Deciding the fate of others
DESPITE all the attendant complaints and struggles, our healthcare system is generally good and has many experienced doctors who have chosen to serve the nation instead of going overseas or the private sector. I would like to share some of the real-life stories of patients that have made us constantly stop to wonder who are we to decide on the fate of a patient.
1. The selfish husband: One day at the breast clinic, a woman was diagnosed with Stage I breast cancer. Her prognosis was good if she had total mastectomy with axillary clearance (TMAC) surgery. The risks and benefits of the surgery were explained to her. She looked indecisive and after thinking deeply about it, she consented. The date for the operation was set but when the time came, she did not turn up. She missed a few appointments for follow-ups and when she finally came back to the clinic, her cancer had progressed to Stage II. When asked why she did not come for the operation, she broke down and cried. She said her husband threatened that if she underwent the operation, he would divorce her as he could not accept a wife without breasts. In the end, the husband did divorce her as her affected breast was too foul-smelling and he could not stand the smell. The poor woman was deprived of her own rights to health. The surgery that was delayed for so long was finally done but the risk of recurrence is still imminent even with adjuvant combined chemoradiotherapy.
2: The mother who refused phototherapy for her infant: Neonatal jaundice is a common phenomenon. It can be classified as pathological (occurs less than 24 hours after birth), physiological (occurs within day one to day 14 of life) and prolonged (occurs after two weeks of life). The real danger of jaundice is when the bilirubin deposition is too high until it deposits in the brain, causing encephalopathy and permanent brain damage. A mother had just delivered her fifth child. The child was noted to have jaundice five days after birth. In view of the high bilirubin level, she was told that the child would need intensive phototherapy immediately. She refused despite being counselled a few times on the risk of permanent brain damage if bilirubin passed through the immature blood-brain barrier of the child. When exploring the reason for refusing treatment, she said her other four chil- dren were also all “Minions” (the yellow creatures in the Minions films) after they were born and they recovered naturally without phototherapy. She refused further discussion and insisted on getting the child discharged at own risk (AOR). She said she would apply some remedy oils on her baby.
3: The father who refused vaccination: Immunisation is an important step in preventing some previously deadly diseases which affect infants. Our Health Ministry has done a great job in drawing up a national immunisation schedule for all children, making vaccination accessible in health clinics and district hospitals nationwide. Although vaccination carries some risks to children, the benefits are undoubtedly greater than the harm. A baby was born vigorous and active. It was found out later that the mother refused any form of injections to be given to her baby. These include BCG vaccination and Vitamin K (which is important to prevent haemorrhagic disease in newborns). The parents were counselled on the benefits of vaccination and it turned out that the father was the one who was strongly against the injections being given to the baby. He said he had consulted his religious teacher who told him to let nature run its course. The mother would only allow the injections if permission was given by the father. Parents are the surrogate consent giver for the baby, not healthcare professionals. Situations like this would put doctors in a helpless position.
These cases are just the tip of the iceberg of what is really happening in our country from the healthcare perspective. It’s undeniable that people have the tendency to accept something to a certain extent and then refusing anything further. At the end of the day, we should question ourselves: “Who are we to decide the fate of others?”
HOUSE OFFICER Penang