Bangladesh Journal of Bioethics

Religious, Cultural and Legal Barriers to Organ Donation: The Case of Bangladesh

Md Shaikh Farid, Tahrima Binta Naim Mou — Sun, 07 Feb 2021 00:00:00 +0000

There is a substantial shortage of organs available for transplantation in Bangladesh. This has resulted in the commodification of organs. This study analyzes the religious, cultural, and legal barriers to organ donation in Bangladesh. It is based on the examination of available literature and primary sources i.e. religious decrees and opinions of religious leaders of faith traditions, and the Bangladesh Organ Donation Act, 1999. The literature was retrieved from databases, such as PubMed, BioMed, and Google Scholar using the key words: organ donation in Islam, organ donation in Bangladesh, organ donation and religions. The study found that although many Islamic scholars accept organ donation, both living and cadaveric, under some conditions, some Bangladeshi Muslim clerics oppose donation. They argue that organ retrieval violates the sanctity of the human body and retrieval of organs may harm a living donor or lead to death, and organ donation may encourage the commercialization of body parts. Both commercialization and harming oneself are considered sins. Thus, the divergent views of Muslim clerics are a major barrier to organ donation among the Bangladeshi Muslims. Cultural and social factors also have a negative impact. Most people desire to be buried with their bodies intact. Although the Bangladesh government promulgated the Bangladesh Organ Donation Act, 1999, and amended it in 2018, it restricted donors and recipients to members of the extended family, which also reduced the donor pool. This study argues that the Muslim Orthodox clerics’ stand against organ donation and other cultural and legal issues are the major obstacles to organ donation in Bangladesh.

The Case of Doctor-Patient Relationship in Bangladesh: An Application of Relational Model of Autonomy

Tanvir Ahmed — Sun, 07 Feb 2021 00:00:00 +0000

The objective of this article is to establish an alternative doctor-patient relationship model and describe its importance in the case of the doctor-patient relationship in Bangladesh. There is a lot of diversity in the religious beliefs, social norms and values in Bangladesh. Likewise, the development of biological science as well as medical technology, the allocation of healthcare resources must be considered as an important issue. That is why the autonomy of both doctor and patient is a relational factor here. Besides, the four traditional doctor-patient relationship models offered by Ezekiel J. Emanuel and Linda L. Emanuel are not beyond criticism. So, we need an ideal doctor-patient relationship model for Bangladesh to protect every patient’s autonomy which will give freedom to the patient in choosing their own treatment as well as which will not conflict with the patient’s social or cultural values. In this article, I have selected the relational model of autonomy as the method of alternative doctor-patient relationship model. Hopefully, this alternative model will work better since it considers care first concerning a patient’s autonomy. Besides, doctors would treat their patients as a ‘care seeker’ rather than ‘client’ or ‘customer’, and simultaneously, patients would perceive their physicians as ‘caregivers’. But, applying the relational model of autonomy in the case of doctor-patient relationship is more challenging in Bangladesh due to some obstacles like large numbers of population, illiteracy, insufficiency of skilled doctors and hospitals, corruption in medical sectors, social prejudices and so on. But, if we can overcome these problems, the relational model of autonomy will be considered as a suitable doctor-patient relationship model in Bangladesh.

Understanding of Authorship by the Post Graduate Medical Students at a Center in Bangladesh

Wed, 10 Feb 2021 00:00:00 +0000

Education on authorship was delivered and evaluated by pre test and post test questionnairen on 30 post graduate medical students at the Department of Anestheology, Dhaka Medical College, Bangladesh between January and June 2019 to understand the knowledge, skill and attitude of post graduate medical students on authorship. Result: Before intervention, majority (60%) of the students felt that who perform the research work should be the author of the article. But 40% students were divided and felt that who advised the design of the research (20%), who provided the grants (10%) and Chief/Head of the division (10%) should be the author of the article respectively. Maximum (70%) respondents did not know the order of authorship. Of 40% respondent felt that the PI should be always the first author and 40% don’t know the answer. Half of the students (50%) felt that keeping honorary author increased the opportunity of acceptance of publication. Of 36.7% and 13.3% of students felt that keeping honorary author increased the article’s value and made good relation to them to get some extra facility from them respectively. Of 20% participants were pressurized by lab head/head of department for inclusion of their name as an author. Half of the (56.7 %) respondents felt that the author’s contribution should be stated in the article. Only few 4 (13.3%) respondents said that their institute had guideline for authorship. However, after education 100% of students felt that who perform the research work should be only the author of the article. All (100%) respondents understood the order of authorship. Most of the students (86%) felt that PI should be always the first author. Of 100% respondent felt supervisor of the research should be the last author. All students (100%) felt author’s contribution should be mentioned in the article. All (100%) students did not want to include as author those who help in research design and secured grant; and they did not like to keep honorary author in their article. All (100%) students expressed that their institute had no guideline for authorship. After intervention, three groups of students were asked to write one page of article on Anesthesiology. Interestingly, they did not include any name in the author by line who were not participate or had any contribution in the writing. Conclusion: The comparative data between pre- and post-text have highlighted a general lack of understanding of the basic concept of authorship ethics which significantly improved after the intervention. The results also indicate that the education on authorship improved the awareness of postgraduate medical students in a particular centre.

