Introduction
Dr. D. and hospital administrator Mr. M. discuss a complaint from a patient who underwent a painful vacuum aspiration without anesthesia, leading to PTSD and anxiety. Dr. D., who believes too many women have abortions—especially those with mental health or substance use issues—admits withholding pain relief to deter young, unmarried women from having children. While claiming to support legal abortion, she criticizes current laws for making termination too accessible. Mr. M. expresses disbelief at her actions, to which she responds that she is protecting “the future of mankind.”
Medical Issues
There are several medical issues in the case, especially regarding Dr. D’s actions in her capacity as a physiologist. Firstly, in her professional capacity, Dr. D fails to administer anesthesia to the patient for a typically painful procedure. As a result, Dr. D subjects her patient to undue pain and, subsequently, anxiety and trauma.
Thus, Dr. D induces mental distress in her patient, for which she needs psychiatric intervention. Additionally, Dr. D ignores her patients’ pain and insinuates that it is well-deserved. As a medical professional, Dr. D is reasonably expected to alleviate her patients’ physical pain as much as is circumstantially possible.
Pain Relief During a Vacuum Aspiration of the Uterus
Vacuum aspiration is the most common surgical means of induced abortion for gestation periods of 15 weeks and below. Azman et al. (2019) note that it has the lowest overall complication rates out of all available abortion methods. Notably, Azman et al. (2019) point out that it has a success rate of more than 95%. Regardless, there are several risks associated with a vacuum aspiration procedure.
Hemorrhage, uterine trauma, and uterine perforations are some of the complications that may result from a routine vacuum aspiration. Due to the possibility of uterine injury, vacuum aspiration is carried out either under general or local anesthesia, depending on the type of abortion required. In case of early loss of pregnancy, local anesthesia is preferred, whereas general anesthesia is used for induced abortions (Kakinuma et al., 2022).
However, the anesthetist and the doctor must discuss the best surgical procedure to ensure patient outcomes. Gynecologists point out that pain must be managed during and after an induced abortion through vacuum aspiration. The benefits of providing pain relief are discussed in the next paragraph.
Vacuum aspiration requires the insertion of a speculum into a dilated vaginal opening. The speculum can be manually or electronically operated to suction the uterine contents, such as the fetus and placenta (Azman et al., 2019). Providing pain relief gives the patient physiological comfort as they can hardly feel the movement of the speculum inside them. They are, therefore, unlikely to scream or suffer from trauma as a result of the operation, which can otherwise be very painful.
For the doctor carrying out the operation, anesthesia facilitates ease of procedure by enabling the patient to remain physically still and relaxed. Another benefit of anesthesia is that it reduces post-procedure pain, which can then be treated using common painkillers such as paracetamol. As such, providing anesthesia during vacuum aspiration of the uterus is humane and operationally sound.
In contrast, not providing pain relief also has its inherent advantages. In hospitals where resources are constrained, such as anesthetists, drugs, and time, providing pain relief during vacuum aspiration procedures may be viewed as less of a priority. Specifically, hospitals must be very prudent with their use of resources during national emergencies or global pandemics.
Additionally, not providing pain relief, specifically anesthesia, may be beneficial where the patients have certain pre-existing conditions that can precipitate an adverse bodily reaction if anesthesia is given. Baillard et al. (2019) highlight some of the inherent risks of anesthesia, such as hypoxemia, whereby a patient critically lacks oxygen in the arteries throughout surgery. Therefore, one of the benefits of not being placed under anesthetic conditions is avoiding certain fatal risks. Thus, the administration of anesthesia is inherently risky as it requires certain calculations and pre-qualifications, which, if ignored or erred in, may render it fatal for a patient.
Human Rights Infringed in This Case
Dr. D. did not observe the right to quality medical care when treating. In particular, the patient was subjected to undue and avoidable physical pain despite her protestations and complaints. Notably, doctors are not supposed to increase a patient’s level of distress or take any actions, whether negligent or deliberate, that could worsen a patient’s mental or physical state. Doctors must use their professional judgment to cure patients as humanely as possible. This caused her to develop mental health issues down the line, which is indicative of the injury she suffered as a result of the doctor’s conduct.
Additionally, the doctor did not uphold the patient’s right to informed consent. In particular, Dr. D. was supposed to inform the patient of her decision to deviate from the norm of using anesthesia for the procedure. Dr. D. was supposed to consult the patient and obtain her opinion and permission before beginning the procedure. Perhaps, upon being adequately informed, the patient would have sought a second opinion or taken a different action with her pregnancy (Glaser et al., 2020).
