Chukwudi Christian EGBARA
Department of English
University of Ibadan, Nigeria
- What other need could be more pressing to a physician than to tend to, and save, a patient who is dying in labour?
- Why should a patient’s social status determine the level of medical attention paid to him or her in Nigeria and/or Africa as a whole?
Bioethics, as one of the research subspecialties of medical humanities, is a body of rules that serves as a compass for regulation of the conduct of physicians and allied health workers in clinical dealings with their patients. It has different though related meanings in the life sciences, environmental studies, medical sciences and technological sciences. With its relevance across disciplines, medical ethics encapsulates the probe into various implications of bioethical conducts by pharmacists, laboratory scientists, nurses, physicians and other caregivers; thereby unearthing the consequences of their decisions and actions on the patients across climes. In view of this, the Encyclopaedia of Bioethics views bioethics as the ‘systematic study of the moral dimensions – including moral vision, decision, conduct and policies – of the life sciences and health care, employing a variety of ethical methodologies in an interdisciplinary setting’ (1995: 6). In its own definition, the International Association of Bioethics streamlines the concept of bioethics to the ‘study of ethical, social, legal, philosophical and related issues arising in health care and the biological sciences,’ (3). Mirjam Sophia Clados projects a broader scope in her submission that biomedical ethics is ‘commonly understood as all considerations about ethical implications of and within medical practice, dealing with questions of ethics as they arise with regard to the diagnosis and treatment of disease, health promotion and disease prevention, the relief of pain and suffering, and the care of the ill,’(2012: 10).
Arnott et al. in Proposal for an Academic Association of the Medical Humanities explain the focus of medical ethics, thus:
This intellectual lineage, Medical ethics, also focuses its attention on issues where moral values are in doubt or crisis. Medical ethics, and more recently bioethics, thus bring into prominence for the medical humanities end-of-life care and decision-making, as well as reproductive medicine. Medical ethics prioritises effective communication across and between all stakeholders in the healthcare setting or context, (2001: 20).
The above definitions are reflective of the labyrinths of biomedical ethics, operationalizing medical encounters and therapeutic relationship between health workers and their patients. By examining how literary narratives have been deployed to question some biomedical ethical issues, scholars of medical ethics have projected the importance of human subjectivity in clinical encounters by asking how a physician should navigate the tricky path of the intersections of societal pressures and the ethical demands of the profession. The questions for ethical probity within the medical profession include: Should a doctor circumvent extant ethical injunctions to please family members? Why should the autonomy of informed consent of the patient be trampled upon just for the exigency of the powerful? Why should the consent of the patient be count for nothing in clinical encounter? Some answers to these questions have been treated by the Hippocratic Oaths and various editions of Geneva Declaration (1948), which contain provisions for improved medical relations between physicians, allied health workers and their patients. These and other country-specific medical codes have been formulated according to cultural peculiarities, and made to accommodate certain environmental and traditional dynamics as they relate to modern realities in clinical operations.
In parts (A and B) of the Code of Medical Ethics in Nigeria, Rules of Professional Conduct for Medical & Dental Practitioners (2004), containing the declaration by a prospective medical or dental practitioner, the following pledges are expected to be made at induction:
I shall exercise the several parts of my profession to the best of my knowledge and ability for the good, safety and welfare of all persons committing themselves to my care and attention, and that I will faithfully obey the rules and regulations of the Medical and Dental Council of Nigeria and all other laws that are made for the control of the medical and dental professions in Nigeria. […]I hereby subscribe to the PHYSICIANS’ OATH as follows: I SOLEMNLY PLEDGE to consecrate my life to the service of humanity; I WILL PRACTISE my profession with conscience and dignity; THE HEALTH OF MY PATIENT WILL BE my first consideration (2004: 7; emphasis in original).
Suffice to state that contrary to the provisions of this code, which are invoked at the beginning of medical practice, certain medical practitioners have violated more than comply with their commitments. The level of faithful subscription to these solemn pledges and other ethical proclamations leaves much to be desired, and this will form the crux of the discussion in the following section. These violations have constituted thematic foci areas for medical humanities scholars and researchers, who continue to interrogate them in literary narratives, pathographies, autobiographies, observers’ narrations – in the physician-writers’ oeuvres and allied caregivers’ accounts. These manifest abuses pose daring threats to the essentiality of biomedicine, which is – to care, to cure in order to save lives.
