Year 5 Semester 1
BEGINNING OF LIFE ISSUES: (3 HOURS)
Prenatal / pre-implantation gender testing in IVF. Induced abortion (maternal disease, unwanted pregnancy, gender selection, congenital anomalies).
Practical: visit IVF / fertility clinic
Stem cell technology: Stem cells (definition, methods, use in disease therapy, use in research, sources of stem cells and ethical controversies).
Embryo/fetal research: Sources of embryos. Types of research that uses embryos (contraception, sterilization, reproductive cloning). Ethical guidelines and controversies.
Genetic technology: Genetic therapy. Genetic banks and patenting issues. Human-animal hybrids. The Human genome project. Genetic testing. Genetic screening. Pre-implantation diagnosis. Genetic engineering and therapy.
END OF LIFE ISSUES (4 HOURS)
Terminal illness (definition). Palliative care (definition, content, organization, institutional vs home, modalities, ethical and legal issues). Diagnosis of brain death (whole brain & higher brain). Initiating / withdrawing artificial life support (principles of saving life, certainty, resource conservation, autonomy). Euthanasia (definition, purpose of life, difference between legal withdrawal and euthanasia, acts of omission and commission). Physician assisted suicide. Solid organ transplantation (living and cadaver donor, xenotransplantation, use of anencephalic donor, neural transplantation, fetal transplantation). Post-mortem examination (purposes, process, ethico-legal controversies). Cadavers (research on cadavers, display and teaching on cadavers, dissection of cadavers, storage and use of human tissues).
ISSUES OF SPECIAL AGE AND GENDER GROUPS (4 HOURS)
Women and maternal conditions. Neonatal and infant conditions. Congenitally abnormal fetii / infants: anencephaly, spina bifida, hydrocephalus (delivery time: before or at term?, delivery method: vaginal or Ceserean?, CPR at birth, long-term life support). Child conditions. Geriatric physical dysfunction: musculoskeletal, falls, fractures, senses, nutrition (taharat, wudhu, salat, saum, hajj). Geriatric psychoneurological conditions and dementias (civil and financial transactions, salat, saum, hajj). Geriatric psychosocial dysfunction (depression, dependency/loss of self esteem, sexual dysfunction, quality of life, civil transactions). Disabilities: rights and obligations. Research on the elderly. Drug prescriptions for the elderly:
Year 5 Semester 2
ISSUES IN NORMAL REPRODUCTION (4 HOURS)
Menstruation (salat, saum, recitation, use of hormones to delay menses in Ramadhan and hajj, activities allowed/prohibited during menstruation). Pre-menstrual tension (impact on social and religious obligations). Irregular menstruations in the climacteric period (impact on salat, saum, sexual life). Prolonged menstruation (saum, salat, coitus). Dysmenorrhea (salat). Menopause (definition, early induction medically or surgically, artificial delay, HRT). Human sexuality & sexual behavior (forms sexual expression and behavior, regulation of human sexuality, guidelines on coitus, moral/cultural relativism regarding sexual behavior). Contraception (legal permissibility, autonomy decisions: individual choice vs public policy, disagreement between spouses, risks and benefits of various methods, allowed and prohibited methods, contraception for the unmarried, sterilization of the mentally retarded, relation to sexual promiscuity, demographic impact, parental consent for minors). Pregnancy (legal minimum and maximum duration). Prenatal screening & diagnosis genetic/non-genetic (benefits & risks, non-therapeutic abortion, human rights of the embryo). Labor (saum and salat). Delivery (autonomy in choice of method, refusal of CS, request for CS, maternal-fetal conflict). Postnatal care (iqamat and adhan at birth, naming, aqiiqat). Breast-feeding (duration, foster feeding).
REPRODUCTIVE SYSTEM DISORDERS (4 HOURS)
Menopausal disorders (artificial menopause, osteoporosis, benefits and risks of HRT, preventive hysterectomy +/1 ovariectomy). Dysfunctional uterine bleeding: peri-menopausal, pre-menopausal, post-menopausal, malignancy (salat, saum, hajj, coitus, hysterectomy +/1 ovariectomy). Erectile dysfunction: definition, causes, treatment (marital dissolution). Sexually transmitted disease (pre-marital screening, condoms for sexually active teenagers, confidentiality in treatment, partner tracing and notification). Pre-natal diagnosis / screening / genetic testing/treatment (indications, methods, test performance, counseling pre and post, informed consent, risks and benefits, relation to abortion, human rights of the embryo/fetus). Assisted reproduction for infertility: in vivo and in vitro insemination (basic permissibility for a married couple, prohibition of ovum or sperm donation, premarital disclosure of infertility, postmortem IVF, masturbation, paternity and maternity disputes, disposal/use of unused fertilized ova, pre-implantation sex selection and diagnosis, selective fetal reduction, developing embryos for non reproductive purposes, IVF for sibling benefit, using fertilized embryos for cloning).
