In Memory of Ethics: A Dissection of Ethical and Social Issues in Pakistani Professional Healthcare Practice

Health sector corruption and fraud are rising not only in developing countries but also in well-developed countries. Up-coding of bills, identity theft, and quackery are some of the major kinds of fraud in this sector. In this chapter, major causes and types of healthcare fraud have been discussed, and how they are affecting the society, with special reference to Pakistan’s conditions. Moreover, a gist of methods to reduce this issue has been proposed. The data suggests that the foremost issue conducive to the poor impact of public investments in the healthcare sector seems to be corruption and an observation system based on butcherly. The need is to overcome the dilemma through diverse approaches that necessitate collaboration and mutual work among politicians, citizens, policymakers, and every person within the community. Only then the cults of health sector fraud and corruption could be curtailed.

Pakistan is confronted with one of the most common ethical concerns that is prevalent worldwide - the common occurrence of abuse of authority. This chapter primarily delves into a pervasive ethical issue in Pakistan, as well as globally – the widespread abuse of authority. Through a comprehensive literature review and qualitative survey methods, this chapter examines instances of authority abuse across different sectors, with a primary focus on the police department, the political system, and workplace misconduct. It seeks to shed light on the factors contributing to such misuse, its consequences, and potential preventive measures. In recognizing the extent of authority abuse, this chapter underscores the urgency for our society to devise effective strategies to combat this unethical behavior, emphasizing the importance of ethical conduct in positions of power.

People find it hard to make ethical decisions in their lives. They often make unethical decisions in certain situations due to several factors and end up with dire consequences. In recent years, organizations have been applying different strategies to create an ethical atmosphere in the workplace. In this chapter, we have discussed unethical decision making at the workplace, its causes, consequences, and how this dilemma can be dealt with. Special insights will be drawn upon the impact of unethical decision making on the behavior of people. The purpose of this data is to elaborate on the importance of ethical decision making in every profession to run the workplace smoothly without causing psychological and behavioral stress among the task forces.

It has been rightly said that greed is a curse. Medical professionals who are either underqualified to treat their patients or are avaricious often prove to deal with the profession with dishonesty. Such doctors or physicians are not only causing harm to the patient’s life, but they are also proving to be havoc to society. Quackery is the term used for such doctors who promote deceitful and oblivious medical practices. Such practices are adopted by individuals who have a blinding ambition to excel, and in most cases, it is the drive to amass as much wealth as possible in a short period until they are caught or else for long. Such practices compel fake and uncompassionate doctors to lose all compassion and empathy for fellow humans, both of which lie at the heart of their sensitive profession. This chapter will evaluate the dishonest practices that are adopted within the medical profession and the ethical issues that arise out of them. A detailed insight will be put forth towards understanding the root causes of these unethical practices and how to deal with them. The basic understanding will help the readers acknowledge the importance of honesty, especially since the healthcare profession is the most sensitive profession in society. 

Malpractices of pharmaceutical companies in marketing their products are widely becoming common. These practices not only involve the pharmaceutical companies but are also associated with other professions. These may include nurses, doctors, technicians, pharmacists, and cosmetic sellers, among others. Traders of pharmaceutical companies give these professionals handsome incentives and subtly ask them to market their products without letting them know about the actual performance of the product whether it is a drug, cosmetic product, food, etc. Such products can have many damaging side effects ranging from minor to major. They can even sell their low-cost products by doubling the actual retail price just to have some extra money. Such practices compromise the doctoral-patient relationship of trust and mutual understanding and thus raise questions on the sanctity of the healthcare system. This piece of literature has been created to discuss issues related to the unethical behavior of pharmaceutical companies. The data shed light on the required steps for mainstreaming ethical practices. It is required to implement proper ethical guidelines within each sector of healthcare, primarily the pharmaceutical domain.

