The perceived role of Islam in immigrant Muslim medical practice within the USA: an exploratory qualitative study.

BACKGROUND: Islam and Muslims are underrepresented in the medical literature and the influence of physician's cultural beliefs and religious values upon the clinical encounter has been understudied. OBJECTIVE: To elicit the perceived influence of Islam upon the practice patterns of immigrant Muslim physicians in the USA. DESIGN: Ten face-to-face, in-depth, semistructured interviews with Muslim physicians from various backgrounds and specialties trained outside the USA and practising within the the country. Data were analysed according to the conventions of qualitative research using a modified grounded-theory approach. RESULTS: There were a variety of views on the role of Islam in medical practice. Several themes emerged from our interviews: (1) a trend to view Islam as enhancing virtuous professional behaviour; (2) the perception of Islam as influencing the scope of medical practice through setting boundaries on career choices, defining acceptable medical procedures and shaping social interactions with physician peers; (3) a perceived need for Islamic religious experts within Islamic medical ethical deliberation. LIMITATIONS: This is a pilot study intended to yield themes and hypotheses for further investigation and is not meant to fully characterise Muslim physicians at large. CONCLUSIONS: Immigrant Muslim physicians practising within the USA perceive Islam to play a variable role within their clinical practice, from influencing interpersonal relations and character development to affecting specialty choice and procedures performed. Areas of ethical challenges identified include catering to populations with lifestyles at odds with Islamic teachings, end-of-life care and maintaining a faith identity within the culture of medicine. Further study of the interplay between Islam and Muslim medical practice and the manner and degree to which Islamic values and law inform ethical decision-making is needed.

Use of restraints in ambulances: a state survey.

PURPOSE: To determine the requirements in all states and the District of Columbia for use of restraints on patients in ambulances. MATERIALS AND METHODS: A structured telephone survey was conducted with all state Emergency Medical Services (EMS) agencies or the agency responsible for the regulation of ambulances. Questions were asked regarding restraint of patients in ambulances. The age definition of a pediatric patient was also queried. RESULTS: Ambulances are regulated in 47% of states by EMS, 14% by law enforcement, 3% by a public safety agency, and in some states by other agencies such as the Department of Motor Vehicles. In 27% of the states no agency is responsible for ambulance regulations. Most states do not require patients of any age to be restrained in ambulances; however, the drivers and passengers are required to wear seat belts. Most of the states with laws regulating ambulance restraints for infants and children were in the northeast. There is great variance in the age that defines a pediatric patient for EMS. CONCLUSION: A means of safely restraining infants and children in ambulances is needed. Until new restraints are available, ambulances should restrain infants and children in car seats and on gurneys. A national age standard for defining a pediatric patient using EMS is needed.

Safety knowledge and risk behaviour of injured and uninjured young skiers and snowboarders.

BACKGROUND: Earlier studies of ski injury indicated that youths were at increased risk of injury, that males were most likely to injure the head or face, and that females were most likely to injure the knee. OBJECTIVE: To obtain information about safety knowledge and risk behaviour that might contribute to injury among young skiers and snow-boarders. DESIGN: Survey of knowledge and behaviour in injured and noninjured cohorts. SETTING: Blackcomb Mountain, Whistler, British Columbia. PARTICIPANTS: A total of 863 noninjured and 118 injured skiers and snowboarders aged five to 17 years using Blackcomb during 1993/94. INTERVENTION: Skier Knowledge Inventory Questionnaire. RESULTS: The injured cohort had less knowledge of the Skiers Responsibility Code. In both groups, almost half had had no lessons, 31% had had bindings adjusted by nonprofessionals and chair lift safety bars were used one ride in four by children age 13 to 17 years. The injuried cohort wore helmets slightly less often. Both groups regularly skied through the trees (60% to 70%), and one-thirds had skied on closed runs. Excessive speed was identified as the major cause of injury. Skiers did not recognize jumping as contributing to injury. CONCLUSIONS: Lack of knowledge of safety rules was more prevalent among the injured cohort. Skiing without due care - including skiing through tress, skiing on closed runs, skiing with excessive speed and jumping, particularly by snowboarders - were identified as potential causes of injury.

