Ms. Carbunari began her presentation by explaining that the three-day conference on Ethics in Medical Care brought together Christians, Muslims, and Buddhists from around the world, including countries such as Korea, South Africa, Saudi Arabia, Pakistan, and the UAE. The conference examined where ethics, medicine, healthcare, and religion intersect, and discussed how religion illuminates ethical issues.

Organ transplantation was a significant issue at the conference and provides a good example of the way an ethical dilemma is studied and a decision made in the Muslim tradition. When such an ethical question is raised, Muslim clerics review all of the religious teachings that have been written up to the current period in order to issue a fatwa or a legal opinion regarding Muslim teachings. (Note that the term fatwa is often misunderstood in the West to be synonymous with a death sentence, as in the case of Salman Rushdie, but refers to a wide variety of decisions rendered in the following manner.) The clerics examine the shari'ahs - canonical laws derived from the sacred teachings of the Qur'an and the histories and teachings of the Prophet Muhammad, related fatwas, papers and books. Once all of this is studied, if the clerics are unanimous in their decision, a fatwa is established. In the case of organ transplantation, after reviewing the religious teachings, the clerics learned that the procedure was not a new concept, and was first mentioned as early as the fifth century A.C.E. regarding the use of bones of dead people in the setting of the bones of the living. They declared such medical procedures permissible.

Ms. Carbunari responded to questions from the presentation participants. One questioner noted that in the Buddhist tradition, one generally does not speak truthfully about a terminal diagnosis with a patient. This is a frustrating problem for physicians in the Muslim tradition, as well, as many have received training in the West which encourages full disclosure to patients. In some countries in the Middle East, receiving a poor prognosis in one region may lead to "opinion shopping," with the patient going to a different region hoping to hear reassuring news, i.e., a provider who will provide less information. Also frustrating is when the family of a patient tells the physician not to tell the patient what is wrong. The physician is in a difficult position because he or she will have to discuss the situation with the patient while the family is present. However, there is nothing in Islam that determines a single correct way to deal with this issue.

The Buddhist chaplain noted that in the Buddhist tradition, family members of a patient are often opposed to withdrawing care because the heart is still beating, and wondered if there was a similar feeling among Muslims. She responded that faithful Muslims generally don't want to make such a decision, preferring not to interfere in God's work, and will instead leave it up to the physician to decide what to do. When a patient is dying, final rituals may be delivered by an imam, but more commonly, family members will sit with the dying patient reading pas-sages from the Qur'an to facilitate pas-sage to heaven.

Once a patient has died, in the Muslim tradition, the body should be treated and prepared by sundown. If a woman dies, a female attendant will usually perform the preparations of the body. The person is buried in a white cloth within twenty-four hours. Typically, the sanctity of the body is respected, though recently more Muslims have requested autopsies, wanting to know the cause of their family member's death.

A participant asked about a situation in which the grandmother of a young Muslim child who died stayed in the morgue with the child's body. Ms. Carbunari explained that, although there is nothing written in the law requiring it, family members often want to stay as close as possible to the body.

Ms. Carbunari explained that Muslims feel God must have a good reason for the person's death, and although they don't feel any less sad at the death of a loved one than anyone else, they aren't generally troubled by existential questions such as "why me?"

A participant asked about Muslim beliefs about abortion. Because Muslims believe in the preservation of life, and children are considered a gift from God, abortion is a very uncomfortable topic in the Muslim tradition. It is not a common practice.

Because Western medicine has been influencing health care practice in the Middle East for some time now, pregnant and post-partum care for women in the Middle East is very similar to the care women receive in the U.S. Ms. Carbunari explained that before modern medicine, the custom among Muslims was for the woman to remain in bed for 40 days and for relatives to manage the household. In the 1960s, this was cut back to 7 days of bed rest, and now there is little difference between the Middle East and the West in resuming normal activities.

When a Muslim/Middle Eastern woman is giving birth, it is not unusual to have large numbers of people from the extended family at the hospital waiting for the baby's birth. Also, there are plenty of family members eager to help out with the new baby, as well as any older children, while the mother recuperates. This is especially true when the baby is a boy.

Family involvement extends to situations in which a child might need long-term, extended care. Muslims believe everything that happens to them in life is God's will. Bad things that happen to them are their burden to endure, and they will do whatever they must, understanding they will be rewarded in heaven. Ms. Carbunari noted that in the Middle East traffic laws are rarely enforced, leading to a high rate of automobile accidents and a significant population of paraplegic children. It is expected that someone in the family will take care of these children. As a result of such family involvement, there are very few rehabilitation facilities in the Middle East. People are only sent to rehab in extreme situations in which the family is incapable of caring for the children.

One question involved cultural sensitivity of health care providers of a different gender than the patient. Ms. Carbunari explained that a male provider should only touch a female patient if clinically necessary. Putting an arm around a traditional Middle East-ern person or other similar physical gestures do not provide comfort to the patient, but rather makes them feel uncomfortable. However, different countries of origin and levels of acculturation may dictate different behavior. If a person has been in America for a long time, they may respond positively to such gestures, and Egyptians, for example, tend to be more open to western traditions that Saudi Arabians.

Discomfort for female patients may also be an issue in the operating room. However, a woman coming to the U.S. from the Middle East realizes there are many male physicians, and expects that she may have to be exposed in ways that are uncomfortable for her. In the Middle East, more and more male doctors are caring for female patients, and vice versa, so the issue is diminishing somewhat. However, if a female patient indicates a preference for a particular way of treatment, Ms. Carbunari recommends clarifying with the patient exactly what she wants. She cites an example in which a patient requested a female perform the surgical prep prior to surgery, and the providers misunderstood her exact request and assumed she wanted female surgeons, anesthesiologists, etc., which caused unnecessary problems.

Ms. Carbunari closed by saying that people of all religions and ethnicities struggle and debate the same healthcare issues and dilemmas.

12/2002