In the textbook “Principles of Biomedical Ethics,” authors Beauchamp and Childress address in detail four principles which for many have become the standard for the examination of ethical issues in the medical system. These four principles are: “autonomy” – or the right of the individual to make their own choice, “beneficence” – or the obligation to act in the best interest of the other, “non-maleficence” which, as contained in the Hippocratic Oath, says, “above all do no harm,” and “justice” – which relates to fairness and equality among individuals.
The application of these four principles to the analysis of matters in the domain of Medical Ethics is critical to the formulation of a judgement on the sensitive issue of medical malpractice and error. These four principles are in complete syncretism with all moral social norms of our society, and therefore cannot be said to be skewed in favour of one individual or another.
For far too long, the medical system in Guyana has operated in an environment of minimal to no oversight, aloof of periodic and systematic monitoring for compliance with established norms, global best practices, and legal regulations. The absence of monitoring and oversight has led to a total absence of sanctions for non-compliance, itself resulting in an apparent disdain for the concept of individual and indirect (vicarious) accountability for actions taken and any liability resulting therefrom. Consequently, many suspicious or unnatural deaths occurring after medical treatment was received, particularly at the Georgetown Public Hospital Corporation (GPHC), have been subjected to internal investigations, many of which have not seen the light of day.
Most recently, we reported on the death of a pre-mature infant, just under two months old, and who spent some time in the Intensive Care Unit (ICU) of the GPHC. During the time spent in the ICU, the infant suffered injuries suspected to be burns but, allegedly, no clear explanation for the injuries was given to the family. Additionally, despite the presence of the injuries, the infant, born in December 2018, was discharged from the GPHC on January 21, 2019 and subsequently succumbed on February 8 after being re-admitted the previous day due to swelling in the injured areas of its body.
The attempts by Stabroek News to obtain an explanation for the infant’s death only elicited the characteristic response from the GPHC’s Public Relations Officer, to the effect that an investigation is underway and no information is available. Needless to say, this was the same response given to the media after the death of three small children in January and to date no information regarding the incidents resulting in the deaths have been made public, although such an investigation should have been wrapped up by now.
Just how long the GPHC intends to carry on with this callous disregard for the loss of lives of innocent children and the suffering endured by their families, without closure and without recourse, we have no clue. The announcing of investigations into suspicious deaths without declaring the results of those investigations, particularly to the suffering relatives, have now become par for the course for the GPHC. The Public Relations arm of the GPHC has nothing of interest to say to the public and is unable to alleviate the suffering of those affected and the unease of the general public. The situation has grown so dismal over the years that nothing short of an overhaul of the medical system can produce any improvement.
While all this is happening there is a deafening silence from the Ministry of Public Health and the Medical Council of Guyana as to the issues of culpability of medical doctors, culpability of other medical staff, or culpability of the medical institution itself. If these issues remain swept under the rug, there can be no corrective action and our medical system will forever remain in the doldrums. With the Oil & Gas economy beckoning and local organisations and individuals being constantly admonished on the need for compliance with international standards and best practices, the medical system in Guyana in general, and particularly the GPHC, seems certain to be inevitably overrun by fully compliant new entrants to the Guyana market for medical services.
Nevertheless, Guyana cannot continue to wait for external institutions to be the drivers of much needed change here. The operations of the GPHC are overdue for a public inquiry with four dead children in uncertain circumstances in less than two months of 2019. This is an unacceptable situation and in most other countries would have been absolute cause for sounding a very shrill alarm. There have been many other complaints levelled against the GPHC over the years relating to the poor facilities and poor treatment of patients, and these must all be ventilated in a public inquiry into the functioning of the hospital and the deaths for which no public cause has been given by the hospital.
The GPHC is a public institution that is meant to serve the general public, particularly those who cannot afford to seek treatment at a private hospital. If the GPHC and its medical personnel are judged by the four principles of “autonomy, beneficence, non-maleficence, and justice” they may be found sadly wanting in more than one of those components when they should embrace all four in an atmosphere of informed professional conduct.
If the Ministry of Public Health and the Medical Council of Guyana cynically continue to maintain their stony silence in the face of the unexplained deaths of four children so far in 2019, and relegates the memory of them to the dustbin of callous unconcern, then we have lost any claim to being a civilised people.
