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Year 2 Semester 1 PPSD Session on 08th August 2008 by Professor Omar Hasan Kasule Sr.
Background
Puan Fatimah went to hospital because she was not feeling well. Physicians took history, made a physical examination, and took blood for laboratory tests. Her medical report was as follows:
Q1. What are her medical problems?
Q2. What advice would you give her?
She was advised to visit the neighborhood health clinic twice a month for monitoring. She came the first time and did not come after that. The clinic nurse got worried and while in the market saw Puan Fatimah and talked her about attending. Puan Fatimah said she was feeling well and saw no reason to come to the clinic. At a funeral the nurse saw Puan Fatimah’s husband and gave him all the details of the condition with the emphasis that he should convince his wife to come to the clinic. When there was no response from Puan Fatimah the nurse got desperate and told the doctor in charge of the clinic. The doctor was angry and decided to write a letter to the village head, Ketua Kampong, asking him to help convince Puan Fatimah to come for treatment. To make the case stronger he summarized all details of the condition so that the Ketua Kampung would understand the seriousness of the case.
Q3. What ethical issue(s) arise(s) in this case so far?
The Ketua Kampong acted quickly. He went to Puan Fatimah’s house to try to convince her to go to the clinic. Puan Fatimah flatly refused saying that there were two women in the village with conditions similar to hers. One went regularly for treatment at the Health center and died within 6 months. The other one used traditional medicine and is still alive 5 years later and recently got remarried after the death of her first husband. The Ketua Kampung begged her to go to the clinic at least once for his sake. She reluctantly agreed to go with him in his car.
The doctor who examined Puan Fatimah at the clinic was very worried because her blood pressure has risen to very dangerous levels. He told Puan Fatimah and the Ketua Kampung that immediate hospital admission was needed to avert a catastrophe. Puan Fatimah refused and returned home by taxi refusing a ride with the Ketua Kampung. That evening the doctor called Puan Fatimah’s son who was his friend from school days and was working as a teacher in another town. Together they worked out a plan to deal with the situation.
Q4. What ethical issue(s) can you identify here?
Puan Fatimah’s son visited her and lied to her that his nephew was very sick in the hospital and that they should visit her. When they got to the hospital, Puan Fatimah was led to a darkened room and was told to lie down on a bed. While she protested and asked what was going on the doctor quickly injected a sedative on her upper arm and she immediately calmed down. Nurses came in and undressed her. The doctor made a thorough examination and she was started on treatment.
Q5. What ethical issue(s) do you identify here?