Statement of Islamic medical care principles regarding doctors and others providing medical care

Doctors should do their best to preserve and protect the life of the patient
(Hippocratic tradition).
The Intention should be always pro-life and all actions should reflect that.
Efforts should be made to return the patient to good health.
In accordance with the above three principles, the best, most appropriate medical
treatment should be given to patients along with the best nursing care.
Food and fluid is a basic need for all people and is the right of every patient. It
is not allowed to withdraw food and fluid at any time except when they may not be
absorbed by the body as might occur in the final stages of the dying process. Food
and fluid is a basic need not medical treatment.
No doctor should play God. It is not for a doctor to make a decision about the value
of a person’s life based on his or her quality of life.
Safe, effective pain killers may be used to alleviate suffering.
Children and adults with disabilities have Equal rights to life and ethical medical
treatment, like any other patient.
It is forbidden to take any step to hasten the death of the patient (active/passive
euthanasia and assisted suicide are forbidden in Islam)
Doctors should respect every patient as a human being, as well as his/her religious
wishes.
During the dying process, it may by right to withhold medical treatment but
palliative care, i.e. keeping the patient comfortable and pain free, may always be
given.

Regarding patients

To look for the appropriate safe effective treatment, because we are taught that for
every disease there is a cure.
GOD Almighty is the real HEALER, doctors and medicine are the necessary means for
getting the healing!
The Moment of death has been fixed only by the Creator (natural death).
Medical treatment allowed in Islam should be (Halal/permissible), except in
emergency when there is no substitute or replacement.
Patience and Tolerance of one’s illness and suffering are great Islamic virtues and
are highly rewarded by GOD. (Angels are surrounding the patient).
It is forbidden to hasten your own death or to take any suicidal step or to ask the
doctor or any one to end your life.
Living wills (death wills) are forbidden in Islam. However it is a duty on every
Muslim to write early and in advance the Will with regards to inheritance.
Prayers and spiritual support are to be encouraged as we believe they are effective
in reducing suffering and curing the illness.
Visiting the sick patient is highly recommended and is highly rewarded by GOD
Care from the patient’s family, social support, and hospice care are to be
encouraged all the times

Dr A.Majid Katme (MBBCh, DPM)

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Editorial October 2010

Editorial  October 2010

The Medical Ethics Alliance is over fourteen years old. Some would say it is still a troublesome teenager! We have not been shy of expressing an unashamedly Hippocratic position, supported in part by a number of World Faiths. Besides promoting and encouraging discussion within the medical profession, we have contributed to  public debates and actively participate in other alliances such as Care Not Killing which is opposing euthanasia and assisted suicide in the public square.

We are also regularly  consulted by professional bodies and our most recent contribution  to the GMC`s  committee on child protection,  is summarised  below, together with an earlier submission on the religious beliefs and values of doctors.

 Despite the rise of secularism of a particularly intolerant stripe, there is a growing interest in what faith and traditional medical ethics offers. The twenty first century is arguably a century of renewed interest in religious belief.

 We reproduce two important declarations of principle, the Declaration of Gdansk, from the Catholic medical associations of Europe and an important Islamic Declaration.

As ever, we invite comments and are pleased to learn that Ethics and Wisdom in Medicine is read world wide.

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Response to the GMC draft document “Personal Beliefs and Medical Practice”

Introduction

The Medical Ethics Alliance is a coalition of six World Faiths and Hippocratic medical and nursing bodies. It seeks to inform and initiate discussion within and without the  profession where ethical matters are involved. We have studied the draft which we find broadly helpful, but would wish to make a few general observations.

1        The medical profession is reflective of society as a whole and has many doctors of different religious and cultural backgrounds and doctors are in a close contact with vulnerable patients at important  times of their lives. In this we agree that they must fully respect the beliefs and values of all patients. We therefore  endorse the core guidance given in Good Medical Practice.

 

2        Many doctors draw inspiration from the from their own faith background and  values. These make them what they are and cannot be separated from their professional lives. In the multi national and multi faith profession that we enjoy today this represents a positive contribution to the welfare of patients. It is also likely to provide doctors with one of the motivations in their professional lives.

