The story of an Ontario man who died in Costa Rica after being treated for blood clots that formed following an experimental
vein-clearing surgery to relieve the symptoms of his debilitating

disease has raised questions about the ethics involved in treating — or

not treating — patients who suffer complications from taking their

health care into their own hands.

The rules for doctors remain the same: treat a patient who requires urgent care in the same way any other would be treated, but that does
not mean giving them everything they ask for.

“I haven’t heard anyone from the medical community saying that people aren’t entitled to urgent care. No one has said that,” said Kathryn
Clarke, a spokeswoman at the College of Physicians and Surgeons of

Ontario. “It just stands to reason that patients are absolutely entitled

to receive treatment if they are experiencing a complication regardless

of how it’s arisen.

“But if it’s non-urgent and a physician feels that whatever is being asked for is beyond their knowledge, they are ethically obliged to refer
to someone else,” said Clarke, before adding the key point: “Physicians

are not obliged to repeat or redo experimental procedures which were

performed outside of an ethically approved research protocol.”

Not enough is known about the case of Mahir Mostic of Niagara Falls, Ont., who died during his second stay at the Clinica Biblica hospital in
San José last month, to determine whether any Canadian doctor dropped

the ball when it came to the type of follow-up care he was seeking.

What is known is that he first travelled to Costa Rica in June to receive a version of the so-called “liberation” therapy pioneered by
Italian researcher Dr. Paolo Zamboni. The therapy is not available in

Canada despite the vocal demands of many MS patients who view the

scientifically unsupported procedure as their last hope for a better

life.

After the surgery, performed by Dr. Marcial Fallas, there were remarkable improvements at first. But a few months later, Mostic’s MS
symptoms returned and, as his girlfriend Bedrana Jelin told the CBC over

the telephone from Bosnia-Herzegovina, no specialist would see him

about it because it had been done outside the country. So he returned to

the Clinica Biblica where doctors tried to dissolve a blood clot with

medication that led to fatal internal bleeding.

Fallas said Mostic was in the advanced stages of the disease, which had confined him to a wheelchair, so after going through the risks he
inserted a stent in his vein.

“We can’t comment, due to lack of information, on whether he was or was not able to access follow-up care in Canada. We maintained contact
with the patient thereafter,” Fallas wrote in a statement issued Friday.

“What is known is that the patient returned to seek assistance for a

complication many months later. The patient was in a very advanced

condition at this point, and unfortunately passed away despite all

efforts to treat him, while treating him for said complication.”

The president of the Canadian Network of Multiple Sclerosis Clinics noted that MS doctors encourage their patients to see them for follow-up
care.

“I think it’s really important that patients get the message that we respect the decisions they make,” said Dr. Anthony Traboulsee. “It’s
important that they don’t let those decisions stop them from coming back

for their regular care for MS.”

Traboulsee said his network is currently working with vascular surgeons and other experts to develop guidelines for doctors and
patients who have sought the treatment overseas, such as using blood

thinners to help prevent blockages and telling patients who experience

chest pains to head to the emergency room.

The MS Society of Canada said anyone travelling outside the country to seek treatment for chronic cerebrospinal venous insufficiency
(CCSVI), the condition described by Zamboni, should be eligible for

post-treatment care back home.

“The MS Society is saddened by this tragic story. Our thoughts and condolences go out to Mr. Mostic’s family,” spokesman Stewart Wong wrote
in a statement Friday. “The MS Society believes people with MS who have

travelled outside of Canada to receive CCSVI treatment should be

allowed post-treatment care and follow-up from the health care system.

We feel the health of the individual returning from outside of Canada is

critically important.”

Amir Attaran, a professor in the law and medicine faculties at Ottawa University, said it is far more likely that doctors are not satisfying
overly demanding MS patients than they are withholding needed care.

“They have chosen to spend their own money, do their own research, very much direct their own therapy — and that is a personality type,”
said Attaran. “They really care about their own well-being and nobody

can be faulted for that; however, when they meet their physician back in

Canada for follow-up care who doesn’t necessarily share their view,

they’re also prone to be dissatisfied.”

http://liberationtreatmentccsvi.com/2010/11/the-ethics-of-treating-medical-travellers-at-home/