Factors associated with Saudi physicians' utilization of clinical ethics consultation services.

Clinical Ethics Consultation (CEC) aims to resolve ethical dilemmas at the bedside. Through a structured process, CEC allows practitioners and patients to consult ethicists at times of moral conflict or uncertainty. Over the past few decades, CEC has become an invaluable part of healthcare practice. In Saudi Arabia, however, CEC services remain inexplicably underutilized. This study attempts to understand the factors associated with Saudi physicians' utilization of CEC to better meet the needs of practitioners and patients. Results indicate that although physicians routinely experience moral dilemmas, they seldom request a CEC. This is not due to unfamiliarity, lack of accessibility, or suspicion of ethical expertise. Rather, reluctance is likely due to an ingrained medical cultural stronghold that pressures practitioners to act heroically, and to resolve ethical dilemmas independently. Recommendations to improve the utilization of CEC services include wider availability, active collaborations with clinical practitioners, routine quality improvements, and managerial and national support.

Enhancing Expert Panel Discussions in Pediatric Palliative Care: Innovative Scenario Development and Summarization With ChatGPT-4.

This study presents a novel approach to enhance expert panel discussions in a medical conference through the use of ChatGPT-4 (Generative Pre-trained Transformer version 4), a recently launched powerful artificial intelligence (AI) language model. We report on ChatGPT-4's ability to optimize and summarize the medical conference panel recommendations of the first Pan-Arab Pediatric Palliative Critical Care Hybrid Conference, held in Riyadh, Saudi Arabia. ChatGPT-4 was incorporated into the discussions in two sequential phases: first, scenarios were optimized by the AI model to stimulate in-depth conversations; second, the model identified, summarized, and contrasted key themes from the panel and audience discussions. The results suggest that ChatGPT-4 effectively facilitated complex do-not-resuscitate (DNR) conflict resolution by summarizing key themes such as effective communication, collaboration, patient and family-centered care, trust, and ethical considerations. The inclusion of ChatGPT-4 in pediatric palliative care panel discussions demonstrated potential benefits for enhancing critical thinking among medical professionals. Further research is warranted to validate and broaden these insights across various settings and cultures.

Motherhood, Fairness, and Flourishing: Widening Reproductive Choices in Saudi Arabia.

In a landmark Fatwa, Saudi Arabia's highest religious authority-The Council of Senior Scholars-declared the Islamic permissibility of oocyte cryopreservation. The fatwa sanctioned the retrieval, preservation, and future use of oocytes, ovarian tissue, and whole ovaries from cancer patients receiving gonadotoxic interventions. Although momentous, the fatwa's specification of cancer patients effectively rendered this technology unavailable to others to whom it may be similarly beneficial, including patients with other medical conditions or patients seeking elective cryopreservation. This article argues in favor of widening reproductive choices through expanded access to oocyte cryopreservation in Saudi Arabia-regardless of the underlying cause of infertility-on three grounds: the technology's compliance with Islamic law, as a matter of fairness in medical practice, and as a means to support the well-being and flourishing of Saudi women within the context of a national societal and economic transformation strategy closely linked to their success.

Ethical uncertainty and COVID-19: exploring the lived experiences of senior physicians at a major medical centre.

Given the wide-reaching and detrimental impact of COVID-19, its strain on healthcare resources, and the urgent need for-sometimes forced-public health interventions, thorough examination of the ethical issues brought to light by the pandemic is especially warranted. This paper aims to identify some of the complex moral dilemmas faced by senior physicians at a major medical centre in Saudi Arabia, in an effort to gain a better understanding of how they navigated ethical uncertainty during a time of crisis. This qualitative study uses a semistructured interview approach and reports the findings of 16 interviews. The study finds that participants were motivated by a profession-based moral obligation to provide care during the toughest and most uncertain times of the pandemic. Although participants described significant moral dilemmas during their practice, very few identified challenges as ethical in nature, and in turn, none sought formal ethics support. Rather, participants took on the burden of resolving ethical challenges themselves-whenever possible-rationalising oft fraught decisions by likening their experiences to wartime action or by minimising attention to the moral. In capturing these accounts, this paper ultimately contemplates what moral lessons can, and must be, learnt from this experience.

Healing Body and Soul: Islamic Morality, Practitioner Obligations and Extramarital Pregnancy.

Extramarital pregnancy is a scarcely explored socio-ethical topic in Muslim countries. Extramarital sexual intercourse is legally prohibited and deemed shameful by conservative Muslim societies. The legal and social implications of an extramarital pregnancy prevent access to care and lead to concealment and/or infant abandonment. This paper argues that the medical community must not become complicit in the criminalization and stigmatization of unmarried pregnant women, but must become a safe and reliable refuge instead. The paper also finds strong Islamic moral commitments that warrant the provision of confidential, non-judgmental care, and encourage compassion and forgiveness over reprimand and punishment.

Phenomenology, Saudi Arabia, and an argument for the standardization of clinical ethics consultation.

BACKGROUND: The purpose of this study is to make a philosophical argument against the phenomenological critique of standardization in clinical ethics. We used the context of clinical ethics in Saudi Arabia to demonstrate the importance of credentialing clinical ethicists. METHODS: Philosophical methods of argumentation and conceptual analysis were used. RESULTS: We found the phenomenological critique of standardization to be flawed because it relies on a series of false dichotomies. CONCLUSIONS: We concluded that the phenomenological framing of the credentialing debate relies upon two extreme views to be navigated between, not chosen among, in the credentialing of clinical ethicists.