3        There is, furthermore, a strong residual Hippocratic tradition shared by doctors of all faiths and none, whether born here or coming into this country,  which we think the draft draws upon but does not directly acknowledge.  Nevertheless, that ethic has been weakened by legislation, most noticeably with regard to the status of unborn human life.

4        We have good reason to think that, not withstanding the conscience clause in the Abortion Act 1967,  those with a conscientious objection to abortion have difficulty in making a career in obstetrics and gyaenocology. This is particularly the case when seeking training posts. Difficulties are put in the way of applicants both by employing authorities and senior colleagues.

5        In your draft document at 21 this is dealt with but does not realistically address the position of junior doctors . In practise, we think many potentially good trainees are excluded. Given the wide nature of modern obstetrics and gynaecology, we think  there is scope for those with alternative interests such as oncology and urology who could make a considerable contribution and should not be involved in abortion. We would welcome a stronger statement from the GMC addressing this point.

6        Junior Doctors may find themselves unable to carry out certain treatment plans.This may arise in many different specialities from geriatrics to psychiatry. Furthermore, these dilemas may not be foreseeable when appointed. In these circumstances the only course of action open to the junior doctor is to inform the senior doctor managing the patient and withdraw from treatment. It then falls to the senior doctor to find another doctor. It would not be appropriate for the doctor who does not carry the ultimate responsibility for treatment to find another doctor. We are aware of difficulties created for anaesthetists, for example, who are asked to treat a woman undergoing an abortion in the middle of an otherwise routine list or where tube feeding is being withdrawn from a patient who is not dying.

7          Many patients approach their doctors with religious and cultural values that may not be familiar to many doctors. In this regard women doctors of similar cultural background may be sought by patients. This is a positive contribution to the welfare of patients, and whilst not wishing to segregate medical practice, a recognition of this in the draft would be helpful. For example women of Muslim background may wish to be treated by women gyaenocologists.

Conclusion

We  broadly welcome and support the core guidance. With regard to specific recommendations, we would like the GMC to address the problem of junior doctor training in obstetrics and gynaecology more realistically.

In general, we would welcome  more recognition that doctors from a variety of faith and cultural backgrounds may have a contribution to make to the care and comfort of patients in a multi cultural society.

Even though the GMC must make recommendations in the particular legal environment of our society, we would prefer to see some more explicit reference to the ethical code that has been traditionally characteristic of medicine and which is still strongly held by many members of the profession, whether born in this country or entering from abroad where such traditions are still strongly held.

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The Gdansk Declaration of the XI th Congress of the European Federation of Catholic Medical Associations

Gdansk, 14 September 2008

Conscious of the trust placed in us as physicians and defenders of life, of the progress in medical knowledge and technologies, and of the ever better understanding gained into the physical, psychological, educational, spiritual, religious and existential needs of our patients and our society,

  • while aware of the dangers of ethical relativism and of moral permissiveness around us and in our midst;
  • in view of ongoing debates over the permissibility of abortion, euthanasia, the use of human embryos for research and so-called therapeutic purposes, human cloning, the creation of human-animal hybrid embryos, contraceptive and sterilization procedures and artificial reproductive technologies;
  • faced with the silent assumption that those carrying out the above procedures will be doctors;

 

authorized by the Christian traditions and ethos of European and world medicine, in dialogue with all doctors who believe in the dignity and freedom of the human being,

