The medical community in Saudi Arabia is facing ethical challenges that perhaps their counterparts in other countries don’t experience at such a level. It cannot be denied that the Saudi health care system is experiencing tremendous growth.
Our medical services need to be in sync with the needs of the 21st century — a goal that tops the priority list of all developing nations. In addition to that, physicians should strictly follow the international ethical standards in the doctor-patient relationship.
Saudi doctors face an uphill task in dealing with their patients in a manner that does not clash with the norms of a tribal and patriarchal society.
Recently there was a nurse specialist who received a female Saudi patient from a tribal area for treatment of a communicable disease. The nurse correctly determined the disease had reached an advanced stage. She asked the doctor to prescribe medication and then started asking a series of questions to determine the origin of the disease. She suspected the husband had infected the patient.
This is the standard procedure in the health profession. A physician or nurse, in order to protect the patient, determines the cause of the disease and then educates the patient to prevent further harm. Doctors are obliged to inform the person who passed the disease to the patient so that individual can receive treatment as well.
But when the nurse began to explain to the patient what kind of disease she had and question her about her husband’s lifestyle, the doctor cut her off. The nurse, trained in the United States, was puzzled.
The doctor took the nurse aside and said that if she explained to the patient what kind of communicable disease she had and that her husband gave it to her, it would ruin her life. In a tribal and patriarchal society, the husband, in an effort to save face, would immediately turn the tables on his wife, blame her for the disease and probably divorce her.
The doctor’s intent was to provide as little information as possible but enough to the patient to save her life and keep her family intact. But he also condemned her to potential brain damage and exposure to destroying her reproductive system.
The nurse took a different approach with her patient, by explaining how to take her medication and how to avoid getting sicker, but she never informed her what kind of disease she had. The nurse determined the husband was a frequent traveler and simply suggested that he be cautious of bathrooms and dirty places.
This is not even close to the proper medical treatment the patient deserved, but Saudi physicians and nurses are faced with these dilemmas daily. How can low-income, under-educated tribal patients in whom females have so few rights and little recourse for medical treatment be treated properly? The fact is these women are denied proper treatment and risk further injury because the consequences of husband’s discovering the nature of their illness would be too great. The irony is that without medical treatment the patient faces the real possibility of death.
There are three types of Saudis: Those middle-income and wealthy Saudis who live in urban areas and are educated and socially sophisticated. The second group includes Saudis living on the outskirts of urban areas or had just moved to a city. They follow tribal customs and values. They may have some education, but they haven’t caught up socially with their urban counterparts. The third group is the rural Saudis governed by tribal rules. This highly patriarchal group is by far the most difficult to deal with because they are essentially a law unto themselves.
Providing vital information and services to a community that live on the fringes of a modern society is fraught with challenges that often can’t be conquered because of the delicate and fragile family dynamic. It compromises the medical profession’s ability to provide the best care to patients and violates the physician’s oath to do no harm.
The medical community is still trying to find an answer, but I suspect that doctors will continue to compromise their integrity to keep the peace in a tribal family, but at the same time endanger their patient’s lives.
