Drawing the line – Professional Boundaries


Healthcare providers are highly respected in our society and enjoy great esteem. The duty of healthcare professionals is to relieve the patients’ suffering of physical and psychological symptoms and in doing so, they must abide by the moral and physical boundaries of their profession.

What happens when a healthcare professional crosses the line..acts in an immoral way…violates physical boundaries?

Let me tell you, what happens…

The vulnerable young patient confides to her parents. They are outraged. They confront the professional who accepts his mistake…offers to apologize and meet again with the patient for closure! (Seriously…guts!!)

The parents console their child. Write to the licencing authorities to take action against such behavior. They politely decline as they’re responsible for giving a degree/issuing a licence and not for the monitoring or character of an individual. (Response of local & international organizations is alike).

The parents then contact the law enforcing agency. “Do you have evidence?”, “..any witnesses?”, “do you even know the legal process….the court hearings…the case inquiry…the questioning…the public humiliation…are you sure?”

The family and friends tell them to live with it. It’s a taboo. Talking about it will only bring bad to the family, the parents and the victim.

Where do we draw the line?

What about the ‘moral’ responsibility of organizations, professionals and society?

Pakistan Medical & Dental Council, Pakistan Nursing Council, Pakistan Psychological Society and all other professional organizations must reinforce their ethical standards and behaviors. Strong actions against unprofessional and unethical behaviors must be taken.

The professionals and society must stand up for what is the ‘right thing to do’. We are all in this together and must act together to improve the quality of care and respect of each person.

For my friends fighting this unprofessionalism and injustice….stay put!

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”

~Margaret Mead



To be or not to be….a practicing physician

A dilemma (Greek: δίλημμα “double proposition”) is a problem offering two unrelated possibilities, neither of which is unambiguously acceptable or preferable. One in this position has been traditionally described as “being on the horns of a dilemma”, neither horn being comfortable.

Life throws at us situations when we have to make a tough choice…a dilemma, be it personal or professional decision. Ever asked a full time clinician how it feels to be away from patients? Impossible….But what if you bump into a group of very progressive professionals…willing to invest in a field that will help improve the quality of care provided to patients? When you get the opportunity to establish a new department, become a pioneer in the region… ambitious and scary at the same time!! So what did I do when I had to chose between a clinical and an academic career!? Wasn’t an easy decision…

Academics it is! Clinicals are on hold for now but not for long…hopefully. So teaching and learning is the next challenge…bring it on!! Already feeling a bit younger knowing I’ll be spending more time with young clinicians to be. The road ahead brings challanges…some foreseen, some not, but that’s what life is all about, especially when you walk the road less travelled!

‘The measure of intelligence is the ability to change.’~Albert Einstein

World’s Only Training Program in Pediatric Bioethic

Certificate Program in Pediatric Bioethics Accepting Applications  

Applications are invited for the 8th class, our 2018-19 cohort, of the Certificate Program in Pediatric Bioethics at Children’s Mercy Bioethics Center in Kansas City, Mo., USA.

Here’s how the program works:

Prior to the start of the program, we work with all the students to help them become familiar with our on-line learning management system, CourseSites. Students introduce themselves to one another on-line and receive a reading list for the Opening Session. Students obtain articles on their own with assistance as needed.

We then gather in Kansas City in September for an intense opening weekend in which we introduce the three domains of pediatric bioethics – clinical, research, and health policy ethics. Along with receiving traditional didactic instruction from our diverse and experienced faculty, students participate in several interactive case exercises in small groups. During the three-day Opening Session, we provide all meals, including two excellent dinners and socials at quintessential Kansas City restaurants. At the end of the Opening Session, students return to their home institutions feeling connected with their fellow students and faculty and prepared with a common framework of knowledge for deeper levels of inquiry. The rest of the year includes on-line discussions combined with face-to-face and online webinars.

The on-line portion of the curriculum has four parts:

  1. Weekly readings and discussion. Each week, we assign several articles on a specific topic. Some of these topics are philosophical and conceptual – topics such as shared decision making or autonomy. Others are specific clinical topics such as genetics or complex pediatric care. Faculty lead the on-line discussions. Students are required to post comments at least twice each week.
  2. Webinars.  Every year, we host approximately 10 interactive webinars. We invite national and international leaders in pediatric bioethics to discuss controversial topics. Webinar participants can ask questions and make comments by typing in questions or via Twitter.
  3. Interactive face-to-face webinars. Periodically, we have live on-line discussions of a particular topic or book. Often, we invite topic specialists from Children’s Mercy or outside experts to join us in these discussions.
  4. Student final projects. Each student designs and completes a final project. To help with these projects, we set deadlines for 1) an initial proposal; 2) an outline; 3) a first draft; 4) a practice presentation; and 5) a final presentation. The practice presentation is done on-line via a face-to-face webinar.