  1. We affirm that ethical norms and principles precede enacted laws and should influence their contents in accordance with natural law and the teaching of the Church.
  2. We affirm that in making decision on the medical treatment of the patients who place in us so great a trust, we should be guided above all by our conscience.  Moral evaluation of medical practice must not be based upon superficial opinions or passing trends but on the sensitivity of a conscience formed according to objective ethical norms common to all people and  consistently defended by the Church.
  3. In order to guarantee the freedom of practice of the profession, we have to uphold the right to conscientious objection
  4. We believe that one of the basic demands made of doctors should be ongoing personal development in both practical know-how and in moral stature.
  5. The special vocation of the doctor to serve the life and health of others requires a clear formulation of  the principles of an objective and universal ethics.
  6. We affirm that the source and basis for all ethical norms is the inalienable dignity of the human person throughout the course of his or her life – from conception to natural death.
  7. Just as human dignity requires the protection of human life, it also demands special concern  for its initial phases and respect for human procreation and sexuality.
  8. We promote activities which permits the protection of patients from procedures that violate their human dignity:

●  Decisively rejecting euthanasia, we support the development of palliative medicine;

●  Refusing to agree to abortion, we aim to ensure proper all-round care for the family and the sick child both before and after birth;

●  We choose the treatment of the underlying causes of infertility and not successive techniques of artificial reproduction;

●  We support the development of research into the use of stem cells taken from adults and umbilical cord blood, rejecting the use of human embryos for this purpose.

  1. 9.     We affirm and emphasize that medical practice with respect to matters as genetic manipulation and the end of life has to be realized without intentional loss of human life.

10.We want to protect our children and young people from neglect, abuse and other threats to their health and dignity. We have to ensure proper education for all aspects of life.

11.Aware of the number of people in our midst who are subject to abject poverty or under threats caused by misfortune, we uphold the tradition of the freedom of physicians to offer humanitarian and charitable aid, especially in neglected areas of the world, on the basis of principles and criteria lying beyond economics.

12.Taking into account the responsibility doctors carry for the health and life of patients, we are convinced that medicine must be practiced in dignified conditions, which are due both to patients and to doctors,  and we consistently affirm that in our activities the good of patients should have priority over other obligations.

Signed by:

President of the XI Congress of the European Federation of Catholic Medical Associations, prof. Josef Marek (in substitution signed by dr Francois Blin);

 

President of the Catholic Association of Polish Doctors,

dr Anna Gręziak;

Secretary of the European Federation of Catholic Medical Associations,

dr Hans Stevens

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Doctors` roles and responsibilities in child protection

The Medical Ethics Alliance is a coalition of 6 medical and nursing  Hippocratic and World Faith bodies.

It is happy to respond to the GMC consultation. The author of this response is a consultant community paediatrician and former member of the magistracy with 12 years experience of the Criminal and Family Proceedings Courts. He has also consulted legal opinion, a general practitioner and medical and nursing colleagues with experience of protection of the elderly and mentally infirm.

 There are a number of  ethical considerations concerning  child protection such as natural   justice, the common good,  and issues of good medical practice and confidentiality.

Consent and confidentiality

Question 1

“What problems do you see in relation to consent and confidentially when doctors work with children and their families where there are child protection concerns? If possible please provide examples of good practice, or areas where problems commonly arise”

Problems can arise on presentation where injuries may suggest child abuse but other explanations have been offered by parents for the injuries which maybe lesions of the  skin, oral cavity, genital region or skeleton.  Until these have been assessed by a senior doctor  trained in the recognition of child abuse it would not usually be necessary to raise the question of abuse with those who have parental responsibility, but once a diagnosis of non accidental injury has been made, this should be shared with the person with parental responsibility and the procedure to be followed explained before notification of the statutory authorities.

For a general practitioner, urgent referral to an A&E department or consultant clinic will normally be required. Children presenting in A&E  with suspicions  injuries should be referred at once. to the on call paediatric team who in turn should involve a fully trained or senior doctor.

 Emergency admission to a place of safety should take place and if necessary an emergency  protection order will be required via the Family Proceedings Court.

 When putting in place procedures to safeguard children and vulnerable adults it is vital that the requirements of confidentiality do not take precedence over the need to protect their welfare

Particular difficulties  may arise in the case of suspected fabricated or induced illness. Detailed investigations would be normative and the diagnosis may only emerge over time. An example of good practise would be for the doctor with ultimate responsibility to share the tentative diagnosis with consultant colleagues to see if there is agreement on the diagnosis. It would also be good practice to seek the advice of colleagues in a tertiary centre.

