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Background material by Professor Omar Hasan Kasule Sr. for Year 1 Semester 1 Med PPSD session on 22nd October 2008
Background
Awang Bangkok presented with neck abscess. The attending physician formed an opinion that the abscess has to be drained surgically after a course of antibiotic therapy. While being admitted, the nurse asked Awang Bangkok to sign a consent form giving the hospital general permission to treat him medically and surgically. He was taken back by the mention of surgery and asked for clarification from the physician. The physician was surprised because this was the first time in 20 years of practice that a patient had doubts and questioned what was going to be done. He had been used to complaint patients who always trusted that the physician knew best.
Smelling trouble the physician decided to play safe by telling Awang Bangkok that he will be treated by injections only and surgery would not be needed. After 4 days of antibiotic therapy the abscess showed no signs of subsiding and a consultant surgeon who examined it decided it was time to incise and drain it surgically. Awang Bangkok refused to even discuss surgery. He flatly refused saying that his elder brother with a neck swelling died as soon as he was anesthetized and that he had vowed never to undergo an operation. The surgeon left to think about what to do next but had to be called back within only 30 minutes because the abscess had burst and required immediate surgical drainage. Awang Bangkok still refused surgery and had his wife and sons swear on the Qur’an that they would never give consent to surgery if he lost consciousness.
In view of the immediate danger to life the surgeon ordered the nurses to give Awang Bangkok a sedative in a regular drink without his knowledge so that as soon as he fell asleep he would be anesthetized and the surgery would proceed. The nurse who had experienced litigation on a similar case while training overseas advised that the hospital contact the high court for permission to carry out the operation. Nobody listened to her and they told her there was no time for that since surgery had to be carried out immediately. Awg Bangkok recovered from the operation and while recuperating in the hospital asked his family lawyer to file a court case against the surgeon and the hospital
Discussion issues
- Identify 2 ethical violations in this case (non-disclosure, informed consent, violation of confidentiality)
- Describe how you can convince a patient to undergo surgery using religious and ethical/moral arguments;
- Describe how a court of law could take action in cases of refusal of treatment;
- Identify conflicts between human rights and requirements of medical treatment.