1.

The man who did not want his leg amputated

Physician: This was a 64-year-old man who had had a stroke which had affected
his mental condition, though his awareness was good. He also suffered from
diabetes mellitus and hypertension. One day gangrene was found on his leg with
sepsis, high fever, and it was a progressive gangrene. I advised him and his family
to have an amputation. The family agreed, but the patient did not. The family
followed my reasoning, that is, I did not want the patient to die merely because of
gangrene and diabetes. Then I suggested to the family that if the patient falls into
a coma, I would have the right to undertake a professional intervention to save his
life without having to obtain his approval. Once the patient went into coma, I
asked the family to sign the informed consent for the amputation. The amputation
was finally done.

When the patient became conscious, he was delighted because he felt that he had
recovered. He was able to sit and became quite happy and felt that he still had his
two legs. When he became completely conscious, and was about to descend from
the bed and walk, he realized that he had been amputated. He was shocked. He
flew into an extraordinary rage and threatened that he would prosecute me and
his family. He was a former lawyer. He was aware of his rights and he had not
permitted that his leg be amputated. The dilemma here was: first, we had to fulfil
the principle of autonomy, and, second, we had to save a life. There were two
aspects that quite contradicted each other. An extraordinary process of
negotiation after the operation followed, and as the patient showed spiteful hatred
against me, I had to delegate the care to others for the time being. When the
negotiation was over, we finally came to terms. The patient survived and had the
opportunity to witness a marriage in his family.
 2. Correcting a colleague's excessive medication of a
patient
Physician: Sometimes you see patients who have been seen by other doctors.
And they come with the prescriptions. Sometimes a prescription which has been
given to the patient contains many drugs, which may not be needed. A mother
came with her child who had been prescribed a lot of unnecessary drugs. Now,
the question arises: Should I tell the mother that "Don't give the medicines, it will
harm your child", because if you tell that, then your personal relationship with
your colleague might be strained. But you know that so many drugs are not good
for the child and therefore should not be used. It is a difficult situation. I told the
mother that "probably these medicines were prescribed when your physician saw
the child for the first time. But I don't think these medicines should be taken any
more. So you can stop all these medicines and give only these drugs."
 3. The child with leukaemia who was not treated
Physician: One patient was a boy of about eight years of age who presented with
very severe haemorrhagic manifestations and the diagnosis was confirmed to be
leukaemia. And not a very good prognosis either. The father was a driver. I told
him that it was leukaemia, blood cancer, and probably even if he provided
treatment, the child may not survive more than a few years. I also told him the
cost involved. It all now depended on him. The father was very frank. He told me
that in that case he would not get his boy treated and took him home.

Seorang pasien anak laki-laki berumur sekitar 8 tahun yang mengalami

pendarahan yang sangat hebat dan di diagnosis mengidap leukimia dengan
prognosis yang tidak baik juga. Ayahnya adalah seorang supir. Aku mengatakan
kepadanya bahwa anaknya mengidap leukimia, kanker darah, dan mungkin
apabila dia dirawat, sang anak tidak bertahan lebih dari beberapa tahun. Aku juga
mengatakan kepadanya biaya jika anaknya dirawat. Semua itu tergantung
padanya. Ayahnya benar-benar terus-terang. Dia berkata padaku bahwa anaknya
tidak akan mendapat perawatan dan langsung membawa anaknya pulang.
 4. The child with hydrocephalus
Physician: Recently, a parent came with a small child who was about three
months old with a suspected enlarged head. And one possible diagnosis was
hydrocephalus. The patient had a CT scan done and it showed a huge
hydrocephalus. The parents asked me about the treatment plan. I knew that the
condition was not good, and the child would not survive; even if it survived the
parents would have difficulty in the follow-up. The prognosis for the child was
very bad. I explained the disease pattern to the father. If the child underwent an
operation, the prognosis was not good and the child would not have normal
development. The child might have complications after the operation. I explained
everything to the father. The father asked me "what would you do in this case if it
was your child?" I told him frankly that "if it were my child, with my experience
and what I have learned from medical science, probably I would not go for the
operation."