The doctor may be well advised also to seek independent legal advice from a defence organisation as well as the NHS legal team. This is a particularly contentious diagnosis and may well lead to a serious complaint against the doctor.

The confidentiality that is required by law in furnishing  reports for prosecutors and the giving of evidence in the civil courts is proscribed. Open evidence will be required in Crown Court and the doctor should not be afforded any anonymity and publicity cannot be avoided. If, however, the doctor has taken the steps outlined above this will afford some protection. Rarely  a doctor may choose to take independent legal steps to protect their interests.

With regard to confidentiality within the family, school or other organisation, doctors and nurses, including school nurses, must be open to disclosure from wherever it comes whilst respecting the confidence of the discloser such as another family member. That disclosure  must then be shared with the group who have a statutory need to know.

When putting in place procedures to safeguard children and vulnerable adults it is vital that the requirements of confidentiality do not take precedence over the need to protect their welfare

Relationships with parents, carers and the wider family

Doctors must ensure that a child`s safety and welfare is paramount and takes priority over other considerations. But they should also ensure that the child`s family members are treated with dignity and respect, take account of the rights of family members, for example to make decisions about their lives and lifestyles, and provide additional support or help they may need.

Question 2

Do you agree with this? If possible, provide examples of circumstances where a child`s and family`s needs and rights have been met and respected in context of child protection  proceedings, or occasions where they have been in conflict and how this conflict was managed by doctors.

Difficulties can arise when English is not understood or where because of a particular culture, the head of the family is the only person who will speak on behalf of parents and may fail to translate what is said by doctors. There can also be fears that translators may breach confidence in close knit ethnic groups. In Family Proceedings Courts and Criminal Courts accredited translators must be provided by law. In the clinical situation difficulties arise and an independent translator is advisable.

The doctor would be ill advised to accept a family representative, usually the senior male, as what is said may not be being accurately passed on. Indeed a parent may refuse to speak to a doctor except through a senior family member. Indeed, where the “honour” of the family is involved , this is likely to be the case.

 There are additional issues of confidentiality. Situations arise where a senior family member knows what is being said but selectively translates it, and later deals with the matter in accordance with his culture. Domestic violence or other injustice may follow the unwise revealing of sensitive information. Generally speaking,  child abuse is even more detested amongst most  ethnic minorities than it is in our own society. There are obvious dangers which can only be avoided by independent translators. These need to be accredited as in the courts and contemporaneous records kept.

Doctors working in partnership

Doctors are expected to work as part of a team alongside other health professional when they provide treatment and care to a child or young person. Doctors are expected to cooperate with other agencies, such as services for children and young people and the police, where abuse or neglect of a child or young person is suspected or known. Doctors may also be asked to work with colleagues when giving evidence to a court, for example on issues which they agree or disagree.

Question 3

What are your views or experiences about how well doctors work with other doctors, professionals and agencies, when there is the possibility of harm to a child.

Regrettably many doctors are loath to become involved in child protection as a result of adverse publicity, threats of legal action or complaints to the GMC. Direct threats also occur and many doctors feel that they or their own families are endangered. Ultimately, if many doctors refuse to become involved in the legal process child protection will fail. Fortunately most doctors feel that they are obliged in consience to do their utmost to protect children.

It has to be said that the GMC is seen as part of the problem and not part of the solution. That is because many aggrieved parents complain to the GMC. Doctors are looking to Lord Justice Thorpe’s expert group with members from the RCPCH to come to clear conclusions that would protect children and professionals alike. When the president of the Royal College of Paediatrics and Child Health is reported to be unwilling to become an expert witness and GMC decisions are overturned in the Court of Appeal, is it any wonder that paediatricians are unwilling to give evidence. It would be very helpful if a clear set of guidelines were to be published. If they were adhered to, then this should provide the doctor with a prime facie defence against complaint including complaint to the GMC. So far confidence has been damaged and children will bear the brunt.

