MEDICAL ETHICS

Hauraki Plains Gazette, Volume XXXII, Issue 4310, 29 August 1921, Page 1

MEDICAL ETHICS

PATIENT AND PRACTITIONER

THE RIGHT OF CONSULTATION

The question of “medical ethics” has been a frequent subject for argument among members of the profession, as well as an occasional source of mystification to the lay mind. , An exceedingly interesting article on the subject, written by Dr* A. V. M. Anderson, of appears in the current number,., of the “Medical Journal of Australia.” The article was originally delivered as the first of a series of lectures to the medical students of the University of Melbourne. It- commences by quoting the 1 Hippocratic, oath, a code of medical ethics dating baclf to the fourth century, B.C. The oath begins: “I swear by Apollo, the Physician, by Asclepios, by Hygeia, and

Panaceia, and by all the gods and goddesses, calling them .to witness that I will observe this my oath and® carry out these my undertakings to the best of my power and understanding.” After swearing to honour him who has instructed me in tms art as I honour my parents,” the budding practitioner of the day affirmed several principles much in accord with the present-day ethics of the British Medical Association.

Various rules of conduct between doctor and patient are laid down, and after a virtuous resolve to “order my life in purity and piety so practise my profession,” the young doctor promised to observe several essentially practical rules of conduct. He swore that he would “yield to no entreaty to supply a poisonous drug nor give advice to him who demands it;’ 7 he swore not to give any wpman the means of procuring abortion; he swore “I will keep silence on that which I hear or see in the course of treatment or in everyday life which should not be repeated, holding such to be a secret.”

RIGHT OF CONSULTATION. Dr. Anderson holds that to speak of the of medical ethics-and etiquette is merely ignorant. “Medical §thics.” he says, “are simply a branch of general ethics.” According to the B.M.A. the distinction between ethics and etiquette is that transgression against the former would constitute an offence against ethical or moral principles, and that against etiquette would be a breach of good manners and’good taste.

The’writer has much to say on a doctor’s relations with his fellowpractitioners, and the man in the street will be particularly interested in his views on the ethics of consultation. “Speaking generally,” says Dr. Anderson, “it may be said that whenever,a consultation with an ethical practitioner is proposed by a patient,, or his ‘friends, the request should be acceded to by the medical man attending the patient. There is no loss of dignity or prestige in meeting a medical man in consultation, and the responsibility of the case is then shared by the 1 consultant.” Cases are laid down where a consultation is not only admissible, but> “specially required.” Dr., Anderson sots them out as follows: —

(a) When a question arises of the propriety of performing an operation qr adopting some course of treatment which may be dangerous to life oi’ permanently injure the patient, especially if the condition which it is sought to relieve be not itself dangerous to life. (b) When the question arises of the destruction of the unborn child in ther 1 interests of the mother:

(c) When the practitioner in attendance is definitely in doubt as v to the diagnosis or as to the treatment to be followed, ’and when delay in arriving at a decision might be fraught with serious consequences to the patient. (d) When there is evidence of serious doubt in the mind of a patient or ■ his friends as to the correctness of a diagnosis or the treatment pursued. (e) When the attendant .has reason to suspect performance of an illegal operation, administration of poison, or commission of any other criminal* offence. Where disagreement occurs between the ordinary medical attendant and the consultant, the former may state his disagreement and yet refer to the greater authority of the consultant, he may suggest a further consultation, or he may withdraw from the case. Dr Anderson emphasises “one of the strictest rules of ethics”: —that a consultant who has been introduced to a patient by the attendant must not see the patient again, except in consultation.

CHANGING THE DOCTOR. Another point in the article that is of great interest-'to the patient as well as the medical man is that bearing on the change of medical attendant. Dr. Anderson quotes the remark “patients are not any man’s property. They cannot 'be bought and sold with the practice. .The relation of medical man and patient, howevei* long continued, does not impair the right of the patient to consult another practitioner or break off the relations altogether at pleasure.” However, he lays emphasis on the desirability of certain observations both on the part of practitioner and patient. The latter should always intimate to his doctor —preferably by letter —that he intends making a change. While any person not actually under treatment is quite free to go for advice to a new doctor, it.is manifestly wrong that' a patient shouldJbe treated by two medical men independently at one time. In France a second;do£tor will not attend a patient until all the fees of the first have been paid. “The general principle,” says Dr. Anderson, “is that no medical man should endeavour to detach a patient from his ordinary medical attendant.” But this does not affect emergency treatment in the absence of the latter. The writer has wine pertinent remarks on the subject of doctors who volunteered for active service returning to find their patients attended by other men who had done little or nothing to help their country. “It behoves the latter,” he says, “to do all in their power to see that the patients return to their fornqer doctors.” The council of the Victorian branch of the B.M.A. has formulated a series of resolutions affirming this principle. Dr Anderson is a believer in “the old-fashioned family practitioner.” His attendance, he says, must be regarded as in the best interests of patient and doctor alike. The doctor is usually intimately acquainted with the medical history of members of the family; “he knows their,habits, constitutional weaknesses, likes,’

and dislikes, and is practically their father confessor.” When, by reason of emergency a substitute is called in by the former medical adviser, he must be as scrupulous in refusing after-aittendance as if he had been called in as consultant. Even where no such relation exists between the family doctor’ and the substitute, the latter, in Dr! Anderson’s opinion, should endeavour to refuse to accept any further work prejudicial to the interests of his fellow-practitioner.