On-line version ISSN 2078-5135
Print version ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.100 n.4 Cape Town Apr. 2010
Medical electives in South Africa
To the Editor: I read with concern and interest the 'personal view' expressed by Matthew Kirkman,1 a foreign elective student.
I deplore the actions of the surgeon described in this report - to the point that I suspect this would constitute negligence and patient abandonment, and feel that this should be reported to the management of the hospital concerned.
I also need to share my concern that this young person has an undue issue with aspects that he describes as of 'ethical concern'. Firstly, as a trainee registered with the HPCSA, he was working in a training hospital, to which patients are admitted knowing that students may interact with them; no specific 'consent', written or otherwise, was therefore required, as it was implied by presenting themselves for treatment. The patient would have consented to the procedure, including, it is to be hoped, being informed that an assistant is required by law, to assist in all surgical procedures. The law does not state the level of assistance required, except that it is to be a medical assistant (which could include student, intern, CSMO, GP or specialist).
Secondly, he appears to have an incorrect balance of the ethical concepts: his concern for autonomy of the patient should be more tempered with justice and beneficence - doing the right thing in the best interest of this patient (in this case the dressing). In bringing into the argument the issue of the extent of the informed consent, he has lost perspective on the place he was at, namely intra-operatively: the patient had already consented to the procedure - the law again does not dictate the 'who' and the 'how'; that is medical decision making. This also begs the issue of students needing patient assent for bedside procedures, which is given readily, when requested in a professional and dignified manner.
Admittedly, the student felt out of his depth, which I sympathise with, but I agree that he made the best decision under the circumstances. Ethical principles apply to the group in general, and are applied on an individual basis as the patient's need dictates.
Thirdly, ethical dilemmas are confronted by doctors every day. This does not mean that the decisions are easy, or that there will be a ready option in every case. The ethical issues must be balanced with their application to the culture of the region, which differs markedly across the world.
Timothy C Hardcastle
Inkosi Albert Luthuli Central Hospital, and Department of Surgery
University of KwaZulu-Natal
1. Kirkman MA. Medical electives in South Africa. S Afr Med J 2009; 99: 789-790. [ Links ]