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25
April 1998
Balance
between Patients¡¦ Rights and Doctors¡¦ Discretion
(Keywords:-
drug withdrawal, contamination, patient rights, doctors¡¦
discretion)
It has been said ¡§you can only please some of the people
most of the time, but never all the people all the time¡¨. How
true. For the Hospital Authority (HA), what transpired in the last
few months could even be described as ¡§you can never please
anybody any of the time¡¨.
A few months ago when it was discovered that a certain
imaging material used on some patients for diagnostic procedures
carried albumin from a donor that recently died perhaps of
Creutzfeldt-Jakob Disease (CJD or Mad Cow Disease). Against the
better judgment of the authorities in Britain (the country of origin
of the imaging agent) that preferred to keep ¡§mum¡¨, HA decided
to come open, informing the public even to the extent of recalling
all patients who had received the agent to provide them with proper
counselling. There was, as expected, overwhelming emotional
distress. There was even hue and cry from both the health care
providers and others questioning the suitability of the open
approach -- after all, there is as yet no proof the CJD could be
transmitted through blood products -- why cry wolf?
Today, the HA stirred up another hornets¡¦ nest -- mothers
during labour were given an anaesthetic agent containing a
preservative. Extensive
literature research and reassurance from international experts
showed that no harmful effect exist. This time, the HA decided to
keep ¡§mum¡¨. Regrettably, the news got into the hands of the
media. There was, as expected, a horrendous outcry -- the patient
rights advocate groups accused HA of ¡§not crying wolf¡¨.
Is the HA right or wrong? More pertinently when is the HA
right and when is it wrong? In the case of the CJD, there is still a
suspicion that the disease could be transmitted through blood
products. It is thus essential that victims ought to be assessed at
regular intervals to ensure early detection of disease. It is also
important that these victims should avoid donating blood for fear of
similar transmission. Informing the victims under such circumstances
is thus essential for public good.
On the other hand, in the incident of preservative in an
anaesthetic agent, where there is universal support that there will
be no harmful effect, what benefit will be achieved by making it
public in particular informing identified recipient patients? Worse,
such could leave an unnecessary permanent psychological burden with
the victims that could stay for eternity.
It may well be said that every patient should know all about
himself and determine his own destiny. Regrettably when it comes to
one¡¦s own health, especially when it touches on possibility of a
terminal disease, most cannot come forward with a clear mind.
Unnecessary life long panic could descend onto the victims and the
families.
Take another example. Even with the progress of medical
science, it is not uncommon to hear occasionally the withdrawal of
drugs after years of common usage simply because of recent
discoveries of possible cancer changes in high doses in experimental
animals. How far should such be publicised? Should every single
health care institute be requested to trace past records and inform
those that could have been prescribed the drug? Is it prudent?
At the end of the day, it is not a wrangle between how much
patients should know versus how much to tell; rather it is a balance
between patients rights and doctors discretion all for a common good
-- the best for the patients. The onus is on the doctors, the
doctors bear the full responsibility, not only then but into the
indefinite future.
Few would deny that when it is a matter of life and death,
any action must be done with the highest degree of transparency. Yet
the spirit and the trust so strongly ingrained in the aged old
bondage between doctors and patients must be maintained and
nurtured. For without which, the Art of Healing will disintegrated
for the benefit of none!
(Hongkong Standard)
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