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Year 2 Semester 1 Medical PPSD session on 13th August 2008
Background
Pakcik Ahmad had retired from the army after 35 years of active service. He was healthy at retirement and fumed at the retirement regulations because he felt that he still had the physical energy needed to serve longer in the army. Two years into his retirement Pakcik Ahmad started worrying about his own health because his elder brother Ali Rustam died suddenly. The doctors said that he died of heart disease. Pakcik Ahmad thought that if his healthy and athletic elder brother could die so quickly he also may meet the same fate.
Pakcik Ahmad went to the government hospital. He did not know how to present his case. Since his youth he knew that people went to hospital only when they are sick. He did not have a good reason for seeing a doctor. He thought of feigning some illness so that the doctors may make a full examination and assure him about his health. He however discarded that idea because as a soldier he could not lie. He decided to tell the whole truth to the nurse at the reception desk. ‘I am here because I am worried about my heart. My elder brother died of a heart attack last week’. The nurse asked whether he had any pain or any specific complaint. When he replied that he had none, she was angry at him for wasting her time saying ‘Look at all this long line of really sick people!. You are healthy and yet want to waste our time. Go away’. Pakcik Ahmad went away disappointed and humiliated. He would have like to see a private doctor but he could not afford because his army pension was not adequate.
Q1: Discuss the ethics and cost-benefit of preventive medicine as compared to curative medicine.
Two years later Pakcik Ahmad collapsed. He was rushed to the hospital and a clinical diagnosis of cardiac infarction was made. Treatment was started but he died after a few hours. The death was so sudden that the doctors were not completely sure of what was the cause of death but as was the custom they did not think of doing a post-mortem to reach a diagnosis.
The family as required by regulations informed the army of the death of Pakcik Ahmad before burial. The army officials immediately contacted the hospital and asked for a postmortem examination to establish the cause of death. The doctors consulted the family who were furious at the mere audacity of the army suggesting mutilation of Pakcik Ahmad’s body. Pakcik’s elder son went to army headquarters to meet the officer in charge of affairs of retired solders. The officer explained that it was in the family’s interest to have the post-mortem done. The army will pay terminal benefits to the family on the death of a former soldier. The amount paid depends on the cause of death. If the cause can be related in any way with the health risks during the period of army service, full payment is made. If the cause is not related, only nominal compensation is paid. When the elder son gave the news to the other members of the family, divisions appeared. Some wanted to allow the post-mortem to be carried out while others did not want it.
Q2. Discuss ethico-legal issues involved in postmortem examination