One of the biggest challenges doctors have to face on a daily basis is the difficult discussions they must have with patients about their illness. There are many considerations that need to be taken into account, from the patient’s own emotions and feelings about their illness, to complex issues of medical ethics. For the doctor, the challenge lies in showing empathy with the patient’s condition, but at the same time avoid getting too involved so as to hamper the patient’s decision making process. In modern medical education, the emphasis is on doctors acting as facilitators for their patients; they are there to help the patient make an informed decision about the treatment they receive.
It is therefore obvious that after a long day’s work, many doctors are left with numerous points of reflection following their encounters with patients, and it is this process that leads them to mature in their clinical decision making. However, in that long drive back home from work, I also try to reflect on my patient encounters through the lens of religion; for doing so allows me to check my own faith and strengthen my belief in God.
Perhaps one of the most difficult aspects of my job as a surgeon is to break the unfortunate news to a patient that they have advanced cancer, and difficult discussions ensue about possible treatment options; they can either opt for a huge surgical procedure, which has a significant risk of mortality and morbidity associated with it, but offers them a chance of a cure (albeit with a severely limited quality of life), or they can accept the advanced nature of their disease and have some palliative treatment to shrink the tumour to give them some quality of life in the immediate future, knowing that the disease is likely to get the better of them within a few years. In many instances patients do opt for the curative option, despite the huge risks associated with it.
After opting for surgery, one such patient recently came to me for a check-up prior to her surgery and asked me ‘Doctor, do you think I am making the right decision?’ I took a long few minutes of silence to digest the question, reminding myself of all those lessons I undertook in medical school of not letting one’s own thoughts and emotions cloud a patient’s decision. After discussing it through, the patient re-iterated their desire for surgery.
I have since been left thinking about the difficult decisions these patients have to make, and fundamentally, what would I do in such a situation? When reflecting upon the verses of the Qur’an, we are constantly reminded about the reality of death, but when death does come knocking at our door, how would we really react? And how would our reflections about God and faith influence our decision-making process, if we found ourselves in such an unfortunate position?
So what would you have done if you were faced with this predicament? Would you opt for the curative option knowing the risks associated with it and understanding that even the basic everyday activities of speaking and eating would be difficult in the post-operative period, or would you go for the palliative option? I suppose there isn’t a right answer to this question.
Perhaps one way to approach this problem for the Muslim would be start from the basic premise that the reason we were created was for the sake of worshipping the Creator. Thus, which of the two options would be better for us in terms of fulfilling this purpose? We could argue that the option of curative surgery gives us a small chance of lengthening our life on this earth, giving us an opportunity to perform more acts of worship to God (although the extent of this is likely to be extremely limited given the morbidity we are likely to experience). Of course, we must also bear in mind that the nature of the surgery means that we might not even make it that far. Alternatively, by opting for the palliative option, although we understand that our time is extremely limited, the short-term quality of life the palliative treatment offers us is likely to give us some time to worship Allah with some comfort, possibly even perform Umrah one last time, before the disease eventually gets the better of us and we finally enter our grave. Whilst I suspect that many of you reading this might have gone for the curative surgical option initially, when we think about God and the purpose of our creation, the palliative option seems to be an equally (if not more) sensible option that one might pursue.
Above all else, thinking through such encounters is a timely reminder for me to be thankful to Allah for the good health he has bestowed upon me. Sometimes, the pessimism we see within the Muslim community, from issues of sectarianism on the one hand to an over-emphasis on political issues both locally and globally on the other, can often lead us to forget that we actually have much to be thankful to Allah for, and for those of us enjoying good health, we are enjoying one of the greatest blessings that God has given us.