Ethics and Laws
Sukhit Phaosavasdi MD*, Surasak Taneepanichskul MD*, Yuen Tannirandorn MD*, Vorapong Phupong MD*, Boonchai Uerpairojkit MD*, Chumsak Pruksapongs MD*, Aurchart Kajanapitak MD*
Affiliation : * Member of Medical Association of Thailand
One evening a twenty-four-year-old woman who had been pregnant for 35 weeks came to the hospital due to premature labor pain. The doctor found that the muscles of the uterus had contracted early so he prescribed an intravenous injection of Terbutaline (Bricanyl) to stop the contractions. Two hours later, USG was performed and placenta previa partialis was found. The contractions increased in frequency and some blood was discharged through the birth canal. The cervix was dilated to 1 finger. The doctor decided to send her to a provincial hospital as he could not stop the delivery(1). At the provincial hospital, after examining the USG, a doctor found that the fetus’s heart was not beating thus, decided that the baby should be delivered. Another doctor found that the fetus was positioned with its buttocks down thus, decided to perform cesarean section. During the operation, the mother suffered shock and there was a DIC complication, which required many blood transfusions. In addition, the doctor found that the fetus was dead in the uterus and the placenta was rotten. It was assumed that the fetus has been dead for more than 24 hours. The mother had to be in ICU for 5 days before being discharged. The community hospital that sent the mother to the provincial hospital was criticized. Questions such as “Why did you give Bricanyl to a pregnant woman who had a placenta previa?” was asked. After the mother was discharged, it was rumored that the doctor at the provincial hospital had said that “The baby was dead before coming here. If the mother wants to file a lawsuit against me, she is welcome. Didn’t the doctor at the community hospital realize that the fetus’s heart wasn’t beating?” The mother’s relatives came to ask what had happened and whether the doctor had done anything wrong. They were upset because they thought that the hospital had not given the proper treatment(1). There are times that some groups of people confuse the public because of the words they use. While the words seem to mean the same thing, they are actually different in meaning. Two words used to illustrate this point are law and ethics. Ethics includes six principles: rights, improper conduct, proper conduct, honesty, secrecy, and justice(2). Law and ethics are included in medical classes and seminars. Some medical students may think that law and ethics are new to them because they lack maturity and experience. They can’t decide whether they should follow the teaching content, the teaching methodology, or the instructor’s conduct. It is hard to predict how then law and medical ethics affect these students. However, it can be said that disorientation may arise(3). From the aforementioned example, it can be assumed that the services provided for the female patient were not up to standard. What the doctor did was not right according to the rules and regulations of the Medical Council, specifically sections 1, 3 and 4 stated in 1983 Profession Ethics(4). One way to make ethics teaching interesting is to give examples leading to rules and regulations that an instructor intends to teach. In those cases, students spend most of the time talking about the examples in detail without realizing that they are studying medical ethics(3). Based on the doctor’s words given above, it seem that the doctor may not have been honest to his profession and did not treat his colleague in the right way. What he did cannot be used to support whether he had acted properly. We do not know what was written in the patient’s file, especially about the death of the fetus in the uterus and the deterioration of the placenta. However, it seems that there was no record about the fetus’s heartbeat and the most important thing, the pathologist’s findings(5).
Keywords : Sue, Medical ethics
