Archive for the ‘Hippocrates’ Category

Hippocrates, Maimonides and the Perfume Canister Incident

April 25, 2008

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.” —Oath of Hippocrates (400 B.C)

Removal of lodged foreign objects in body orifices is expected in medical practice, but it occurs quite uncommonly. Whether it’s a little boy crying with a corn kernel trapped on his nose, or a grandmother in pain with a spiky fishbone stuck in her throat, or a homosexual humiliated with a light bulb caught in his butt, doctors and nurses always remove them. It’s their duty. Knowing their role, they defer judgment and blame. In these situations, there’s no cause to make fun of the patient.

We know there’s nothing more heart-rending than the sight of a patient in pain. We feel lucky not to be in the patient’s shoe. The doctor’s instinct is to allay suffering. They often do anything to help human beings in distress.

The nurses don’t invite on-lookers to break the dictates of hospital privacy. As a general rule, nobody is allowed to take pictures on patients having treatments. Hospital workers are expected not to gossip on patients in the corridors. They must earn trust. Patients can’t imagine a hospital where they can be put to shame.

Like the sin box of neighborhood churches where confessions are heard, our hospitals are supposed to be sacred grounds for respectful patient-doctor relationships. What goes on in the doctor’s room is protected by confidentiality and trust. Yet regrettably, at times, something goes wrong and we start asking why.

Primum non nocere. (trans. First, do not harm.)

That’s the first lofty ethical advice that doctors and nurses remember. We expect our care-givers to heed the holy caveat of comforting the sick first before they institute cure. Thy must abide with this rule similar to the pledge of the great physician Hippocrates and the prayer of the rabbinic philosopher-physician, Moses Maimonides (1135-1204 A.D.) which, in part reads:

“Grant that I may be filled with love for my art and for my fellow men. May the thirst for gain and the desire for fame be far from my heart. For these are the enemies of Pity and Ministers of Hate. Grant that I may be able to devote myself, body and soul, to the children who suffer from pain.

Preserve my strength, that I may be able to restore the strength of the rich and the poor, the good and the bad, the friend and the foe. Let me see the sufferer the man alone.

When wiser men teach me, let me be humble to learn, for the mind of man is so puny and the art of healing is so vast. But when fools are ready to advise me or to find fault me, let me not listen to their folly. Let me be intent upon one thing, O Father of Mercy, to be always merciful to thy suffering children.”

The ancient aphorisms embody what ethical medicine must be for all of us today. But we couldn’t fully understand why the clear moral norms set in medicine had been violated in Cebu’s government-run Vicente Sotto Memorial Medical Center.

A group of doctors and nurses assisting in the removal of a perfume canister in a patient’s rectum were caught jeering in glee and making fun of the patient during the procedure. The disgraceful footage landed in cyberspace’s You Tube embarrassing the patient, the nation, and the whole world.

Although there are tenets in the Hippocratic Oath and the Maimonides Prayer which aren’t strictly followed today (partly because medical practice has evolved through the ages,) humility, respect, and mercy for patients remain integral in the great physicians’ core exhortation. For their truism, such rule of conduct has been adhered to since pagan times.

The perfume canister controversy made us reassess our moral values. The overwhelming majority who learned of the incident thought it was sickening and downright wrong. Many condemned the hospital personnel’s arrogant indiscretion and blamed them for brushing aside the golden rule:

Do unto others what you want others to do unto you.”

For the infamy we earned, the Department of Health (DOH) called for an investigation and planned for a disciplinary action. A priest-spokesman of the Archdiocese of Cebu laid blame on the victim’s behavior and opined the incident shouldn’t have occurred if he didn’t engage in bestial sex. While others recommended those involved be stripped of their licenses, the priest asked for a review of the ethics curriculum under which the hospital personnel were taught.

Swept with emotional trauma, the patient, a florist, sued the hospital, a move that could have easily assured him of hefty damages if the case happened in a different country. Friends of the erring doctors and nurses however believed those involved don’t deserve punishment for they already “suffered enough for their misdeed.”

Ladlad, an irate group of lesbians and homosexuals plus the Bagong Alyansang Makabayan disagreed and demanded full disclosure of the doctors’ and nurses’ names—something the authorities often won’t ordinarily do for reasons that weren’t justified. But they did it anyway for this case.

There were those who couldn’t forget the protests incited by ABC’s Terri Hatcher’s suggestion in a TV sitcom that our doctors aren’t competent. According to them, the incident proved that Terri was correct after all and we have little basis to whine. Some were convinced it would be hard to keep the world supporting us if there had been other evidence that cast doubt on our medical professionals’ integrity.

Yet, whatever the outcome of this case, the need to upgrade our medical ethical standards is self-evident. By any means, our mistake isn’t tenable and a re-calibration of our moral compass is required.

Hippocrates and Maimonides still speak to us on ethics and moral behavior that have applications outside the hospital setting. But the hideous perfume canister incident makes us wonder if similar incidents would happen again.=0=