It should also be recognised that all doctors coming into contact with children need training in the recognition of abuse and neglect and the legal framework. Paediatricians would certainly benefit from training in the writing of  legal reports and presenting evidence. As a member of the bench, I have seen witnesses` evidence undermined by hostile cross examination when a more experienced witness, such as a police  officer, would have been better able to assist the court. The police are trained in how to give evidence,  doctors are not.

With regard to expert evidence,  I believe there would be real benefit in a trained cadre of expert witnesses such as anticipated in Bearing Good Witness where a multidiscipline team including paediatricians are available. But in the pilots so far, there are insufficient paediatricians` involved. This may need to be addressed by inclusion of this task in  paediatricians job plans and sufficient time allowed  for this such time consuming work.  

Question 4

In your experience, what factors help or hinder clarity about who has what roles and responsibilities to protect children and young people? This might include, for example local working arrangemants, and apply to doctors working in different areas of practice, or the way doctors work with other professionals.

In the consultant  practice with which I am familiar, it was usual for examinations for possible sexual abuse to be carried out  in the ward in the presence of the mother, an experienced paediatric nurse and a  paediatrician and police surgeon examining the child jointly. This minimised the number of examinations and stress for the child. It must be remembered that for the young child in particular, the examination was almost a second assault. The police surgeon could bring to bear forensic skills, including photography which assisted the courts. It also reduced the likelyhood of conflicting evidence and was an important liaison. Police surgeons have their own skills and expertise from which paediatricians can benefit.The role of the nurse is also critical as it may result in additional evidence such as disclosure or an observation.

It has always to be remembered that, especially in cases of possible sexual abuse,  the medical evidence is often only a small part of the evidence upon which the court will rely. Paediatricians should not feel that their evidence is decisive, it is likely to be collaborative at best.

The method of obtaining reliable evidence from disclosure depends heavily upon the way in which it was obtained and the role of specialy trained police officers. In this field, paediatricians may only have a minor role to play and yet it is one with which  they are most reluctant to be involved. It would be helpful if they were reassured that it is all the evidence taken together that is decisive, and the most significant is likely to be disclosure. It is outside the scope of this submission to discuss how evidence is obtained by skilled professionals but doctors should be aware of the often limited nature of physical findings in sexual abuse.

The role of the local authority legal department is central in putting together any case that comes into court. Thus the multidiscipline case conference is of central importance. It is very important that all doctors, including general practicioners and paediatricians attend the conference and understand what the court will require of them. It has often been the case that doctors, and general practitioners in particular, do not attend or send represenatives.  This is not sufficient and certainly anyone giving evidence whether doctor or nurse, needs to be aware of the role they will be expected to play. We certainly hope that the working group under Lord Thorpe that is looking into child protection will have nurse representation. If it does not, it should. The evidence of say health visitors can be crutial and the role of nurses in general seems to be underplayed in child protection.  

Doctors` knowledge skill and experience

The GMC`s  guidance requires doctors to keep their knowledge and skills up to date, and work within the limits of their competence, and consult and take advise from colleagues where appropriate. These requirements apply to doctors` clinical knowledge and skills and to other professional activities, for example acting as a professional or expert witness in the family court. All doctors have some role in protecting children, but some have additional, specialised  knowledge and skills to undertake specific tasks in protecting children. 

Question 5

What training and other support do doctors need to undertake their particular roles in child protection, for example, in preparing and training to give evidence to the family court? If possible provide examples where doctors are (or are not) receiving appropriate training or other support.

Child protection should be included in the basic training for future doctors. Those who are likely to be front line doctors with children. Paediatricians, accident and emergency doctors and general practitioners in particular need to be trained by their respective colleges using such documents as the RCPCH compendium “ Child Protection  Companion”, 2006 which should be used in the annual appraisal of paediatricians.

Doctors should also be aware that other vulnerable groups besides children are in need of protection. It is a general requirement of all those close to vulnerable persons.

Local training should be made available on the presentation of evidence in family courts. The Magistrates Association and local Courts Committees may have a role.  