Year 6 Semester 1
DIAGNOSTIC PROCEDURES (3 HOURS)
History (consent, scope, lifestyle questions, confidentiality, nasiha). Physical examination (consent, uncovering awrat, physician of opposite gender). Radiological examination (consent, confidentiality of images). Laboratory tests (consent, confidentiality, disclosure). Esophagoscopy and colonoscopy (wudhu, salat, saum). Aggressive investigation of common symptoms (cost vs risk of missed diagnosis, legal liability for missed diagnosis). HIV testing (compulsory mass testing, compulsory testing of a suspect, targeted testing of high risk groups, testing at the workplace, pre-marital testing, anonymous testing for epidemiological purposes, disclosure to the employer and the spouse).
Practical: visit to outpatient clinic, laboratory and radiology departments.
THERAPEUTIC PROCEDURES (4 HOURS)
Balance of benefit and injury (benefit>injury, benefit<injury, benefit=injury, choice between 2 evils, choice between legality and benefit, individual vs public interest, prohibited vs necessary, double effect). Prescriptions and administration of medications (ethico-legal issues, financial violations, conflict of interests, pharmacogenetics, regulations of drug administration, request for lifestyle drugs, porcine derived anticoagulants). Medication and wudhu (oral and rectal routes, vomiting after medication). Medication and saum (oral, rectal, intramuscular, intravenous, sublingual). Surgical procedures (disclosure of surgical risk, consent). Anesthesia (consent, wudhu, salat). Blood transfusion (safety, cross matching errors, consent/refusal, selling/buying, unwilling donors, donation by relatives, prisoners, and drug addicts). Resuscitation (without consent, principle of certainty about nett benefit, doctrine of futility). Cosmetic / reconstructive surgery (concept of changing Allah’s creation, beautification, prostheses, gender change, results less than desired, injury). Solid organ transplantation (indications, preventive transplantation, sale of organs, informed consent for donor and recipient, friend and family donors, living will on organ donation, issues of organ harvesting and determination of death, minor donors and recipients, ownership of organs, decision to donate for incompetent terminally ill and the dead, condemned prisoners as donors, opt-in and opt-out systems, organ donor card, organ donor register). Doctrine of double effect. The slippery slope. Ordinary vs heroic means in treatment. Acts of omission vs acts of commission. Use of drugs in sports. HIV treatment (compulsory treatment of pregnant HIV+ve, free retroviral drugs for HIV +ve)
CARDIOVASCULAR & RESPIRATORY DISORDERS (1 HOUR)
Dyspnea due to cardiovascular causes: (salat, hajj, saum). Dyspnea due to respiratory causes: pneumothorax, pulmonary embolism, chronic bronchitis, emphysema (salat, hajj, saum). Congestive cardiac failure (saum).
PSYCHO-SOCIAL DISORDERS (4 HOURS)
Legal impact of loss of competence (salat, hajj, zakat, marriage contract, divorce, wills and testament, financial transactions, legal proceedings). Human drives and the genesis of emotions positive and negative. Anxiety disorders (unbalanced drives, classification of anxiety: normal and pathological, anxiety vs fear and depression, normal and pathological anxiety, spiritual malady and cognitive impairment as causes of anxiety, salat in extreme anxiety, wudhu/salat with compulsive/obsessive disorders, prevention of anxiety by renewal of aqidat, ibadat, doa, and removal of stressors, socialization). Stress (competence, spiritual treatment of stress, salat with stress, prevention of stress, salat as cure of stress). Loss of consciousness: sleep, forgetfulness, anesthesia, coma (salat, saum, zakat, civil, financial, and judicial transactions, proxy decisions by the guardian, wali). Personality disorders (salat, saum, hajj, marriage). Psychiatric conditions /psychosis/schizophrenia (salat, zakat, hajj,stigmatization, compulsion:, Brunei Lunacy Act 1984, psychosurgery, ECT, confidentiality). Depression and suicide / para-suicide / harm to self and others (compulsory detention and treatment, process of mental committal, liability of physician who fails to identify potential suicide, conflict on suicide religious prohibition vs autonomy rights). Psychogenic sexual disorders (definition: lack of libido, sexual dysfunction, sexual deviation, treatment, impact on marriage and divorce: divorce or khulu’u). Neurotic / anxiety / compulsive-obsessive disorders (salat, marriage and divorce, civil and judicial transactions).