One of the pressing issues in any workplace environment is not only optimizing working and maintaining a healthy environment of the workplace but also keeping a check and balance of employee relationships and maintenance of peerless interaction among the employee, head, and other staff members of the organization. Workplace harassment is one of the imperative issues in the workplace throughout the world, regardless of geographical discrimination. Obnoxious and biased conduct is lawfully considered harassment when it is distressing enough to adversely affect a workplace habitat. There is a general lack of awareness among the masses in a working environment about workplace harassment; people often fail to recognize the harassment until and unless they find themselves at the receiving end of extreme delinquency and abuse. This chapter will elaborate upon the ethical concerns underlying workplace attitude with special reference to bullying in the workplace and its outcome. Some ways to tackle these abnormalities will also be made part of the discussion to let the readers know the right way out, whether they are the boss, the subordinate or a colleague suffering from bullying at a workplace.

Patients have a fundamental right to be informed about their medical treatments and the implications of anesthesia. Failing to disclose such crucial information is ethically unacceptable. However, there are instances where physicians, concerned about the psychological distress that comes with awareness of a severe illness, opt to keep patients in the dark. In such cases, the responsibility of decisionmaking often falls upon the patient's family or the clinicians themselves. Additionally, concerns about medical confidentiality and patient comprehension can lead to incomplete disclosures regarding surgical procedures. This chapter delves into the ethical dilemmas arising from the withholding of information by healthcare professionals and its profound impact on patients, their families, and healthcare workers. It also explores how these practices influence the public perception of healthcare practitioners. The pressing need in this context is to establish comprehensive regulations and standardized guidelines for information privacy and disclosure within the healthcare sector, ensuring the long-term delivery of satisfactory healthcare services. 

Human radiation experiments have been utilized for a long time for dealing with healthcare complications. Their usage is undeniably acceptable for diagnosis, treatment, and preventive and detection processes. However, the dilemma attached to unethical practices in radiation experiments compromises its beneficiary accounts. The health sector throughout the world is facing the dilemma attached to radiation experiments. The problems associated with unwanted radiation exposure and excessive and unnecessary application of radiation experiments are a major concern for scientific and healthcare authorities to deal with. This chapter gathers data regarding ethical issues that arise out of such human radiation experiments. It is required to learn lessons from case studies and research and to devise better experiments for future radiation experiments.

Euthanasia is a burning ethical issue as some people have an opinion that it is better for a person to die than suffer from a painful and incurable disease. Murderers hide behind euthanasia and cause the death of a human no matter what the reason is against human dignity. This chapter revolves around the topic of critical ethical issues pertaining to the ‘end of life’, which includes euthanasia and physician-assisted suicide (PAS). Information that can help society cope with this ethical issue (Euthanasia) is explained, as nowadays, people are more careless towards weak, old and ill people. The concept of long-term care for terminally ill patients seems to have become very rare, and people have started considering death better than life. This piece of information will help create public understanding regarding euthanasia as a professional, ethical issue, its prevalence across the world, causative factors, and some strategies to overcome euthanasia.

PAS is opted for when the patient is terminally ill and he/she no longer wants to continue life-supporting treatments that are often excruciating, financially unaffordable and offer no hope for survival to terminally ill patients. This chapter talks about the ethical concern of physician-assisted suicide (PAS), which is one of the perennial ethical problems of medicine, how it can be distinguished from euthanasia, and what are the different types of practices that constitute end-of-life procedures. It talks about the factors that make PAS a legal and ethical issue. Furthermore, PAS’s prevalence across the world, especially in Pakistan, is discussed, and also the causative factors leading to PAS have been shed light upon. Moreover, the influence it has on individuals and society and the ways by which we can address issues encountered as a result of physician-assisted suicide are made part of this discussion.

 It has long been assumed that a woman's most important right is to be a mother, but today, it takes quite a bit of proof to be called the mother of a child. Who came first, the parent who became a parent or the parent who gave birth? Or do both need to be present in order for it to be referred to as one? Such repugnant arguments are the outcome of internalized societal shifts. Regrettably, it has come time for authorities and ethics committees to decide who the mother of the child is. Simply insert a needle and perform a DNA or birth test. These tests are pointless. The transformations that society is experiencing now have both benefits and drawbacks. Both positive and negative developments are absorbed by society. To determine if something is excellent or harmful, society even sets the scale. But, it seems somewhat terrible to go through the anguish of bearing a child inside of oneself for nine months and then give the baby away after delivery. Renting a mother's womb is not permissible under any circumstances, regardless of the contracts that have been written, the amount of money that has been spent, or the number of prior unsuccessful attempts. For the very cause, surrogacy is creating an ethical dilemma, especially in Pakistan. Assisted Reproductive Technology (ART) techniques being employed in surrogacy are increasingly common infertility alternatives. The introduction, historical context, types, and popularity of surrogacy, as well as several ethical concerns it raises and how it deviates from bioethics, are all briefly covered in this chapter. The information will help in finding answers to various surrogacy-related questions on dignity, exploitation, rights, and the use of women's bodies as commodities. 

