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Should doctors go beyond advising patients?

An article questioning responsibility of a neurosurgeon triggers debate on ethics

A physician from Mahad in Raigad district has triggered a debate on whether doctors should just advise professionally or go a step ahead.

In the Indian Journal of Medical Ethics, Dr. Himmatrao Bawaskar has cited a case of a 25-year-old pregnant woman who found out that her husband had been suffering from brain cancer before their marriage only when he secretively gave his medical history to a doctor after an accidental fall. While the marriage ended with a divorce on the same ground, Dr. Bawaskar has argued that it was the responsibility of the patient’s treating neurosurgeon to warn him against the marriage due to his incurable condition and high risk of mortality.

“Is it not the duty of a responsible treating doctor towards a patient with a life-threatening condition and his parents, to counsel them on marriage? A doctor occupies the position of a respected adviser and his counsel would surely be considered seriously,” Dr. Bawaskar wrote in the article published this month.

It has now become a talking point within the medical fraternity.

Dr. Bawaskar, who is known for exposing the deeply ingrained ‘cut practice’ within the profession, told The Hindu on Sunday that doctors have to move beyond the mechanical and commercial approach towards their patients.

The case Dr. Bawaskar has cited is from Buldhana. The couple, both engineers, got married in 2014 and everything went well till last year when the husband fell off his two-wheeler and became semiconscious. In the hospital, the husband secretively revealed to a resident doctor that he had been detected with grade IV glioblastoma multiforme — a rapidly spreading tumour — in 2012 and that he had undergone a craniotomy (temporary removal of flap of skull bone) for removal of the tumour, followed by chemotherapy and radiation. The scar that this surgery had left was passed off as a road accident injury by the husband and his parents.

During the medical investigations last year, it turned out that he again had a metastatic brain tumour with big cystic changes and had to be operated. After the surgery, the wife questioned the neurosurgeon on why he had not warned her husband against marrying. The neurosurgeon had said that matter concerned only to the patient and his parents. Given that he performed a huge number of brain surgeries, it was difficult for him to counsel every patient.

“The wife obviously felt cheated. Her husband’s surgery and the concealment of facts took a toll on her health too and she eventually had a stillbirth. The couple divorced soon after,” said Dr. Bawaskar, adding if the neurosurgeon had advised properly, two families would have been saved from the trauma.

Medical experts said Dr. Bawaskar has raised a tricky question and that there is no uniformity on how much a doctor can advise. For example, should a doctor advise only when he is asked a pointed question? Or should he advise proactively?

The scenario also changes completely if the patient is suffering from an infectious, transmissible or genetic disease, which will directly have an impact on the partner or the offspring. “Doctor should definitely provide fair advice. But isn’t it a bigger responsibility of the man and his family to be truthful?” a doctor asked.

In a comment, neurosurgeon Dr. Sunil K. Pandya has stated that the woman and her parents should have been provided details of the illness and prognosis by the patient and his family. “An instruction to this effect from the doctor to his patient would have been correct and salutary,” Dr. Pandya wrote, citing a case where a jilted lover had confessed his intent to kill a woman, to a doctor and eventually murdered her.

The California Supreme Court order held that a medical professional has a duty not only to a patient but also to individuals who are in danger consequent to the acts of that patient.

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