OTHER CONDITIONS (1 HOUR)
Patho-physiological disturbances: fever, dehydration, infecrtions, (wudhu, salat, hajj, civil and financial transactions). Hematological disorders: anemia, leukemia, lymphoma, coagulation disorders. Skin disorders: eczema, psoriasis, SLE, etc. Diabetes mellitus (ouasa).
Year 6 Semester 2
PHYSICAL ACTS OF WORSHIP FOR THE SICK (2 HOURS)
Toilet hygiene (istinjau, colostomy, urinal, discharging fistula). Wudhu (conditions that do/do not nullfy wudhu, wudhu with skin conditions, wounds, bleeding, urinary, and fecal incontinence; wudhu for immobilized patient, wudhu for hemiplegics, wudhu with extreme sensitivity to cold or heat, wudhu with dysfunctional bleeding). Tayammum (definition, conditions of recommendation: skin and cold, etiquette, soil / sand in the hospital), Ghus for the sick., salat (salat with musculoskeletal and neurological disability, joining and shortening salat for a reason; salat for immobilized patient, salat for the blind and deaf, salat in extreme cold/hot weather, salat with extreme thirst or hunger, salat with hemiplegia, vestibular disorders, postural disorders, dysfunctional bleeding). Saum (diabetes, ulcers, vomiting, diarrhea), zakat, and hajj (muscoskeletal and neurological disability, hajj for the blind and deaf, vestibular disorders, postural disorders)
LOCOMOTION, SUPPORT, AND CONNECTIVE SYSTEM DISORDERS ( 3 HOURS)
Orthopedic problems: sprains & fractures, orthopedic fixation, osteomyelitis, osteoporosis, malignant bone neoplasms (salat, hajj, work-related injury, workmen compensation, factory work with tremors, physical activity, rest, and sleep). Limb disorders (salat and hajj), Gait disorders (salat and hajj). Involuntary movements:chorea, athetosis, spasciticity etc (salat, hajj, work with moving machinery, driving, accidents in activities of normal living). Myasthenia gravis (salat, saum, hajj). Joint disorders with restricted/painful movements: osteoarthritis and rheumatoid arthritis (tayammum if cold exercabates the pain, salat, hajj, risk-benefit analysis of chronic pain medication, addiction to analgesics and opiates). Vertebral column pain: spondylosis, intervertebral disease, sponylolidthesis, ankylosing spondylitis, root compression, etc (salat, hajj). Laryngeal, pharyngeal, or oral disease (recitation of Qur’an, public duties like judging, leadership, and court testimony).
ALIMENTARY AND URINARY DISORDERS (4 HOURS)
SENSORY SYSTEM (1 HOUR)
Blindness and deafness (salat, hajj, court testimony, marital contracts, civil contracts, financial contracts, leadership, judgeship, employment). Olfactory disorders (wudhu, salat, halitosis in saum, use of perfume in public). Taste disorders (selling and buying food). Tactile disorders (work accidents). Temperature disorders (heat stroke in hajj, salat and saum in extreme temperatures, work accidents). Pain disorders: headache (salat in extreme pain, dyspareunia and marital stress). Hunger and thirst (delay of salat for hunger, saum with extreme hunger/thirst).
NEUROLOGICAL DISORDERS (2 HOURS)
Stroke (salat, saum, hajj, civil transactions). Epilepsy (salat, hajj, driving, factory work, job discrimination, injury due to inadequate anti-convulsive therapy). Parkinson disease (salat, hajj, employment). Dementias (salat, saum, hajj, legal competence, civil and financial transactions, court testimony, tests of capacity). Brain tumors. Brain /skull trauma. Spinal cord injury: lower motor vs upper motor, hemiplegia/hemiparesis, paraplegia/paraparesis (salat, hajj, marriage). Aphasia/dysphasia (marriage and contracts, evidence, public leadership). Vestibular disturbances (salat, hajj). Peripheral neuropathies:
