Refugee Attitudes Towards Patient Autonomy-Based Ethics of Informed Consent

Introduction

Migration is as ancient as the history of humanity itself; however, forced migration is another matter, and increases during wars, persecution, violence, and in situations involving human rights violations (UNHCR, 2018) According to a report by the United Nations High Commissioner for Refugees (UNHCR), at present, 70.8 million people have been forcibly displaced worldwide (Edwards, n.d.) Because current authoritarian regimes are essentially a modern form of the feudal-authoritarian system, usually based on religious tradition and/or ethnic nationalism, socio-economic injustice and inequality, including gender discrimination and other human rights violations, tend to be inherent in their make-up. These issues, by no means unique to Middle East and North Africa (MENA) countries, triggered the so-called ‘Arab Spring/Upheaval’ in Tunisia in 2010¹, and subsequently spread throughout the region, resulting in what would become this century’s largest migration of peoples from MENA to western countries (Solati, 2017). However, the consequences of this rebellion have been dire: a refugee crisis triggered by the massive increase in migration; divided countries unable to establish institutions in support of democracy and human rights as a result of their long history of authoritarian rule (Anouti, 2018; Bendebka, 2020); natural resource extraction primarily benefitting foreign multinational corporations (Diop, Ndiame; Marotta, Daniela; de Melo, 2012) and; the involvement of foreign powers in countries affected by the “Arab Spring” (Ross, Kaiser, & Mazaheri, 2011) resulting in the former possibly being ensnared in civil wars that could last decades. Despite the collapse of dictatorial regimes in some MENA countries, nonetheless, democratic governments based on universal human rights have yet to be established. These refugees generally do not wish to return to their homelands. Refugees arriving in Turkey, the latter occupying both culturally and economically a kind of transitional space between MENA and Europe, express a desire not to remain in Turkey but prefer instead to settle in various developed western countries (Macer, 2015).

Although the refugees whom we interviewed expressed their support for peace and economic development in their homelands, they gave little attention to questions of gender equality, human rights, and democracy, all vital components of well-functioning western and secular countries. Traditional religious beliefs prevalent in MENA countries do not involve the principle of equality between women and men; moreover, gender discrimination itself is inherent in Islamic religious traditions that purport to protect the family, with the autonomy of women limited in nearly every aspect of life, including health care (Agich, 1995, 2014). Traditional beliefs and sharia law justify the control of both women’s attitudes and activities by men (Glas, Spierings, & Scheepers, 2018; Gouda & Potrafke, 2016). Therefore, the concept of human rights in patient care (Cohen & Ezer, 2013) is not well developed in MENA countries compared to most western liberal democracies. The majority of the countries to which MENA refugees migrate, including Turkey, have instituted regulations concerning patient rights both legally and from the standpoint of acceptable ethical practices (TC. Ministry of Health, 1998). Autonomy, one of the fundamental parameters of patient rights and a basic principle of biomedical ethics, ensures respect for the patient by ensuring their right to accept or refuse treatment. The patient evaluates the medical information provided by the physician and makes an autonomous decision regarding their treatment accordingly; these decisions may be communicated orally and/or in writing. If this process is not managed appropriately, the patient has the right to complain to their doctor; the legal equivalent of this complaint is also enshrined in criminal law.