Medicolegal: Issues of Consent, a minefield; Recent HK "wrong organ" case« Back to Questions List

Posted by admin
Asked on 05/17/2019 5:34 pm

Consenting requires both the person taking the consent to make many assumptions & deliver information that the recipient, hopefully, fully understands. In other words, there ought to be a meeting of minds but in reality, there is often a mismatch of the expectations & the process , often is like walking through a minefield that needs to be carefully negotiated at every turn.

Medical practitioners were once said to be full of jargon. Maybe so but the world today is a lot less daunting when terms & phrases are thrown around. There is Google. There is wikipedia!
Alas, though lots of electronic help in hand – pain & illness – often clouds the mind. There is also a reluctance to listen as patients in hospital are psychologically ”turned off”. So, where there is a decision that needs to be made or addressed, it is prudent for the information to be repeated, more than otherwise is necessary.

Nurses used to carry out the role of communicating with patient, family members & other ancillary staff also caring for the patient. In Singapore, there is often an issue with the lack of communication skills as many nurses are foreign trained & are not always fully conversant in the English language or in dialects, for instance. Therefore, all the information transfer is carried out by medical practitioners themselves. Often at the point of consultation, there is so much information that needs to be processed that patients find it daunting & overwhelmed.

In Aged care & in children, there is the added complexity. Ageing need not necessarily mean loss of cognitive function. It may be that the elderly is tired or is not responsive to the conversation. There lies a dilemma of a person fully able to consent but is not attentive or distracted to be able to understand enough to provide sufficient understanding to satisfy the requirements of an informed consent. What would you do? If it is an elective procedure, there is not that urgency & there are other means of dealing with the issues of consent.

Recently, it was reported that a surgeon here in Singapore was asked by a colleague from a different speciality to give an opinion during the progress of a surgery. While he concurred with his colleague who was operating at the time, he could not get involved for the lack of consent. It is unfortunate – as this means – that the patient will have to undergo another surgery should this other problem needs to be rectified.

This issue came to light recently in Hong Kong when a surgeon was accused by the Medical Board of operating on the wrong organ. In his defense, he said that while he was attempting the surgery for which the patient had consented for, he had noticed something more urgent at the time of surgery. He therefore, addressed the emergency & left the elective as the patient would have otherwise died from this other issues.

The case is on-going & the surgeon is suspended. Such cases will keep coming up in light of the elderly & ageing issues that we face. Ageing comes with many complications & sometimes, it may be that a generic consent is given to cover for any of the un-forseen. But then again, that is blanket consent which may be detrimental as patient autonomy means that patients ought to have a say to what ever happens to their own bodies.

This is only the beginning of many more interesting cases to come from the deluge of ageing population in this region & the world over.
Consent or not to consent – we decide – or at least, it’s for every party to try for the best.

Posted by admin
Answered On 05/17/2019 6:11 pm