Medical ethics in Libya: where to start?

When it was decided that I will write the editorial for the second issue of the Libyan Journal of Medicine, I was not sure where to start. There are many topics that are related to global health issues and many are specifically related to the health system in Libya. For this issue, I decided to start some discussion on medical ethics as it relates to the Libyan medical culture. In our culture we tend not to inform the patient about the seriousness of his or her illness especially if the case is terminal. We do tell the family and some times other relatives. We even answer questions about it during social events. This means that the patient's lack of information is complicated by lack of privacy and confidentiality. We have very little time to sit with the patient and discuss the issues with him. Of course the situation is better in private practice (anecdotal, but no scientific studies). Some consultants tend to make rounds as they wish without respect to their teaching duties or their patients' needs. Others have neglected patients after a major surgical procedure and not visited the patient at all until the patient's death. Is it a wrongful death? The answer is beyond the scope of this editorial. It is not unusual to be sarcastic and make fun of the older patient who presents with symptom of sexual dysfunction and remind him that he is too old for that and that he should be ashamed of himself. The way the patient is treated and talked to depends to a great extent on his or her social status. If you are rich or poor, high ranking official or average human being, young person or old, presented to a Government hospital or to a private clinic, all of the above criteria may make a difference in how the patient is received or treated.