What it means to be a woman in the field of biomedical informatics: exploring the lived experiences of women managers in the kingdom of Saudi Arabia.

OBJECTIVE: Although women in the field of biomedical informatics (BMI) are part of a golden era, little is known about their lived experiences as informaticians. Guided by feminist standpoint theory, this study aims to understand the impact of social change in the Kingdom of Saudi Arabia- in the form of new policies supporting women and health technological advancements-in the field of BMI and its women informaticians. MATERIALS AND METHODS: We conducted semistructured telephone interviews with 7 women managers in the field of BMI, identified through LinkedIn. We analyzed interview transcripts to generate themes about their lived experiences, how they perceived health information technology tools, identified challenges that may hinder the advancement of the field, and explored the future of BMI from their perspectives. During our analysis, we utilized a feminist theoretical approach. RESULTS: Women managers in the field of BMI shared similar experiences and perspectives. Our analysis generated 10 themes: (1) career beginning, (2) opportunities given, (3) career achievements, (4) gender-based experiences, (5) meaning of BMI, (6) meaning of health information technology tools, (7) challenges, (8) overcoming challenges, (9) future and hopes, and (10) meaning of "2030 Saudi vision." Early in their careers, participants experienced limited opportunities and misperceptions in understanding what the field of informatics represents. Participants did not feel that gender was an issue, despite what feminist theory would have predicted. CONCLUSIONS: Recognizing the lived experiences of women in the field of BMI contributes to our collective understanding of how these experiences may enhance our knowledge of the field.

Her Uterus, Her Medical Decision? Dismantling Spousal Consent for Medically Indicated Hysterectomies in Saudi Arabia.

Against the background of a recommended hysterectomy, this article examines the current requirement in Saudi Arabia for the husband's consent for any medical procedure that affects the reproductive ability of his wife. The history and background of this decree is explained, along with the major arguments for its support. Additionally, the legitimacy of the requirement is discussed from the Islamic and legal perspectives. Special attention is given to relevant cultural considerations, such as the family unit, the medical community, and the larger Saudi society. Arguments advocating for discontinuing the requirement are offered along with measures to implement in order to overcome this social artifact.

From Paternalistic to Patronizing: How Cultural Competence Can Be Ethically Problematic.

Cultural competence literature and training aim to equip healthcare workers to better understand patients of different cultures and value systems, in an effort to ensure effective and equitable healthcare services for diverse patient populations. However, without nuanced awareness and contextual knowledge, the values embedded within cultural competence practice may cripple rather than empower the very people they mean to respect. A narrow cultural view can lessen cultural understanding rather than grow it. In its first part, this paper argues that a hasty, unrestrained, and uneducated willingness to accept something as a cultural good, despite being well intentioned, can still cause significant harms-particularly when based on false, misinformed, and stereotypical conceptions-including the minimization of issues, the reinforcement of stereotypes, and the impediment of cultural change. The second part of this paper examines medical autonomy within the context of Saudi Arabian women. It pushes back on the common perception that Saudi women, by virtue of culture and religion, view dependency on and deference to male relatives as a cultural good. Through a historical examination and a presentation of the current women's movement in Saudi Arabia, it is argued that the continued assumption that personal agency is a value external to Saudi women is false, misguided, and ethically problematic. Lastly, this paper considers some approaches to help providers navigate the narrow grounds between paternalism and patronization when caring for patients.

Reexamining the Prohibition of Gestational Surrogacy in Sunni Islam.

Advances in reproductive medicine have provided new, and much needed, hope for millions of people struggling with infertility. Gestational surrogacy is one such development that has been gaining popularity with infertile couples, especially those unable to benefit from other reproductive procedures such as In Vitro Fertilization. For many Muslim couples, however, surrogacy remains a nonviable option. Islamic scholars have deemed the procedure incompatible with Islam and have prohibited its use. This paper examines the arguments presented for proscribing surrogacy arrangements in Sunni Islam in particular. These include preservation of lineage, exclusion of third parties in reproduction, upholding the rights of the child, and protection from the negative effects of surrogacy arrangements. The rationales for banning surrogacy are subsequently refuted utilizing Islamic law "Sharia", bioethics, and medical evidence. The paper also presents reasons for why surrogacy is not only consistent with Sunni Islamic teachings, but is also both ethically justified and medically necessary. Lastly, Islamic scholars are urged to take into account the arguments presented in this paper and reconsider their rulings on the permissibility of surrogacy.

The Role of Physicians in State-Sponsored Corporal Punishment.

The question of whether there is justification for physicians to participate in state-sanctioned corporal punishment has prompted long and heated debates around the world. Several recent and high-profile sentences requiring physician assistance have brought the conversation to Saudi Arabia. Whether a physician is asked to participate actively or to assess prisoners' ability to withstand this form of punishment, can there be an ethical justification for medical training and skills being put toward these purposes? The aim of this article is to examine aspects of Islamic law along with the different professional and religious obligations of Saudi Arabian physicians, and how these elements may inform the debate.

Commentary: Cultural Issues in Decisionmaking.

This case presents several fundamental ethical issues. The first issue is the patient's refusal of treatment (a nasogastric tube [NGT] insertion). Second, the patient's refusal of a seemingly beneficial treatment, combined with her medical history, ultimately necessitates an assessment of her decisionmaking capacity. Third, the sister's reluctance to participate in decisionmaking requires a discussion of appropriate surrogate decisionmakers. Finally, the main ethical component to this case is a cultural one, which should be addressed appropriately.