Fundamental Right of A Patient

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MY ex-colleague sounded flustered on the phone. Anguished, even. “Albert, I really don’t know what to do. My husband’s doctor called me. He would like my husband to undergo more CT and MRI scans. You know, my husband has an advanced incurable cancer of a rare kind. He is in a semi-comatose state. He has not long to live. Perhaps weeks, perhaps days.

“His doctor said that he needed the scans to monitor his progress. The doctor also wanted to use the scans for teaching trainee doctors and medical students.”

Professors, scientists and doctors have always resorted to humans, their blood and tissues, their x-rays and scans, to teach and instruct their students. We also use cadavers.

There was once a disreputable practice called body-snatching. In the nineteenth century and before, it was not legal to dissect a corpse, apart from those condemned to death by the courts. Unsavoury characters used to procure the bodies of those who recently died (usually by digging graves) and supply them to the medical profession.

Doctors dissected these cadavers and learned about the human body. The Anatomy Act of 1832 made it easier. Patients who died in hospitals could be used. However, doctors who wished to dissect a human body had to obtain a license from the Home Secretary.

Without patients, there can be no progress in medicine. Patients are recruited into clinical trials. This is the yardstick we use in ascertaining if a new drug truly works.

The hundreds of thousands of patients who have participated in clinical trials are the true heroes of medicine. Without them, we will not be able to confidently prescribe drugs the way we do, whether it is for cancer, heart disease, stroke, arthritis or diabetes, or for any disease for that matter.

She continued, “I don’t want the doctor to think I am uncooperative or ungrateful. After all, the doctors have treated my husband well the past year. But, Albert, he is so ill and there is no point subjecting him to more procedures. It will only stress him further.

“Truth be told, I feel guilty. I feel bad if I deny the doctor his request. At the same time, I want my husband to die peacefully and with dignity.”

“Was the doctor insistent? Did he hint that your husband’s on-going palliative care will be compromised if you do not agree to his request?” I asked.

“Oh, no. He was nothing like that. But I must say he played on my sentiments. He spoke about how much the scans would contribute to the teaching of medical students. And, by the way, the doctor also let on that he was preparing a paper about my husband’s case for publication.”

For doctors, who are advancing their careers, it is ‘publish or perish’. Promotions are much dependent on research activities and publications. For those with many publications of repute, rewards go beyond a promotion. Speaking engagements and trips to conferences in exotic locales are in the offing. There is also peer recognition and peer respect to bask in.

There was no doubt in my mind about the advice I would give her. “To me, your husband’s welfare and your wishes count. This is the first principle of medicine. It should be the last. Please tell the doctor politely you do not wish your husband to undergo more scans. You do not have to justify your decision.

“In any case, your doctor has to obtain your written informed consent if your husband’s blood, tissues or x-rays are to be used for any teaching or research purpose.”

I want to be very clear on this issue. This is all about fundamental human rights. No patient or person should be coerced to be physically examined or to be treated without her consent. The same goes with blood and tissue samples.

No organ (eye, kidney, lung, heart) should be harvested from those who have died without a living will or an advanced medical directive. No data of any patient shall be used for research or teaching without the patient’s (live or dead) consent.

The question of guilt, conscience or charity does not arise. In any case, charity is not charity if forced or guilt-ridden.

My ex-colleague politely turned the doctor down. I hope the doctor accepted her decision with grace and understanding.

It was right for her to say no. It was her right to say no.

(Written by Dr Albert Lim Kok Hooi)