Not too long ago, at a Federal Teaching Hospital in the South East Nigeria, there was a reported ethical case of possible medical infraction by a medical doctor. This doctor was formally assigned to a night shift. However, for reason not officially communicated, he absconded from duty that night and left for his home. There is little or no need to state that many Nigerian hospitals lack sufficient and competent medical personnel. On the night when a pregnant woman who was in labour was rushed to the hospital for medical attention, this doctor was nowhere to be found around the hospital. All calculated and frantic efforts made through a series of phone calls and text messages put across to the doctor for him to return to the hospital when the condition of the woman deteriorated, proved abortive. The physician neither took his calls nor returned the calls and messages sent to him. The resultant effect was that the mother and the baby eventually died from the referred pregnancy, and regrettably so. The family subsequently sought relief from the court of justice. The family of the deceased woman sued the doctor together with the hospital and won. After adjudication over the matter, the deceased’s family was paid compensation. In view of this ugly scenario, the strain in physician-patient therapeutic relationship is foregrounded. Although justice was served, and the erring physician punished, there is no critical documentation of the event for further cross-references available to the public, safe for this. This is one of the avalanches of underreported and undocumented clinical encounters in doctor-patient relationship that occurs nearly on daily basis at some hospitals in Nigeria. Further research would be conducted to unearth some of these medical theatrical infelicities.
Mr. Mark’s Daughter
“I lost my daughter because the doctors select who they treat first at the hospital”, a man recounted as he narrated how his daughter died at a popular hospital in Abuja, Nigeria. Mr. Mark (pseudo name for the sake of ethical confidentiality) has his family based in a state in the North Central Nigeria, while he lives and works with one of the companies in Abuja. The daughter took ill and was rushed to a University Teaching Hospital in the state. After some treatments, the physicians at the Teaching Hospital referred them to a specialized hospital in Abuja for a better treatment. Having been admitted, treatment began. Subsequently, against their expectations, doctors’ attention to the patients became sluggish, selective and discriminatory at the hospital. There was an interplay of power-based discrimination in the course of responding to the healing needs of the patients.
According to Mark, the flamboyance of the dressing/appearance of the relatives of the patients determined the level of care and attention given to the patients. “The pharmacist delayed in bringing the drugs requested by the doctor,” Mark recollected, “because my daughter is not a daughter of a senator or a big politician”. Angered by the delay, Mark went to the pharmacy section of the hospital to inquire about the cause of the delay and an argument ensued. Out of curiosity due to overstay of her husband at the pharmacy, the wife, Kindness who was sitting beside their sick daughter on the hospital bed, again, went to find out what was happening at the pharmacy. The pharmacist on duty was reluctant in dispensing the drugs because there was no mark on the paper showing it was for an upper-class patient or a patient of interest. It was alleged that the hospital had a system of indicating the class of patients among the health-care workers. On getting to the pharmacy, one of the pharmacists at the counter, who studied at University in the state where Mr. Mark’s wife plaits hair for students, immediately recognized her. Kindness could not immediately recognize her in return, but after exchanging pleasantries, the former student introduced herself and explained how Kindness was considerate to her when she hadn’t enough money to pay for her hair as a student. Strangely, and quite unethically, it took the intervention of this former student, now a pharmacist for the drugs to be brought without further delays. Unfortunately, however, before the pharmacist’s mediation began to yield the desired result, the health condition of their daughter had gone from bad to worse.
These stories, among other biomedical ethical encounters, contextualize ethical challenges, breaches, abuses and malevolent violations that are being displayed and witnessed on daily basis at the Nigerian hospitals, health centres and clinics. Many unprofessional conducts abound in the Nigerian health sector. The stories seek to draw attention to some of these practices to assist policy makers, public health stakeholders, physicians, nurses, and allied health-care givers for empathy and more humanized physician-patient therapeutic relationships. This contributes significant to entrenching the call for stricter adherence to ethical codes in all medical encounters within the Nigerian medical landscape and beyond.
Caveat Emptor: These are factional narratives. Any correlations (directly and/or indirectly) – in names, places and experiences among others – are mere coincidences.
Chukwudi Christian Egbara, a Creative writer, Lecturer and professional editor is a self-motivated and achievement-oriented early career researcher of repute with research specialism that straddles African Literature, Literary Theory and Criticism, Medical Humanities, Narrative Medicine, Biomedical Ethics, Postmodernist Dialectics, Ecocriticism, Postcolonial Ecocriticism, Postcolonial Theory, Cultural Studies, Nollywood, Cultural Studies, African Studies, World Literatures, Media Studies.