Ethical issues in biomedical research in Nigeria: a systematic review

Chinaza Richard Ikeagwulonu, Chigozie Jesse Uneke, Obeta Mark Uchejeso — Sun, 07 Feb 2021 00:00:00 +0000

The use of human subjects in research comes with lots of ethical challenges. The purpose of this review is to assess the various ethical issues that have been associated with biomedical research in Nigeria. This article also finds out the possible ways of improvement of this scenario. Pubmed/Medline, Google Scholar, JSTOR, and AJOL search were the possible search engine for literature from 2000 to 2020. Key words were used including, ethical issues, biomedical research and Nigeria. Of the 113 publications were found., A total of 18(15.9%) articles fulfilled the study inclusion criteria and were included in this review. Twelve ethical issues were highlighted including Informed consent (12 studies), autonomy and voluntariness (8 studies), beneficence (8 studies), counseling (5 studies), compensation (4 studies), professional behavior and attitudes (2 studies), confidentiality (2 studies), social, cultural and religious practices (2 studies), scientific integrity (1 study), communitarianism (1 study), equity (1 study), and trust (1 study). We found that there are ethical issues in biomedical research in Nigeria of which informed consent is most widely studied. Also, participants had varying degree of understanding of their rights as research subjects. As a result, there is need to enhance the capacity of investigators to better understand these issues and also increase their explanatory skill to help participants achieve complete understanding of their various rights and process.

Editorial

Rhyddhi Chakraborty — Sun, 07 Feb 2021 00:00:00 +0000

With its origin in the Hippocrates Oath (5^th-3^rd Century BC), The Nuremberg Codes (1947), and The Declaration of Helsinki (1964), medical ethics set the rules of the professional conducts for the physicians and other medical specialists. It amounts to the deployment of bioethical concepts, values (Autonomy, Non-maleficence, Beneficence, and Justice) and methods within medical set up to suggest the day-to-day decision-making procedures by combining theory and practice. It is a multidisciplinary study as it seeks to develop a set of guidelines for moral decision-making utilizing the resources of not only medicine and biology, but also of law, philosophy, theology, and the social sciences. As the branch of Bioethics, it investigates the complex ethical problems which arise for human life and society from sophisticated medical-technological usages and biological practices. The problems specifically include the nature and distribution of treatment and medical resources, the informed consent and authority of the patient, the physician and others involved in the medical practices, the scope and limits of confidentiality, the limits of acceptable intervention and experimentation, and the propriety of research involving humans and their applications. It also deals with the questions of moral dimensions and professional responsibilities involving all forms of ‘life-related’ issues such as research involving foetal tissues, withdrawal of life-sustaining medical treatment, issues over death, prenatal diagnosis and abortion, the storage of frozen embryos. Medical ethics is intricately linked to the culture and glocal values. To emphasise such aspect, the following papers come together to enrich this volume.

COVID-19 Pandemic: Ethical and Medical issues arising for people with disability in Bangladesh

Taslim Uddin, Hassan Tasdeed Mohammad, Naima Siddiquee — Sun, 07 Feb 2021 00:00:00 +0000

The disability viewpoint is the fundamental for understanding social justice in a given population. Disability rights need to be obeyed in the inclusive preparedness and response to all the disasters or during the crisis period including COVID-19 pandemic. COVID-19 pandemic jeopardized the health and rehabilitation services globally. The impact is much more in low resource developing countries like Bangladesh. In general, people with disability (PWD) suffer from multiple medical and rehabilitation complications and they need frequent rehabilitation consultations or hospital admissions in comparison to people without disability. As a developing country, Bangladesh has poor ratios of doctors, nurses and technologists of 1:0.4:0.24 (WHO: 1:3:5) to face the COVID-19 challenge. Rehabilitation services have been disrupted in almost two-thirds (63%) of countries of the world. Even though rehabilitation is the key to recovery following severe illness from COVID-19. There are many concerns and debates about the preparedness, response and mitigation the process of COVID-19 on the part of the national government. According to recent study reports, the lives of about 100% of PWD have been impacted by the COVID-19 pandemic. COVID-19 National Technical Advisory Committee is working for strategic planning, response and mitigation process but omission of a representative of PWD or a rehabilitation physician in the committee has created much dissatisfaction. The difficult COVID-19 testing process due to country wide shutdown of rehabilitation essential services and central pulling of rehabilitation physicians have side lined the PWD inclusiveness. It is expected that the rehabilitation preparedness, response and mitigation of the pandemic should be based on an ethics driven process.

Why A New Ethical Framework Is Needed To Eliminate Disability Discrimination? A New Learning From The Pandemic

Gausul Azam Ranju, Tania Serice — Sun, 07 Feb 2021 00:00:00 +0000

Discrimination between disabled and non-disabled people is still an issue of fairness and justice. In this COVID-19 pandemic time, this issue highlighted in a significant way. In hospital, the disabled persons to face today issues while triage like whether they have the right to get the ventilator first when there is limited ventilation support or their vulnerability could be the cause for being neglect or they do not have to have a quality of life. There are lots of ethical dilemmas that we face today and these are not solvable overnight by the existing framework or policies. The existing paternalism, utilitarianism, or even ableism can not ensure making people living with disabilities (PLWD) rights equal. It is very clear that the professional expertise, policy or framework have so many loop holes that we are still struggling to take steps to effective and ethical decision making. This paper focuses the emergency of ethics based research, policy directions, and frameworks to eliminate those discriminations.