Regional teams of expert witnesses including psychiatrists, psychologists and paediatricians should be established and funded, with appropriate job plans to support local paediatricians and general practitioners.

Specific audit of the roles of doctors using sufficiently anonymised cases as a training and supportive tool.

A specific protocol on the preparation of medical reports should be available. Bearing Good Witness  and subsequent pilot studies and the work of a local family justice council may be helpful. 

Training on presenting evidence should be available.  Local prosecutors and the police may be able to advise on this. Many doctors have access to a local medico legal association which may take on this role such as the Worcestershire Medico Legal Association etc.

Clear guidance is required from the GMC which doctors would find helpful and supportive and in which they could be confident that their conscientious work and compliance would protect them from vexatious complaints.

Conclusion

Lord Justice Thorpe`s expert group is necessary if the lack of confidence of doctors in the legal process, which is endangering child protection and for which they are inadequately trained, is to be halted .

Dr Anthony Cole

JP FRCP FRCPCH

Chairman the Medical Ethics Alliance

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“Eyewitness Gaza, a journey of pain and hope”

given by Dr Jafer Qureshi.

The speaker is a consultant psychiatrist and former chairman of the health committee of the Muslim Council of Britain and a trustee of the charity Muslim Aid.

Muslim Aid is a major charity with £35 million to disburse. It is similar in its aims to CAFOD and operates in 65 countries. It works in the Holy land and has links with the Catholic hierarchy.

He described the position in Gaza is “dire” and that it is not permissible  to overlook this fact. He held that “silence is betrayal”, a phrase used by Martin Luther King and recently repeated by Donald Moore SJ the director of interfaith relations at the Pontifical Biblical Institute in Jerusalem .

Following the Israeli incursion into Gaza in December 2008, ending on the 11th January 2009, he and a few others in  a small party consisting of  two clinical psychologists and a journalist, gained entry to Gaza from Egypt. They were told that they were at risk of kidnap or worse but felt that “like the followers of Christ”, they were responding to their destiny.

In fact, they were treated with great friendship and hospitality by the people who had themselves sufferer great loss. Despite this, they found themselves amongst a people who were resilient and resourceful making prostheses from wood and bricks from mud as cement and metals were unavailable.

Access to Gaza is confined to 3 days a month and strictly controlled by the Israelis who man the borders and patrol the sea.  Much aid is piling up on the border and a little does make its way through tunnels under the border with Egypt.

They found that the economic centre of Gaza was almost totally destroyed. He illustrated this with a DVD taken by his party. The destruction extended to the hospitals which were without gas or even sewage. The ambulance and emergency department had been singled out for attack and were in a state of complete carnage.

The Gaza population were people of strong faith in their destiny and of indomitable courage and unbroken. They shared what little they have between themselves and there was no starvation though the economy had been largely destroyed. There is a population of 1.5 million confined to an area 40km long and 4km wide. They are living under a virtual siege and there was a danger of generalised helplessness.

The land itself was very fertile and the relief mission set itself several  tasks in the short time it was there. It established a bakery supplying 60,000 people with bread. In answer to a question he said that 55% of the population were children most of whom had been traumatised.

The main problem now, after addressing the needs of the injured was post traumatic stress disorder, especially in these children. This showed itself in irritability, violence, depression, aggression, regression, bedwetting and the inability to cry. His particular project was to train teachers and parents in how to address this through art, self expression , symbolism and play.

There were now some sign of “green shoots” with children, who formally could only expressed themselves in drawings of violence or pain, gradually turning to normal   pictures. He drew attention to one child who began by drawing a black face in a barren landscape shedding a tear of blood, who is now drawing normal pictures. He illustrated this with a DVD in which these images featured

His work could be characterised as training the teachers and parents in how to make appropriate psychological approaches. Some of the Gaza medical staff had also suffered psychological trauma  from treating those injured and he referred to one paediatrician who could not sleep since treating a a victim of a phosphorous shell.

The meeting closed with a vote of thanks from Father McGinley of St George’s friends of the Holy land group.

