The patient doesn’t want to be saved, and yet, after he was saved, he was, back to his normal self, so, did the doctors do right, by going against the wishes of the patient??? Translated…
Should the Patients’ Views be Taken into Account?
My patient returned in a wheelchair, very refreshed, with a huge grin on his face, “Doctor, I’m truly grateful to you this time.”
Although I’d often heard things like this, but this time, it’d, touched me. I looked over at his eldest daughter who’d come from Kaohsiung to accompany him, then replied, “No need, actually this time, you shouldn’t be grateful toward me, but your own child.”
Returning back to last week’s midnight emergency room calls, this patient hollered out in there, “I’m already over ninety, I’d lived long enough, I don’t want anything done! Don’t do anything to me!” He was an elderly patient of mine, he’d been seeing me for twenty odd years now, this time, he’d felt cramped in the chest, dizzy, and nausea, was rushed to the E.R. by his son we’d found, that his pulse was less than forty, and, the medications didn’t do a thing either. At this time, the most standardized measure to take was to go to the operation rooms, spend time minutes, and, insert an electric wire through his veins, into his heart, temporarily connecting him to the pacemakers, then, his heart beats would be regular again, and thus, problem solved!
But, the patient had signed the DNR when he was in my office, and this time, he was lucid enough, clearly stated that he wasn’t, willing to have anything else done to him, what should we do? Should we, respect the wishes of the patient? But, on the other hand, it only needs a very simple set of measures, then the problem would be, solved, does he really expect us to, let him die?
At this time, the family members stated their different opinions, given us the right, to do what we believed to be right.
And, in the battling of our morale, we’d still, implanted that pacemaker in him, but the patient kept fighting it, screamed, struggled on, “Why? Why do I need to suffer through this sort of pain, I’m already ninety years old, and still need to be, abused by you all like this? Why?”
The elderly man of that age, is naturally, NOT strong enough, we’d suppressed the patient, and quickly, the surgeon on duty, Dr. Wang placed that temporary pacemaker inside of him, and, he regained his heartrate, then, we’d sent him back to the ward for further observations.
The Debate of Ethics in Medicine is a Multiple-Choice
Early next morn, I’d gone to the hospital room to check up on him, feeling quite unsettled; the ethics of medicine taught us, that we should always consider the patient’s opinions first, that the doctors shouldn’t, make the decisions on their own, we’d needed to make this shared decision. And yet, this time, in the panic that came late at night, we’d gone against the patient’s wishes, and placed that temporary pacemaker inside of him against his will, don’t know what sort of a reaction he will have today?
I’d bucked down, took along the resident, and the intern into the room, but, I was surprised to see him, lying comfortably, smiling, on the bed, like nothing had, happened.
I’d asked him a few simple questions regarding his conditions, did simple exams on him, and, I’d asked him timidly, “Uncle, we will be doing a small surgery on you, to replace that temporary pacemaker into a more permanent one, is that okay? That way, you get to get off the bed and move around.”
But, I didn’t get scolded, the patient looked me straight in the eyes, and without any hesitation, called out to me, “Okay!”
He didn’t have any doubt in his voice, I was so very surprised, didn’t dare ask anything else, just rushed with my junior associates out, and called to schedule the surgeries for him.
Later, the process went smoothly, a few days later, after all his symptoms subsided, the patient was discharged from the hospitals and went home.
Recalling, I’d still feel very scared, during that midnight hour, had the families not insisted, or that we’d insisted on following the wills of the patient, then maybe, the elderly man would not be here, but, is this right? If a person insisted on leaping off a cliff, should we, respect her/his wishes? If the patient is someone who gets swayed easily? Or, if the patient was clearly, making the wrong decisions about things?
The ethic debate in medicine, are often multiple choice, with NO set right answers.
So, this, is the ethics of doctors, like in the case above, had the doctors gone according to the elderly man’s wishes, then, he would not be sitting in the hospital bed, laughing when he did, and, the surgeon is now, wondering about, the ethics taking the patients’ wishes into consideration, when there a situation of life versus death.