Physician-directed injury prevention for young skiers and snowboarders.

Based on earlier studies of ski injury, which indicated that youths were at increased risk of injury, that males were most likely to injure the head or face and that females were most likely to injure the knee, a study to identify factors relevant for physicians to use in injury prevention initiatives was undertaken. The authors then conducted a search for effective injury prevention strategies using MEDLINE. The results of both undertakings were the basis for proposed guidelines for prevention strategies that physicians can use when counselling skiers and snowboarders.

Treatment of post-operative pain.

The effectiveness of three treatments for alveolar osteitis was compared. It was found that chlorhexidine gluconate mouthwash treatment and 2.5 percent Lidocaine ointment treatment reduced the number of days a patient was symptomatic compared to the conventional eugenol-impregnated iodoform gauze treatment. With the conventional use of eugenol-impregnated iodoform gauze, the severity of the patient's symptoms were reduced more effectively than with the other two treatments, but the symptoms lasted longer.

Let's get rational about suicide.

Recent events have focused national attention on the appropriate role for physicians in relieving the suffering of the terminally ill. Is suicide ever rational? Should physicians participate? An attorney-nurse turned ethicist examines well-known cases and helps frame the debate.

Treatment refusal, noncompliance, and substance abuse in pregnancy: legal and ethical issues.

Prenatal caregivers often note that the behavior of pregnant patients creates the risk of fetal harm. Three such cases are reviewed, together with care providers' responses and relevant law. Pregnant womens' rights to disregard medical advice are increasingly being overridden in courtrooms and bedside hearings. To preserve the patient-provider relationship, and to avoid coercive actions that may have little legal basis, emphasis should be on helping the woman act in her own best interest and that of her fetus, rather than on the law or the courts as a means of directly or indirectly controlling her behavior.

Starting and stopping the ventilator for patients with amyotrophic lateral sclerosis.

Only a minority of patients who have ALS require, request, and receive assisted or supported ventilation. Usually, when a mechanical ventilator is needed, nonsurgical methods can be used for prolonged periods of time. Appropriately timed discussions can reduce the need for emergency management of breathing failure. The doctrine of informed consent applies to decisions about life support. It involves both the physician (to exercise clinical judgment on behalf of the patient) and the patient (to make personal decisions). They must interact. The patient's firm decision must be clear but need not be in the form of a "living will," and it does not need to be sought repeatedly or reiterated endlessly. Just as a considered decision cannot be arbitrarily overthrown in a time of crisis, neither can a change of mind be willfully ignored. In practice, this may test the capability of even the most experienced and understanding physician, and may result in less-than-ideal outcomes, as our examples show. As in any other area of medical practice, personal experience teaches valuable lessons. Unfortunately, even extended publications discussing clinical management of ALS have failed to address the subject of discontinuing ventilatory support, and ethicists have not always been helpful. Bernat and Beresford have, however, successfully summarized the ethical issues involved. Failure to sustain breathing mechanically or withdrawing artificial support of breathing from a requesting patient who, in the terminal stage of ALS, has become unable to breathe without a mechanical ventilator cannot be called assisted suicide, mercy killing, or either passive or active euthanasia. It is allowing a competent person to die naturally of the incurable illness that afflicts him. The state has no legal interests to be served by intervening in the process just described, which bears no relationship to issues of malpractice, much less to criminal negligence or homicide. Neurologists have not uniformly understood these points, as demonstrated by previous publications addressing the issue and by the findings of our own survey of neurologists who have special experience in the area of neuromuscular diseases. In regard both to starting and to stopping the ventilator, we believe strongly that it is time to lay aside the moral, legal, and ethical conflicts that have needlessly delayed or prevented physicians from complying with the resolute decisions that competent patients have made about their own lives. We urge doctors to act in these cases, as in all others, with their best medical judgment.(ABSTRACT TRUNCATED AT 400 WORDS)