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Paper presented at the 5th International Muslim Students’ Camp held under the theme ‘recuperating Muslim Strength: Success Beyond the Horizon’ at the International Islamic University Malaysia Gombak Campus 12-16 January 2005 by Professor Dr Omar Hasan Kasule, Sr. Deputy Dean Kulliyah of Medicine UIA Kuantan MALAYSIA
1.0 INTRODUCTION
Professional and unethical conduct is increasing in modern medical practice. This is not surprising because medical practice has changed from being a compassionate service to being a source of material gain. The ethical behavior of medical practitioners has been adversely influenced by the creeping secularization of society and marginalization of moral values. Islamic Law provides adequate measures to prevent and treat professional misconduct.
2.0 ABUSE OF PROFESSIONAL PRIVILEDGES
Research: Physicians who get paid to carry out research on patients that does not follow ethical guidelines are abusing their professional priviledges
Treatment: Unnecessary treatment for the sake of billing patients is unethical. The physician may be liable for causing iatrogenic infection by not following proper asceptic techniques. The physician may also be liable for allowing or abetting an un-licensed person in performing medical tasks.
Prescriptions: It is illegal to manufacture, possess, or supply a controlled drug unless you have a license for that class of drug. Prescription of controlled drugs must follow certain procedures. Diverting or giving away controlled substances is illegal. Control of hazardous substances/waste is a personal responsibility of the physician. Physicians must exercise care in dispensing controlled or harmful drugs. Sale of poisons is forbidden. It is forbidden to write prescriptions using secret formulas that only some pharmacists know is unethical
False documentation or certification: False or inaccurate documentation is a breach of the Law. Issuing a false medical certificate of illness is professional misconduct. The certificate should state only facts known personally by the physician and should not include any hearsay. A death certificate should be issued without delay and should be as accurate as possible. Wrong certification of death is a serious violation. Forensic examination must be objective and thorough because it could be the basis for convicting an innocent person. False injury reports may be issued by unethical physicians in cases of workmen compensation.
Crimes against the person: Court action could be brought against a physician for the following crimes: homicide: murder: voluntary manslaughter, involuntary manslaughter; Infanticide; Euthanasia: active mercy killing, passive euthanasia; Battery conviction for forced feeding; Criminal liability for patient death; induced non-therapeutic abortion; Iatrogenic death; Abusive therapy involving torture; intimate therapy: rape and child molestation; and sexual advances to patients or sexual involvement.
Breach of confidence: The physician-patient relation requires that the physician keeps all information about he patient confidential. Breach of confidentiality can be done only in the following situations: court order, statutory duty to report notifiable diseases, statutory duty to report drug use, abortions, births, deaths, accidents at work, disclosure to relatives in the interest of the patient, disclosure in the public interest, sharing information with other health professionals, disclosure for purposes of teaching and research, disclosure for purposes of health management.
3.0 UNETHICAL BUSINESS PRACTICES
Medicine was traditionally a social service provided voluntarily. Patients in appreciation of the services gave gifts to physicians. Later the fee-for-service mode of health care delivery developed and was not a major departure from the voluntary social service mode. The physician spent time and used equipment and supplies for which he had to be compensated. With the commercialization of medicine in the form of private for profit hospitals and health insurance, serious business ethical issues have arisen in medicine. Patients became clients, customers, consumers, or purchasers. Physicians became providers. The concept of beneficence of the medical profession became replaced by business self-interest. The medical profession started looking at itself as a business. Market mechanisms were allowed to set medical priorities. Concern about rising medical expenses led to using business management methods in hospitals which involved dictating the type and amount of care that physicians could provide. The regulations of third party payers make it difficult for the patient to exercise choice. Issues of social justice have also arisen. Is health a right of a citizen or health care is for those who can afford it?
In this climate of commercialization bad business practice have developed in medicine such as financial fraud, criminal breach of trust, charging interest, riba, on bills and fee splitting. Promise of miracle cures is another device used to cheat poor patients.
The following instances of financial fraud occur commonly. Pharmacy fraud is committed by billing for medicine not delivered. Billing fraud is billing for services not performed or billing for non-existent patients. Equipment fraud is using equipment that is really not needed or using equipment of poorer quality. It is also illegal and unethical for a physician to get financial advantage from prescriptions to be filled by pharmacies owned by the physician. Kick-backs are unethical and illegal.
Islamic Law provides many guidelines on good business practices. The Prophet said that immoral earnings were not blessed, la barakat fi al kasab ghayr al taib[1]. He also condemned unfair competition by selling over another brother’s sale, bayi’u ‘ala bay’i al ghayr[2]. He forbade selling prohibited things, bayi’u ma nuhia[3]. He condemned cheating, al ghish[4]., and bribery[5]. The Prophet taught that the physician should be compensated, ajr al tabiib[6] but in general he refused to fix prices[7] leaving that to market forces. It is however unfortunate that modern medical care is overpriced beyond the reach of many citizens.