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Book review

“Abortion and Mental Health”

By Dr Pravin Thevathasan MRCPsych

Life Publications
Life House, 1 Mill St.,
Leamington Spa. Warwicks. CV31 1ES

£1.95

When the Abortion Act was passed in 1967, the Royal College of Psychiatrists did not oppose it and put out a statement to the effect that there was no evidence abortion harmed women. Then came the Rawlinson Report of 1994 and two years  ago the College were saying that … “some studies identify a range of mental disorders following abortion”. Fergusson and colleagues, in their 30 year longitudinal study published in 2006, showed that women who had had an abortion were 30% more likely to suffer mental health problems and, moreover, this was not dependent on prior mental ill health.

The dispute was also fuelled by Dr Paul Dragg`s Paper in 1991 in the American Journal of Psychiatry of a meta analysis of 250 papers. But in this admirable and courageous publication Dr Thevathasan  points out that many of the studies that Dragg was relying on were carried out too soon with many less than a year after the abortion and some were based on small numbers or had many women dropping out.

Dr Thevathasan not only points out that many of the adverse mental health outcomes  come many years after the abortion. They also manifest many of the features associated with Post Traumatic Stress Disorder and he uses the term Post Abortion Trauma or PAT which includes a number of features such as uncontrolled weeping, sadness, recurrent nightmares, flashbacks and sleep disorder grief and guilt. Many women turn to drugs or alcohol for relief and depression and suicide may take place. Nor is the author unwilling to enter the spiritual realm mentioning  the woman’s desire to find peace and reconciliation with her lost child.

He challenges ordinary clinical psychiatry by saying that healing can only come after the murder of the unborn is honestly faced. He rightly points out that this is a “taboo” subject and there are no social rituals of atonement to help women damaged by abortion. He asserts that post abortion counselling needs to be done by “pro-life”, and “pro-women” counsellors.

Sometimes PAT is experienced after the birth of a wanted child or in the presence of other people’s babies. Surprisingly often women go on to have an “atonement baby”. Abortion can also be destructive of relationships and interestingly, he mentions that PAT can also affect men. 

It is his willingness to share with us, not only the mental health symptoms which amount to serious mental disorder that, according to one source, affect 10% of women who have had an abortion, but graphically illustrates their anguish by mentioning their own descriptions of  their feelings. He dedicates this publication to those  women who have shared their abortion experiences with him. There may be  little prospect that this problem will be addressed at the level needed, but this publication comes closer that most to explaining the need. 

Dr A P Cole
FRCP FRCPCH

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Saint Elizabeth of Hungary

St Elizabeth of Hungary is the patroness of nurses and many hospitals have been named after her. She lived in Hungary, then part of the Holy Roman Empire, between  1207 -and 1231. In that short time she was a Queen, mother of one of the crowned heads of Europe, and friend of the poor and sick. She knew great hardship and internal exile and was steeped in  Franciscan spirituality. After her short and remarkable life she was canonised  by Pope Gregory IX in 1235 a mere 4 years after her death such was her place in the hearts of her people.

From an early age she showed such natural piety that her mother doubted that she could rule but rule she did whilst also ministering to the poor. She was born in Hungary on July 7th 1207 the daughter of King Andrew II of Hungary and entered the Court of Thuringia. In a political alliance between families she was betrothed at the age of 4 to Ludwig whom she married at the age of 14 years and who ascended the throne of Thuringia in 1221. He was a staunch supporter of the Holy Roman Emperor and moved to Cremona to join the Imperial Diet leaving his young wife to rule Thuringia.

 In 1223 Franciscan monks arrived and Elizabeth became a devout follower of St Francis of Assisi endeavouring to live according to his spirituality whilst reigning as Queen. Her husband approved of her works of charity but in 1226 famine , floods and plague struck Thuringia. The Queen distributed alms throughout their stricken territory giving away her ornaments and state robes. At Warburg she founded a hospital with 28 beds using money from her own dowry. Not only did she visit it daily but humbly nursed the sick there.