IVF (In vitro fertilization), by definition, is a complex series of procedures used to treat fertility or genetic problems and assist with the conception of a child. Reproduction is a basic human right and an inborn instinct, the existence of which no one can deny; however, sometimes nature does not allow a man to fulfill this desire. In this modern world, people no longer take ‘No’ for an answer to nature and fate incidences, and for this reason, many who are unable to conceive naturally opt for medical procedures like IVF to become parents artificially. The initial concept behind IVF aimed to help married couples have children, but as times progressed, numerous ethical issues have emerged. This chapter briefly explains some aspects of in vitro fertilization, including its introduction, historical background, types, prevalence, different ethical issues related to it and its deviation from the bioethics principles.

Although human experimentation has greatly increased our understanding of the human body and diseases, there are still occasions when limits of morality are crossed during clinical trials. Illiteracy, poverty, corrupt health practitioners, and lack of law enforcement in developing countries have led to an increase in the exploitation of people as guinea pigs for trial purposes. These unethical clinical trials in Third World countries have caused an inferiority complex and a general mistrust in the healthcare system. It is the duty of the physician and scientists involved in medical research to protect the life, health, and integrity of research subjects, for which strict regulations are a necessity.

The deliberate termination of a pregnancy before a fetus can live independently is called abortion. On the other hand, the natural ending of pregnancy is called a miscarriage. This chapter describes abortion descriptively, along with its types, causative factors, risks associated with it, and the potential consequences it can have on the individual and society. It also discusses the different religious points of view on abortion and the worldwide prevalence of abortion, with special reference to Pakistan. Some organizations are also mentioned that are working to prevent it. An extensive discussion has also been carried out regarding its ethical concerns. In the ending, keeping in mind all the factors, a brief conclusion has been drawn.

Embryonic Stem Cells (ESC) are pluripotent cells that give rise to all cell types and are used for cell replacement and regenerative therapies. However, ethical, social, and legal controversies have questioned the morality of the procedures to obtain ESC lines, and the moral status of an embryo is oscillating in the debate about the origin of life, whether it originates at the totipotent stage or at the point of syngamy. Ironically, the moral status of women is also being defied by inadequate informed consent for medical procedures and their life-threatening consequences. In response to the ESC controversy, an alternate approach of using low-grade embryos for obtaining ESC lines has been proposed. This study aims to define the moral status of an embryo, question the defined status of a woman, and find new ethical-based medical procedures to obtain ESC lines.

The world is a natural heritage where everything is revolving in a balanced way. The whole universe is moving in a way that is not disturbing the flow of life, the stars, the moon, the planets, seasons, and the process of life and death. But when something disrupts the nature of this cycle, the outcome of that will be seen in the world as a whole. With the evolution of science, man has made and produced things that people were not aware of. However, with every advantage comes its drawbacks and disadvantages. Similarly, the process of human cloning was once a farfetched idea but now has become a genetic disaster for humans. But, many oppose this and talk in favor of human cloning, mostly those who can afford it. However, if one looks at all the aspects of human cloning, then it is a genetic disaster. To create or not to create is the question. Do they serve the human race by human cloning? This chapter has been devised to answer this question and to elaborate on the ethical concerns that arise out of human cloning experiments. The purpose is to make the reader aware of the sensitivity of this medical topic and to elaborate on what limitations could be there to deal with in such medical procedures.

