Ethical Ophthalmology

A 74-year old male recently emigrated from Pakistan and speaks no English visits the DR screening service. He had diabetes for 27 years. You have no information on his diabetes control. His recent visit was prompted by the GP where the patient complained of deteriorating vision. His niece comes with him, she speaks reasonable English, but she is 15 years old only. The patient cannot read anymore and he finds that reading was an important part of his life. During screening it is revealed that there are cataracts in both eyes, best corrected visual acuity 6/24. The retina cannot be visualised on the screening visit.

The patient is given reading material in English about cataract surgery and told that an appointment was going to be sent to him from the hospital.

Your decision was to send the patient to cataract operation to the local hospital where again the niece translated. It was carried out then the following morning tractional diabetic retinal detachment was found in one eye. In the other eye the retina was visualised at the slit lamp by the medical retina fellow and he was found to have proliferative diabetic retinopathy.

Questions:

Please discuss issues related to informed and voluntary consent.

  1. Was the patient able to comprehend the true nature of his condition and the planned treatment?
  2. Was it fair/ethical to use his niece as a translator?
  3. Was the information given about where the photographs might be transferred to compliant with the level of information expected to be given to the patient and in line with Data Protection and the Caldicott report?
  4. What would you have done differently if you would have to manage this case again?
  5. Was the patient aware of who had access to his information?
  6. How would you have managed this case if the patient opted out of photography once you have taken history?
  7. The patient submitted an official complaint of how his case was handled. Describe why he might have complained and what the local protocols and policies about complaints in your screening.

Please add any other issues that you consider relevant to this case.

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