Moreover, it can be argued that the patient’s reproductive rights were infringed. In particular, the doctor punished the patient for having an abortion and therefore sought to restrict her expression of her reproductive rights (Aiken, 2019). Patients have the right to undergo safe and, to the extent possible, comfortable abortions in light of the medical resources available to doctors today.
Standards of Practice in Hospitals and Outpatient Surgery
A hospital must ensure that each member of its professional staff is professionally qualified and, where necessary, accredited. Additionally, the health facility should ensure that its staff are well informed about the ethical requirements of their roles and continuously apprised of performance, with special attention paid to complaints by dissatisfied customers. Where there are updates to human rights or ethical rights edicts, staff should be continuously educated on the same, with the hospital’s practice adopting the relevant guidelines as soon as they are implemented. For instance, Aiken (2019) notes that rights on reproductive laws vary temporally and spatially, whereby certain states or countries may have different guidelines depending on the lawmaking body of the time. It is a good standard of practice if medical staff know the latest developments in their field.
Another standard of practice hospitals should adopt is hiring open-minded professionals who do not look down upon minorities or less advantaged groups. Doctors are bound by bioethical guidelines to treat every patient to the best of their ability, irrespective of their personal inhibitions towards the patients. Since it may not be possible to inculcate such a mindset in a professional adult, hospitals should devise methods to screen out health workers with tendencies toward discriminatory or condescending attitudes. This may affect their conduct and have disastrous results for the hospital.
Course of Action for the Hospital Administrator
Mr. M. should take the patient’s complaints seriously and start the necessary steps toward a resolution. Firstly, the hospital administrator should collaborate with the other departments to see if she can obtain psychiatric help at the hospital or another facility. Once the patient gets treatment for her mental health issues, Mr. M. should request her to take part in an internal inquiry on the matter in the interest of its resolution.
Mr. M. should inform the patient of her rights in this matter, including whether she wants to commence legal proceedings against Dr. D. As a professional, Mr. M. should assist the patient as much as possible, regardless of the course of action she chooses. Suppose there are other complaints arising from malpractice similar to Dr. D.’s in the past. In that case, Mr. M. should establish steps to address them.
Mr. M. should suspend Dr. D. from the hospital immediately, pending a case resolution. In the meantime, Mr. M. should establish an inquiry into the matter led by a team of about three experienced medical doctors who should ascertain the facts of the case and provide Mr. M. with a list of recommendations. The doctors leading the inquiry should not be acquaintances of Dr. D. in the interests of obtaining a balanced and fair report.
Notably, the recommendations should not only be specific to how the case should be resolved but also provide future directions in handling such cases in the hospital. Moreover, the recommendations should guide how the hospital can avoid a recurrence of the same. At the same time, Mr. M. should establish whether Dr. D. has behaved similarly in the past to inform the inquiry further.
Conclusion
In conclusion, Dr. D. put the patient’s well-being at significant risk owing to her prejudices. The patient suffered physical agony and subsequent mental illness following the doctor’s decision not to use anesthesia for a procedure where it is necessary as a matter of practice and necessity. Dr. D. infringed on the patient’s reproductive rights, her right to informed consent, and her right to quality medical care. As such, the hospital should take remedial action to facilitate the patient’s wellness and ensure that such a case does not arise again.
References
Aiken, A. R. A. (2019). Erosion of women’s reproductive rights in the United States. British Medical Journal, 366, l4444. Web.
Azman, A., Sakri, N. A. M., Mohd Kusni, N. A., Mansor, N. H., & Zakaria, Z. A. (2019). Manual vacuum aspiration: A safe and effective surgical management of early pregnancy loss. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 8(6), 2256. Web.
Baillard, C., Boubaya, M., Statescu, E., Collet, M., Solis, A., Guezennec, J., Levy, V., & Langeron, O. (2019). Incidence and risk factors of hypoxemia after preoxygenation at induction of anesthesia. British Journal of Anesthesia, 122(3), 388–394. Web.
Glaser, J., Nouri, S., Fernandez, A., Sudore, R. L., Schillinger, D., Klein-Fedyshin, M., & Schenker, Y. (2020). Interventions to improve patient comprehension in informed consent for medical and surgical procedures: An updated systematic review. Medical Decision Making, 40(2), 0272989X1989634. Web.
Kakinuma, T., Kakinuma, K., Kaneko, A., Kagimoto, M., Kawarai, Y., Ihara, M., Saito, K., Matsuda, Y., Ohwada, M., Tanaka, H., Takeshima, N., & Yanagida, K. (2022). Safety and efficacy of manual vacuum aspiration under local anesthesia compared to general anesthesia in the surgical management of miscarriage: A retrospective cohort study. Patient Safety in Surgery, 16(1), 1-5. Web.