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Material by Professor Omar Hasan Kasule Sr. for Year 3 Semester 1 Med PPSD session on 3rd November 2008
Background
X was a brooding type who was always sad. The beginning of his marriage was stormy with the wife feeling that he had no interest in marriage at all. Always quiet, despondent, and dozing or sleeping all the time. He could sit for hours on end doing nothing. He also was very slow in whatever activity he undertook. The wife insisted that he see a psychiatrist. The psychiatrist concluded after several meetings that this was a case of endogenous depression. He referred him to a physician for assessment of thyroid and pituitary function. No physiological anomaly was found. The condition got worse with virtual loss of speech spending 2-3 days without uttering a word. There was also deterioration in self care missing meals, poor personal hygiene, dirty and unkempt hair and clothes. He had a mental break down when his wife had a spontaneous abortion of a 3-month pregnancy. He was taken to the hospital emergency room. The attending physician finding nothing physically wrong with him decided to discharge him. The physician ignored the repeated talk of the patient about following his dead baby into the grave and just gave him valium and sent him home. When the effect of valium wore off at home he became agitated. His wife found him 10 minutes later lying unconscious on the bed with a half-empty bottle of detergent next to him. She called an ambulance that arrived in record time. By the time he was seen by the physician in the emergency room, he had recovered some consciousness and could talk. He told the physician that he wanted to die. He categorically refused to consent to the procedure of gastric lavage to remove the detergent from his stomach. A psychiatrist called to assess his mental competence concluded that he was competent to make decisions.
Discussion:
- List and explain ethico-legal issues in this case.
- Was there any medical negligence? Give your reasons.
- What would you do if you were the physician in the emergency room who wanted to carry out emergency gastric lavage? Justify your decision