Sick persons have rights and obligations
CONCERNED daughter’s letter, “Duty to advise all patients prior to medical procedures” (The Star, June 19), highlighted the importance of informed consent.
Medical investigations and procedures in general can be divided into invasive and non-invasive categories. Invasive procedures have an inherent complication rate – and even mortality rate – wherever it is done and whoever does it. For example, a liver biopsy has a complication rate of five in 1,000 and a death rate of five in 10,000.
When a doctor does any invasive medical procedures, an informed consent has to be obtained. The patient has to be informed of the procedure, any alternatives and possible complications.
Even simple intravenous sedation given for tooth extraction may be complicated by over-sedation and acute allergic reaction (anaphylaxis). Death must not be masqueraded behind euphemisms like life-threatening complications. How a doctor obtains an informed consent and not deprive a patient of a life-saving procedure is down to tact and experience.
Non-invasive investigations or procedures like ultrasound, taking blood and digital (the finger kind and not the computer type) rectal examination, while having minimal complications and no mortality, still cause some discomfort to the patient. Although non-invasive investigations do not need a formal signed informed consent, a doctor still has to get verbal consent and communicate in order to carry out these procedures. A doctor can’t very well insert a needle into a patient’s vein or a finger up his anus without asking for his permission and cooperation first.
On the other hand, it would be unreasonable for doctors to get a formal signed informed consent even for non-invasive investigations and procedures.
The moment a person accepts the “sick role”, he becomes a patient. The concept of the sick role was created by American functional sociologist Talcott Parsons in 1951. Parsons theorised that a sick person has two rights and two obligations.
The two rights are: (1) the sick person is exempt from normal social roles; and (2) the sick person is not responsible for their condition.
And the two obligations are: (1) the sick person should try to get well; and (2) the sick person should seek technically competent help and cooperate with the medical professional.
So you see, consent for treatment is implicit within the social contract between patients and the medical profession. Trust is the glue that cements a patient-doctor relationship.
Looking at the second obligation from another angle, the sick person must be able to trust the doctor to be technically competent. If there is no trust, then this social contract cannot be fulfilled.