Wednesday, February 11, 2009


Yet another frustrating obstacle and issue to deal with when it comes to healthcare and managing patients.

Perhaps more so in the suburban and rural areas -which i happen of course to be working in, although i do at the same time have to say that 'civilisation' i realise is very much an issue of mentality because i've met my fair share of patients and their families or significant others who are very urbanised indeed but have the mentality and perspectives of cavemen!

Just to set the record straight there is such term (unless i coincidentally made up a term that happens to exist somewhere in the lost annals of the law) as "consent-by-proxy", so to speak.

Of course, there is the concept of a parent or guardian giving consent when it comes to children and those below the legal age but that is because of the fact that these individuals are deemed not entirely capable of making an informed decision on their own so as such the responsibility lies in the hands of those who are more able (i.e. parents/guardian).

And in other cases where the patient or the individual patient is unable or incapable due to whatever reason to give informed consent as in for example the case of certain mental disabilities and the like the next of kin or even a person appointed by a governing body (in some instances even a court of law) thereby gives the power of making such decisions to that person instead.

And in other cases still (which i think is exclusive to healthcare and the like) in which decisions are made on behalf of the patient or victim in situations that can be life-saving where the doctor (usually the case) makes the decisions and is given sort of an 'implied consent' to carry on with a particular procedure in the best interests of the person in order to prevent death... there is that concept of someone taking the liberty of giving consent on behalf of the recipient.

However, that's not what i'm talking about cos' in all these cases the concept is valid and even necessary.

What i am talking about is the frequent (well, disturbingly often at least) occurrences of patients who are themselves fully able of making informed decisions on their own and yet resort to and leave themselves at the 'mercy' of their husbands/uncles/aunties/even boyfriends who most if not all of the time do not know any better. And to make matters worse, are not experiencing the brunt of the pain and suffering and threat to life that the patients themselves are subject to.

Let me give an example and simplify it in as much as i can.
i recently was attending to a patient, a relatively young lady, who quite simply was in kidney failure.
She was already experiencing all the complications as a result of her problem but when i urged her to undergo dialysis which in her case is life-saving and could translate to many more years added to her life her response was... i need to discuss with my husband.

Now, i totally understand the need to include spouses and even family in the healthcare of patients and in fact in some cases it is even more warranted because it involves them inevitably in terms of lifestyle changes, logistics, emotional and mental strain and even finance.

However, in some case where there is no other option really and time is not on our side, the urgency and severity and most of all the potential benefit demands a complete response especially from the patient in question.

Still, i let her go back and discuss the issue with her husband.

To my dismay, she later on came back to me with the reply that they (or rather her husband) has decided that it is not necessary.


Sorry, did i miss something?!
Is your husband the one with kidney failure?
Is your husband the one suffering through the complications that ensue?
Is your husband going to suffer from eventual heart failure and death as a result?

of course i didn't say all this out loud. But i made sure that i got the idea across that the patient herself had to deal with her own problem and consent to it and not wait on 'every word that proceedeth' out of the mouth of her husband because she's 'paying' for it.

i know the Bible talks about the body of the wife belonging to the husband and vice versa but i believe that it means to say that the spouse must love and take care of their partner's personhood and even physical body as if it were their very own.

In some of these case i see, it's the direct opposite.
They seem to be harming the person instead of helping them!
i would go so far as to say that some of them are literally killing the very persons they are supposed to love and care for.

It's sad really.
Just sad.


Enviroman said...


Can you tell me how you got the favicon to display beside the blog titles in the blogroll in the sidebar?

Dr V said...

Really sorry...

you lost me at "favicon"

Enviroman said...

Please refer to customizing with favicon

The Intractable Nemesis said...

A really insightful article which is highlighting a very important point written from a very thought-provoking viewpoint...Brilliant!...By the way I also lost Enviroman at "favicon"... It was a truly bizarre and random response to your well-written and interesting entry...

Dr V said...

thank you for your generous compliments.

Much appreciated.