At the age of 20 she was widowed. Ludwig died en route to join the VIth crusade. Elizabeth was devastated crying,

          “He is dead, he is dead. It is to me as if the whole world died today”.

Her misfortunes were just beginning. Ludwig’s brother became regent during the minority of Elizabeth’s eldest son and her family began to plan another political marriage for the young widow. She, though, took vows of obedience and celibacy and would not give way.

She was held a virtual captive in her uncle’s  castle but would not move from her vows. Arguments arose over the disposal of her dowry and the Pope appointed  a priest,  Conrad von Marburg to be her defensor and Elizabeth left the court. Conrad was also her harsh confessor and was not beyond beating his penitent. He later became a strict inquisitor. The unfortunate woman  was exiled by her brother in law who usurped her rights and those of her son the heir to the throne. No citizen was allowed to give her shelter and she took refuge in a pigsty. Eventually eventually finding a home with another  uncle who was a Bishop

Her position was restored when comrades of Ludwig returned from the crusade and took up her defence. This led to her brother in law changed his attitude towards and her restoring her rights.  But she died in 1231 at the early age of 24 having been widowed for 4 eventful years. In due course her son ascended the throne and her second child Sophie, married Henry II Duke of Brabant  whilst her youngest daughter became the abbess of the convent of Altenburg.

She is depicted in rich robes with a loaf of bread behind her back and a lap full of red roses. This arises from a popular legend which says that when her husband asked her what she was concealing in her purse when she was secretly taking bread to the poor and on opening her purse the loaves had been changed into red roses. A similar legend this time of roses changed to loaves for the poor is attached to Queen Elizabeth of Portugal a granddaughter of King Andrew II and named after her great – aunt. The legend  is depicted  in a famous statue of St Elizabeth of Hungary in  Roses Square in Budapest. The main church dedicated to her is the Elisabethkirche in Marburg which is now Protestant but there are churches and hospitals bearing her name all over Europe. In London the Knights of Malta dedicated their hospital in St John’s wood to St John the Baptist and St Elizabeth of Hungary.

She was interred in the church of her hospital and almost at once there were claims of miraculous healings attributed to her. The Pope opened an examination of these claims and her handmaids gave an a account of the life she had lived and she was canonised on 27th May 1235

By the 15th Century her shrine had become one of the most popular pilgrimage sites in Germany and attracted the attention of Martin Luther and the Protestant reformers who dispersed her bones and took the agate chalice upon which her skull had rested. After the thirty years war it was taken to Sweden and is now in the Museum of Stockholm whilst her skull is in the St Elizabeth convent in Vienna with some relics surviving in Marburg.

She is the patroness of brides, widows, exiles, dying children and nurses. Her feast day in the Roman calendar is 19th November. She is venerated by Anglicans, Lutherans and the Orthodox as well as Catholics and there is a community of St Elizabeth in the United States where the Latin and orthodox liturgies are celebrated on alternate days.

On the 800th anniversary of her birth an “Elizabeth Year” was held in Warburg in 2007 and a musical based on her life was “Elizabeth – Legend of a Saint”, was performed up until 2009. The Catholic Medical Association (UK) have now adopted St Elizabeth of Hungary as a  patroness in addition to the physicians Sts Luke, Cosmos and Damian in April of this year.

Sources;

The Roman Calendar 1969. Vatican Library
“Legend of St Elizabeth” by Ruth Sawyer, Catholic Information Network
“The Charity of St Elizabeth of Hungary”, by Edmund Blair
Wikipedia, the free encyclopaedias
Dr Tony Cole

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About us

The Alliance is a coalition of Hippocratic and World Faith Medical bodies. It also has individual members including those engaged in non medical professions related to Medicine.

The purpose of the Journal is to educate and promote discussion in Medical Ethics.

It is interested in exploring the contributions that World Faiths can make to an understanding of medical ethics but invites contributions and correspondence from all, irrespective of beliefs. and welcomes those from other countries.

The views expressed are those of individual authors and do not necessarily reflect the views of the Medical Ethics Alliance.

Editor in Chief
Dr Anthony Cole

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