IMANA-Hofstra Ethics Symposium: Closing Remarks.

First, I would like to congratulate Dr. Hossam Fadel and Professor Daniel Varisco for organizing this informative and educational two-day conference. I wanted to share a brief snapshot of the conference from my perspective. The conference started with a discussion on brain death. We found a lot of commonalities among the Abrahamic faiths, and the consensus was that brain death is an acceptable criterion for the vast majority of scholars of Jewish, Christian, and Islamic faiths.1 Dr. Aasim Padela presented a dissenting viewpoint.2 During the presentations and discussions all the presenters emphasized the importance of evaluating the quality of life as we deliberate and decide upon the many options available at the end of life. We heard about distributive justice and proportionality, which are important in decision making, particularly at the community level. We heard about deep-brain stimulation and how we are learning that some things that we took for granted are not really true. Dr. Tanveer Mir enlightened us regarding brain recovery after serious trauma, from complete recovery to minimal recovery.3 We heard about the applications of hospice care and its usage within the community.4 I particularly enjoyed Professor Varisco’s presentation on the anthropological view regarding grieving.5 This is one of the few meetings I have attended where we have nonmedical speakers, and that broadens and enriches the conversation. Professor Varisco shared with us information dealing with the manner in which animals grieve for their dead. To learn about how chimpanzees and monkeys and elephants grieve for their deceased was informative and enlightening. On the second day, the morning session on compassionate care was very enjoyable. I wish I had exposure to that session when I was a medical student. Dr. Stephan Post’s presentation and the subsequent discussions by Professors Julie Byrne and Warren Frisina were really enlightening. We were presented with some hard evidence about the relation between emotion and health. When we are under stress, the lymphocytes go down which can be a set up for frequent colds etc. We also learned from Professor Post’s presentation that there is scientific evidence regarding the beneficial effect on the recovery process of a good upbeat mood.6 The afternoon session on day two was an eye-opener for me. All the challenges which our colleagues in obstetrics and pediatrics are facing as the result of rapid advances of technologic and surgical techniques are mind-boggling. Dr. Fadel presented the variety of procedures to diagnose and, in some cases, repair fetal anomalies or defects while the fetus is still in utero. He also discussed the ethical implications of these procedures. Who would have thought just a few decades ago that one could operate and fix anomalies in-utero?7 Certainly the challenges that Dr. Ali Nadroo presented are worth pondering. At what stage and weight can the neonatologist decide that the risks of saving the neonate outweigh the benefits? Is it 400 grams, 500 grams, or 600 grams? In addition to the associated costs, we need to keep in mind the long-term implications for the family and the society. These are very important issues.8 The final two presentations were provocative in that Drs. Aasim Padela and Hasan Shanawani challenged the traditional teachings of the “mainstream” discussions held over the two days of deliberations.2,9 Personally, I feel it is not the question of determining who is right and who is wrong. This is an evolving field, a work in progress, and as we gain more information our thinking and recommendations are likely to be modified accordingly. I am particularly delighted that we were able to have a joint meeting between the Islamic Medical Association of North America (IMANA) and Hofstra University, which is an upcoming and prominent institution in New York with a new medical school expected to accept its first class in 2012. I was particularly pleased to hear Dean Bernard Firestone’s welcoming remarks. He welcomed this initial collaboration between IMANA and Hofstra University and hoped that it would be the beginning of a long mutually beneficial collaboration. The take-home quote for me was the quote by Professor Stephan Post: “Small things done with great love have a great impact.”6 Our patients come first, a warm welcome, honest service provided with a smile will go a long way in improving the patient-doctor relationship, whether we call it patient care, compassionate care or customer service. The bottom line is that we need to take care of our patients in a humane compassionate manner with a smile. A personal experience will highlight this point. Many years ago I was hospitalized for a brief period of time in the hospital where I was the Chief of Medicine. During that intensive care experience, one of the few things I remember is the following. The house staff and consultants used to come in droves. One of the second year residents visited and asked, “Dr. Khan everybody is looking after you so well. Is there something I can do for you today?” I would answer, “Yes, get me a hot cup of tea.” And she did. I remember that. I do not remember which medications I was given, but I remember that small gesture from a junior trainee. “Small things done with great love have a great impact.” That basic human touch makes all the difference. In closing, my special thanks to the leadership of the Islamic Center of Long Island for providing the logistic support for this conference: transportation, audiovisual, and last, but not the least, the nutritional support. Of course, our special thanks to Professor Mamdouh Farid, the head of the Department of Management at Hofstra and also the Muslim chaplain. He was the key person responsible for making the arrangements at Hofstra University.