Once the on-line curriculum is completed, we conclude the program by regathering in Kansas City for three days in May. Students each present their final project. We invite guest lecturer(s) to present. As with Opening Session, all meals are provided, including two dinners and socials at more of Kansas City’s finest restaurants. For the past few years, the Bioethics Center band (“The Futility Project”) has provided entertainment at the final dinner.

Importantly, we do not view completion and certification as the end of our commitment to each student, but rather the first step in a long-term partnership to further their education and professional development. Each alum has the opportunity to join a dynamic and impressive network of international health professionals who also completed the Program (currently 149 strong!). Alumni engagement includes regular meet-ups at major professional conferences such as Pediatric Academic Societies (PAS) and the American Society for Bioethics and Humanities (ASBH), as well as invitations to return to Kansas City to participate in our bioethics events, including each year’s Closing Session. Our faculty also continue to mentor students on an ongoing basis in their professional aims, including reviewing and co-authoring research and program development projects. Some former students join our faculty as topic specialists.

We designed this program in 2011 with one goal in mind: to educate experienced child health professionals in pediatric bioethics. Our interactive curriculum integrates on-site instruction with on-line discussions, webinars, and virtual seminar discussions. Additionally, we match each student with one or more faculty mentors who guide the student through the process of completing a year-long final project. Over the last seven years, our students have included doctors, nurses, social workers, geneticists, chaplains, hospital administrators, researchers, lawyers, and parents from across North America and around the world. Indeed, our program is uniquely international and interdisciplinary. We provide multiple scholarships to health professionals working in developing countries, as well as to nursing ethics leaders, which means that each cohort of students typically includes experienced clinicians working in dozens of specialties and disciplines on 4-5 continents and in 8-12 different countries – an unparalleled learning opportunity for aspiring pediatric bioethicists!

Apply now and join our diverse and experienced faculty, international and interdisciplinary student body, interactive curriculum designed for working professionals, and vibrant alumni network.

Apply for our 2018-19 cohort. Applications for our certificate program and all scholarships are due December 15, 2017. For more information on our programs, please contact Vanessa Watkins at

Contd…PMDC Code of Ethics

Before starting any discussions, it is important to have knowledge of the ‘Code of Ethics’ by Pakistan Medical & Dental Council. So, here is the PART II

Medical Ethics and religion:

” A medical or or dental practitioner shall
respect the beliefs of the patients and shall not impose his beliefs on the patient.

Practice of medicine, surgery and dentistry prohibited without registration
etc with Council.-(1)

No person shall practice modern system of
medicine or surgery unless that person is a doctbrOr dentist having registered
qualification and valid registration with Pakistan Medical and Dental CounciL
(2) Every medical or dental practitioner has to ensure that his registration with
the Council is valid. –

Display of registration numbers.- (1):

Every medical or dental practitioner
shall, in his clinic or place of practice, display a copy of valid registration certificate
issued to him by the Council and referhis registratiorinumber in all his pre-
-scriptions, certificates, money receipts given to his patients. .
(2) No medical or dental practitioner shall display suffixing to his name those
degrees or diplomas which have not been -registered by the Council. A medical-or
dental practitioner shall not be considered a specialist unless an -additional qualification
of that specialty has been registered by the Council against his name.

Rational use of drugs.- (1)

Every Medical or dental practitioner shall adopt
practice with good and rational practices to prescribe drugs.
(2) A medical or dental practitioner shall
(a) be free to choose whom to serve, with whom to associate and lay
down the timings and place of professional service for the patients;
(b) not be bound to treat each and every’person asking his services, but
he shall not only be ever ready to respond to the calls of the sick and
the injured, if in his opinion the situation Warrants it as such, but shall
be mindful of the high character of his mission and the responsibility
he discharges in the course of his professional duties;
(c) in his treatment, never forget that the health and the lives of those
entrusted to his care depend on his skill and attention; and
(d) if not available due to any reaSOAand the patient requires continuous
monitoring or care, then the Medical or dental practitioner shall
arrange for another Medical or dental practitioner of sufficient
proficiency as an alternate and inform the patient.
(3) For. a medical or dental practitioner to advise a patient to. seek service of
another medical or dental practitioner is acceptable, however, in case of
emergency, the medical or dental practitioner must treat the patient firs\.
(4) No medical or dental practitioner shall normally refuse treatment to a patient,
however for good reason if the medical or dental practitioner thinks it would
not be appropriate to.provide his to a particular patient or
when a patient is suffering from an ailment which is not within the range of
experience of the treating medical or dental practitioner, the medical or dental
practitioner may refuse treatment and refer the patient to another medical or
dental practitioner.