Professionals who consult online should understand the limitations of digital consults and comprehend the numerous legal and ethical concerns that apply to this task to maintain quality of service, prevent potential challenges, and support public safely. This chapter discusses contemporary ethical guidelines in online mental health care practice. The professional internet counselling ethical framework is explored in this chapter. The different principles of ethical issues in counselling and psychotherapy make it easy to understand the ethical responsibilities of online practice. It is important for online professionals to keep in mind that not all clients and/or problems should or can be resolved online. Some cases need in-office assessment or treatment. Online communication and pseudonyms provide some level of privacy for receiving services; therefore, it would be challenging for professionals to engage in therapeutic contact with clients whose identities they do not know. A trained professional should insist on knowing the identity of the online clients for two reasons. The client's safety is the primary priority. It is important for the practitioner to be able to provide concrete intervention if and when it is required. The main reason online professionals have to verify their clients' identities is to prevent dual relationships. Professionals must follow the limits of their professions and malpractice insurance policies when providing professional services online. In simple words, online practitioners are only permitted to provide professional care to customers who live in the state where the practitioner is certified or licensed. 

In recent years, vaccines have been found to be the most effective tool for mass protection of people against infectious communicable diseases. Despite technological advancements, the obligation of these essential preventive healthcare treatments, to date, remains a subject of debate and, to an extent, opposition arising from vaccine hesitancy and/or vaccine opposition. The COVID-19 pandemic exacerbated shortages in resources and personnel owing to its rapid spread globally. With little known about this uncommon disease, efforts for early development of vaccines to achieve herd immunity, control disease transmission and reduce morbidity and mortality were undertaken. The emergence and administration of vaccines raised ethical concerns about loss of liberty and autonomy under mandatory provisions. This chapter aims to highlight the processes through which an infectious disease such as COVID-19 is politicized and securitized in the global policy arena, driving the development and administration of vaccines as specific protection. It further discusses the ways in which COVID-19 vaccine sufficed ethical standards for mandatory vaccination programs. 

Social media is a useful innovation of the 21st Century, which has provided mankind with a wide range of facilities and comforts. It is a benchmark of communication, technology, and business which comes with several risks. Different countries and organizations have adopted various strategies such as the enactment of bills to reduce the unethical acts being done on social websites such as Facebook, Twitter, MySpace, etc. Through guidance and strict regulations, such online unethical misconduct can be restricted ensuring a safe working environment for the users.

Journalists all across the world regularly violate journalistic ethics, which has a detrimental effect on societal peace and order. Due to unrestricted and independent media, there is a serious problem with journalists misreporting, making up news, inventing facts, and revealing improper material. The frequency, probable causes, and effects of this situation are all covered in detail in this chapter, along with international instances of poor journalism. There are also some recommendations in this chapter for addressing this problem at the individual and organizational levels. 

Since the evolution of life on Earth, there has been a great expression of gender discrimination. Women have always been its prime and more susceptible target. Be it the absence of rights to property or the limited acceptance in the education field, etc., women have always been the constant victims of this issue. This chapter explores the ethical issue of gender discrimination against women in general, particularly in workplaces. It sheds light on the prevalence of gender biases with special reference to Pakistan. The basic causes of gender disparity and discrimination against women have been stated in the light of various studies that were conducted. Some of the methods and efforts that are being made to minimize this ethical issue are stated with examples of some well-known organizations from all around the world. Moreover, the consequences of gender discrimination against women in society and especially in workplaces have been analyzed.

Ethical debates over rehabilitating prisoners have been in discussion since imprisonment began. Rehabilitating rrisoners is meant to restore a person who is incarcerated for some crime back to a beneficial life. The interpretation of rehabilitation is that if anyone commits a crime, it does not necessarily prove him to be a permanent criminal and there is always a possibility that they might quit those illegal acts and get back to normal life and become a functional member of society. Researchers have shown that these rehabilitation programs have proved to be practically handy in bringing out something better for the prisoners themselves and upright for society. Rehabilitation programs help to comprehend societal behavior and psychological needs. This piece of literature has been adopted through a comprehensive data analysis approach. Data regarding successful rehabilitation services has been gathered, including the world's successful practices. The purpose is to make the scientific, social, healthcare and justice-associated public aware of the positives of rehabilitation on the behavior of people. The need is to ensure the implementation of rehabilitation programs on a wider scale in countries where punishment is preferred to control crimes.