To all concerned: I am writing from the United States and I doubt that anything I say will be useful in your friend's specific situation.
What you have written is essentially the prototype of situations in which people with AIDS found themselves in the 1980s. These issues required many years of changes and were/are primary in furthering gay marriage in the US. That said, you have not mentioned your friend's age. You have similarly emphasized his parents, I assume because the hospital has taken that approach. In the US if someone is over a certain age (18 to 21, the actual age varies by state) -- no matter what his address -- he may make an affidavit stating his wishes. The next-of-kin position is a "default" in lieu of any other provision, very much like financial inheritance which goes to the next of kin (in a certain specified order) unless there is a will which states otherwise. Hospitals in the US are now so terrified of being sued I essentially had to get such an affidavit to act on my mother's behalf despite being her only living relative and even though she was over 90 years of age. In other words, I suggest that you might approach this from the perspective of protecting the hospital. You may not care about that, but that is what the medical center and physicians and anesthesiologists and so on want. One thing that might be required is that your friend forfeits all rights to sue the hospital (or have the hospital sued on his behalf), once again within certain defined limitations. In addition to this particular doctor, I would try to meet with other hospital administrators who would tell you first what they would require. By the way, we would not NOW regard this doctor as "scrupulous" (your word, and probably his), but obdurate (my word, developed over time.) His approach would be thought of as impeding treatment! My advice is to contact an attorney and ask to create a document which would give a named person the "power of attorney," with certain proscribed limitations. For example, the limitations may cover A. between such and such a date, B. all treatment decisions but not financial costs over XXXXrupees, C. requiring consultation with X person and Y person for any life-and-death matters. There is a great deal of literature in the US on the fights in the initial AIDS years which led to many of the changes now. Sadly, what we have come up with is a kind of twisted inversion of everything. Supposedly nothing is revealed without specific permission. However, like the good capitalist system which the US is, ANYTHING can be revealed 1. in order to expedite payment for services or 2. in order to further necessary treatment. What has been eliminated is dealing with even the designated next-of-kin or any agency (for instance to arrange home nursing care). All my good wishes to those of you facing this nuttiness, Scott On Oct 9, 2012, at 4:30 AM, Vikram D wrote: > > A friend of mine recently had to have a minor surgical procedure done for > which he had gone to a surgeon in one of Mumbai's leading hospitals. My > friend is HIV+ which, of course, was known to the specialist who had no > problem doing the procedure. > > This surgeon said the procedure would require general anesthesia, but it > could be done in the morning and my friend would be able to leave by evening. > This was important for my friend because he lives with his parents who do not > know about his HIV status and he is very clear he does not want them to find > out. > > The condition he needed help with is not necessarily HIV linked, but he was > worried that if he tells them about the operation and they go with him they > could get to learn from the staff, or from medical reports that would be > issued for him since his HIV status is something the staff would have to > know, and it would probably be highlighted on his reports. So it was > important for him to have this small operation done without his parents > knowing. > > My friend followed the usual procedure to prepare for general anesthesia, > taking some medication the night before and not eating in the morning. When > he went to the hospital he was given a form where he had to fill in the > people to be notified in case of problems. This is standard, and we had > agreed that he would give my name and contact details. > > But when the surgeon saw this he said that the person to be contacted had to > be a family member and, ideally, someone from the family should actually be > there during the operation. He completely refused to accept that a > non-relative, like me, could be the person to contact, even if I was actually > sitting there right through the operation and recovery time. > > The surgeon said the operation couldn't proceed and gave the operating > theatre to someone else and told my friend to reschedule when he could come > with a family member. My friend was not prepared to take the risk of telling > a family member, and was prepared to give up having the operation at all at > this hospital, but was then told by the administrative staff that the money > he had paid could not be refunded. > > I checked with Vijay Hiremath, who advises us on legal matters, and he said > the rules in this case were unclear. Hospitals can, and do, operate on people > in emergencies when there is not time to find out who the person to notify > is, but this was not an emergency procedure and the hospital could refuse to > do it without a family member. Vijay said that sometimes hospitals would > accept a notarised affidavit giving a non-relative responsibility for the > patient, and if there was no time for this sometimes even just a letter from > the patient stating that such an affidavit could be given when possible would > do. > > My friend and I went back to meet the surgeon to see if he would accept this, > but he wouldn't. It was perhaps my friend's bad luck that this surgeon was > also the hospital's legal and ethical adviser, for which he had legal > training and he pointed out that the affidavit would not stop the patient's > parents from suing the hospital in case something went wrong and they > realised they had not been notified, as was their right. > > The surgeon agreed that other doctors might be less scrupulous on this, but > he was not willing to be. He wasn't unsympathetic to my friend's issue, and > he said that there was no reason why his parents were likely to find out > about his HIV status. But he admitted that he couldn't give an absolute > guarantee about this, and this was a risk my friend was not willing to take. > > We pointed out that this requirement for a family member should have been > pointed out from the start, so my friend could have been clear what his > options were, and could have been prevented the problems of preparing for the > operation and having to deal with it not happening. Among other things, he > had taken leave from a job he had just got. And of course, he was extremely > upset at all this happening at the last minute. The surgeon acknowledged > this, but said that having a family member was really so routine that it was > not mentioned and they could not be expected to think of all possible cases > when taking in a patient. > > Since the surgeon was clearly not going to change his mind and my friend's > condition didn't have to be treated with extreme urgency, he decided to put > it off. We also knew there was another specialist in Mumbai who would > probably operate on my friend without requiring relatives to be told, so he > did have the option of going to him. (He didn't do this from the start since > this other doctor practices very far from where my friend stays and the large > hospital was much more convenient and didn't seem to pose any problems until > the last moment). > > So my friend decided to forget having the operation there and I will say this > of the surgeon that he said he would ensure that a full refund would be made, > and accompanied us to the administration office and told the staff to make > sure it was done. And I'm not recounting all this because I want to attack > the surgeon or the hospital. I do wish they could have been more flexible, or > at least made the family requirement clear from the start, but they would > have had no issues operating on my friend because he's HIV+ (his being gay > didn't come up at all). And its true that legal action is a constant threat > for hospitals and they need to be careful about protecting themselves. > > I guess the reason I'm putting all this down is because this was a learning > for us about the problems that people face when dealing with medical issues > like this where they don't want family members, but people who not blood > relatives to be placed in position of responsibility over them. This is > something we can see coming up quite a lot with lgbt people, and its > something we need to find ways of tackling in different ways, like listing > doctors who are willing to be flexible about this issue, or trying to find a > legal format that would satisfy most hospitals, or just in raising the issue > from the start when they go to discuss surgery. > > Any suggestions, views, comments or stories of similar incidents would be > welcome. I'm particularly interested in comments from the many doctors (real > medical ones!) who are on these lists, > > Vikram > > > > > > > > >
