Islamic Medicine History and Current Practice - International Society ...

Nuket ORNEK BUKENinsistence no further investigation was felt necessaryand the patient was discharged. After surgery thepatient’s speedy recovery improved his morale. Therewas no hypertension, diabetes or secondary illnessthat could have caused the blood clot. The event wasforgotten by everyone and no one was unhappy (4).Seven months passed. Symptoms of coughing andbloody sputum appeared in the patient. A pulmonarymedicine specialist was seen. This time a mass wasseen on the chest films that were taken. A biopsyobtained from the mass with bronchoscopy revealedthe adenocarcinoma of his brain metastasis’s primarysite and the patient was sent to an oncologist. Beforethe patient was seen by the oncologist he was warnedby the patient’s wife and the neurosurgeon not to tellthe patient that the mass removed from his surgerywas cancer. Whatever needed to be done to keep thisinformation from the patient was to be done. Theoncologist scathingly explained to the patient’s wifeall of the wrongs that were done in the dramatic sideof this scene of excessive pressure. He told her thatthe patient still had a chance at recovery becausethere was no recurrence in the brain and there wereno other metastases found outside the lungs. Ofcourse he added that if the mass had been found inthe lungs 7 months previously and treatment hadbeen begun his treatment chance would have beenhigher than it was then (4).The patient’s wife did not like the warnings or recommendationfrom the oncologist. She was only concernedabout how she was going to explain to herhusband what she had kept hidden seven months previously.She tried to place all the responsibility on theneurosurgeon who did the surgery. However the surgeonhad a relationship with the oncologist and toldhim the patient’s wife had insisted that he keep thediagnosis secret. As a result the sides could not cometo an agreement. The patient, who had an operablelung tumor with no other distant metastasis and norecurrence of brain tumor seen on the last MRI, wasnever seen by the oncologist and disappeared. Thereason is probably because the patient’s wife foundanother oncologist who was willing to keep the secretand condition from the patient. In fact in this entireevent the patient has been out of sight. What is seenis his wife who has the authority to make decisionson his behalf, the physician and the patient’s records.TRUTH-TELLING INFORMATION AND COMMUNICATIONWITH CANCER PATIENTS IN TURKEYEvaluation of the CaseIt is necessary to emphasize four important pointsin this case. The first of these is that the patient wasnot told the truth and the probable results of this. Inour case study, without determining how the patientwould confront and react to a diagnosis of cancer bya professional, the truth was hidden from the patientby an amateur making a completely emotional decision.Here keeping the diagnosis secret from thepatient was a situation that would hold someoneresponsible for the results and which needs to begiven legal sanctions. This attitude that is said to beonly for the benefit of the patient can never be consideredright. The process that kept the patient whohad possible treatment from receiving that treatmentmust absolutely be given legal sanctions.In the physician-patient relationships in our countrythe one who is primarily responsible for makingdecisions about the patient’s treatment is not thepatient but the patient’s next of kin. In particularwhen the diagnosis is cancer this situation is veryclear. The family members who see that they have theauthority to make decisions in the patient’s place givetheir motives as the patient’s morale, that is wouldnegatively effect them psychologically, or that theircondition would worsen if they were told their prognosis.Essentially the physician’s negative attitudesalso play a role in this understanding becoming takinghold. Sometimes the diagnosis is known byeveryone except the patient but the patient is not ableto receive this information without requesting it.An important second point is the condoning ofthis situation by the neurosurgeon from the beginningwhere his decision to operate was made not by thesufficient and autonomous patient but without hisknowledge by someone else. The patient’s right torespect for his autonomy was abused and the physician’sresponsibility to get informed consent was notpracticed. On the other hand the patient had the rightto know the whole truth about himself. Interventionsduring medical care and decisions that are appropriateto ethical concepts and values require that thephysician has great care and sensitivity. In fact theoriginal problem, beyond what type of method andthe kind of approach the physician should implementwhen faced with ethical problems, the medical pro-32 JISHIM 2003, 2