Medical Ethics

Oath taken by Medical graduates in Pakistan:

At the time of being admitted as a member of the medical profession:
I solemnly pledge myself to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude which is their due;
I will practice my profession with conscience and dignity;
The health of my patient will be my first consideration;
I will respect the secrets which are confided in me, even after the patient has died;
I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
My colleagues will be my sisters and brothers; and I will pay due respect and honour to them.
I will not permit considerations of age, disease or disability, creed, ethic origin, gender, nationality, political affiliation, race, sexual orientation, or social standing to intervene between my duty and my patient;
I will protect human life in all stages and under all circumstances, doing my utmost to rescue it from death, malady, pain and anxiety. To be, all the way, an instrument of Allah’s mercy, extending medical care to near and far, virtuous and sinner and friend and enemy.”
I make these promises solemnly, freely and upon my honour.


Adapted from the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948; and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968; and the 35th World Medical Assembly, Venice, Italy, October 1983; and the 46th World Medical Association General Assembly, Stockholm, Sweden, September 1994. and the Islamic Medical Association Oath for Muslim Doctors.]

First blog post

This is my very first post. So I’ll use this post to tell readers why I started this blog and what I plan to do with it.

Medical practice today is facing the challenges to professional boundaries at one end and struggling with patient preference vs clinical authority at the other. How we balance the patient-centered care with the greater good of community often leaves us perplexed with an unanswered question…what we ‘ought’ to do?

Ethics involves the application of a moral code to the practice of medicine. As healthcare providers, it is important for us to be conscious of what we do and why we do it. This blog is an attempt to create discourse on common ethical issues faced by healthcare providers and patients alike. To learn as we discuss and share experiences with a common goal of providing best possible healthcare despite limited resources.

Let’s first review the Pakistan Medical & Dental Council’s Code of Ethics:


Duties of Dental and Medical Practitioners (International Code of Medical Ethics)

Drawing on the Declaration of Geneva, the WMA formulated a more detailed code of ethics which was approved by the 3rd Assembly of the WMA meeting in London in 1949. The International Code of Medical Ethics was subsequently amended in 1968 by the 22nd Assembly of the WMA in Sydney and again in 1983 by the 35th Assembly held in Venice. The text, as amended, reads as follows:

Duties of Physicians in General

A physician shall always maintain the highest standards of professional conduct and should actively participated in continuous Medical Education .
A physician shall not permit motives of profit to influence the free and independent exercise of professional judgement on behalf of patients.
A physician shall, in all type of medical practice, be dedicated to providing competent medical services in full technical and moral independence, with compassion and respect for human dignity.
A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception.
The following practices are deemed to be unethical conduct:

  1. Self advertising by physicians, unless permitted by the laws of the country and the Code of Ethics of the Pakistan Medical Association.
  2. Paying or receiving any fee or any other consideration solely to procure the referral of a patient or for prescribing or referring a patient to any source.

A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidences.
A physician shall act only in the patient’s interest when providing medical care which might have the effect of weakening the physical and mental condition of the patient.
A physician shall use great caution in divulging discoveries or new techniques or treatment through non-professional channels.
A physician shall certify only that which he has personally verified.

Duties of Physicians to the Sick

A physician shall always bear in mind the obligation of preserving human life.
A physician shall owe his patients complete loyalty and all the resources of his science.
Whenever an examination or treatment is beyond the physician’s capacity he should summon another physician who has the necessary ability.
A physician shall preserve absolute confidentiality on all he knows about his patient even after the patient has died.
A physician shall give emergency care as a humanitarian duty unless he is assured that others are willing and able to give such care.

Duties of Physicians to each other

A physician shall behave towards his colleagues as he would have them behave towards him.
A physician shall not entice patients from his colleagues.
A physician shall observe the principles of the “Declaration of Geneva” approved by the World Medical Association.