In a recent group therapy session at our clinic, one member who is a vegetarian and believes in holistic medicine shared an ethical dilemma. She wanted to become a Personal Support Worker to become financially independent but she began to have reservations when she learned that certain vaccinations were required prior to registering for the course. She found herself in an ethical conflict: accept vaccinations, which was contrary to her values and beliefs, or give up the course that she wanted to pursue. During the session other group members shared their ethical dilemmas and how they had tried to resolve them. Listening to their stories, I remembered two incidents from my professional life.

          The first took place when I started work at Whitby Psychiatric Hospital as a psychiatrist in 1984. Before going to the wards and seeing patients I had to meet with Suzanne in the Personnel Department for some routine formalities. After giving me my keys and a nametag, Suzanne asked me to read two papers and sign them. The first document, I realized, contained a statement of allegiance to the Queen. I told Suzanne that I was not going to sign it.

“Why not?” she asked.

“I do not see its relevance to my job as a psychiatrist.”

When Suzanne looked surprised I added, “You probably do not know that I am from Pakistan which was part of India until 1947. The Queen ruled India for nearly 100 years, as it was a British colony. But now we are free and no longer have any loyalty to the Queen. I thought Canada was also a free country.”

Suzanne was speechless. After she had composed herself, she said, “I am sorry. These are routine papers. I didn’t know it was such a hot political issue.” She quietly took the paper back and I started reading the second document. I said to Suzanne, “I don’t mind signing this one because it deals with the confidentiality of patients but I have to cross out the last line.”

“What is the last line?” Again she looked puzzled.

“Help me God.”

“And why do you want to cross it out?”

“Because I do not believe in God.”

“Are you an atheist?” She stared at me as if I were from another planet.

“I am a humanist.”

“What is a humanist?”

“A humanist is a person who thinks human beings are more important than religions and gods.”

“I have never met one before”

“So now you have.”

“Dr. Sohail, that is fine. You start your work tomorrow. I will check with Queen’s Park and I will let you know if there is any problem.” She did not know what had hit her. Obviously she had not met an outspoken Pakistani humanist psychiatrist before. We shook hands and parted. After that encounter I worked in that hospital for ten years. Suzanne never called me and I never asked her how the people from Queen’s Park in their political wisdom had responded.

          The second incident occurred was when I went to Montreal for my psychiatric Fellowship exam. In that final exam a resident in psychiatry interviews a patient for an hour while two examiners observe them through  a one-way mirror. Then both examiners interview the student for an hour and decide whether or not to award the Fellowship. Students who fail can repeat the process in six months.

          Candidates are divided into four groups and the exams are scheduled at 8 a.m., 10 a.m., 12 noon and 2 p.m. and the results are announced at 6 p.m. Some celebrate at the end of the day while others feel sad and start preparing for the second attempt.  My exam was set for 8 a.m. which I learned afterwards was a handicap, because the patients scheduled for   later interviews were emotionally stable outpatients while those chosen for 8 a.m. were inpatients, some of whom were very unstable. Unfortunately the patient I was introduced to for my exam was a young man who had been admitted to the hospital the night before in acute psychosis and had been given heavy doses of antipsychotics.

          After about 12 minutes into the interview the patient became so restless that he began pacing back and forth in the room. I could see he was uncomfortable. I tried to reassure him and explain to him that it was my final exam and I needed his cooperation. So he sat down and tried to cooperate for another 8 minutes. During that time I realized that I was facing an ethical dilemma. I asked myself: “Should I insist on keeping him there or should I let him go?” My conscience said, “Let him go even if you fail the exam. You consider yourself a caring and compassionate and humanist therapist and you are letting a psychiatric patient suffer because of your selfish motives. Who is more important, the patient or you?”

So I thanked the patient and let him go and failed the examination. In my heart I was happy that I had failed the fellowship exam but passed the exam of my conscience. While my colleagues and friends were feeling sorry for me and were shocked that I had failed the exam, I knew what had happened. I shared the details with only a few close friends. It was a private matter, an existential encounter between the patient, the examiners and me. I wondered why the examiners had not appreciated the sensitivity of the situation. The next time I appeared for the exam I passed with flying colours and the rest is history.

We all have to make choices in life and there are times we must make sacrifices for our values, principles and philosophy. We need to be ready for the ethical dilemmas we face and make those choices not resentfully but with grace.