and what should be told by the treating practitioner. d. If the consultation is done by the patient or his/her family, the healthcare practitioner consulted should make sure that the treating healthcare practitioner knows about this consultation before accepting the invitation and it is not acceptable to have access to the patient s (medical) file without the permission of the treating healthcare practitioner. e. If the patient is willing to transfer to another healthcare practitioner, it is the duty of the healthcare practitioner to inform the treating healthcare practitioner about that. f. The treating healthcare practitioner can, when needed, consult another colleague in the same speciality or another, after considering the visions and recommendations of the first consulted healthcare practitioner. 11. It is preferable not to take fees for the examination or medical consultations of colleagues or their families unless paid by third party. 12. A doctor should respect his/her non-doctor colleagues, and appreciate their role in the treatment of the patient and taking care of him/her. The doctor should establish rapport with them on mutual respect and constructive cooperation to serve the patient s interests, and do his/her best to teach and direct them to make sure they are committed to the principles of professional ethics. 25