Chapter 316: The Ultimate Goal of Medicine (Bonus chapter for 3k monthly votes)

"Objection!"

The defense attorney, Guoping, immediately said: "Your Honor, regarding Uesugi's testimony, the object has changed, and the argument has shifted from medical issues to other matters. I request that the testimony be stopped immediately!"

"Uesugi, is there anything you wish to say?" The presiding judge pondered for a few seconds and asked.

"What I am about to state is not a matter of medical appraisal, but a matter of medical procedure." Uesugi Muneyuki nodded, and he said quite calmly: "Just like this report in my hand, it has been tampered with; this is the reason I have come to testify in court."

"Mr. Uesugi." The defense attorney asked: "You entered the First Surgery Department upon enrollment at the Medical and Dental University, and you interned under Professor Zaizen, correct?"

"Yes." Uesugi Muneyuki nodded.

"During that period, according to our records, you were subjected to multiple complaints from patients, and in the end, you had to transfer to the Forensic Pathology Department, is that correct?" Attorney Guoping held up the case file in his hand and waved it toward Uesugi Muneyuki.

"Yes."

"And according to our understanding, before you transferred to the Forensic Pathology Department, it was precisely Professor Zaizen who made the arrangements for you. What a pity; having been admitted to medical school, yet you had to transfer from surgery to the Forensic Pathology Department. May I assume that you harbor certain prejudices against Professor Zaizen, and that is why you decided to testify in court?"

Attorney Guoping was full of confidence: "As a discarded student, opposing the judgment of your former mentor—that seems quite logical, doesn't it? May I assume that because of some resentment toward Professor Zaizen, you are using the fact that your autopsy report was modified to attack your former mentor? But as you said yourself, you have no objections to the results of the medical appraisal, so you coming here is purely a matter of personal vendetta?"

"Objection!" Attorney Sekiguchi immediately interrupted: "This question has absolutely no relevance to the trial! I request that it be withdrawn!"

"No, this is a court of law, and a poisonous tree cannot bear good fruit!" Attorney Guoping immediately said: "I am merely stating a fact! And that is that personal vendettas cannot influence a trial!"

The presiding judge was silent for a moment and said: "Uesugi-kun, please answer the defense's question."

"I can." Uesugi Muneyuki nodded and said: "Actually, this question is also very simple. I think Professor Zaizen should know exactly why I received so many complaints, and exactly why I was driven to the Forensic Pathology Department?"

The entire courtroom was silent, yet filled with curiosity.

"Actually, the reason is simple: because I never hide a patient's condition. Under any circumstances, as long as a patient asks me what illness they have, whether it can be cured, and how much the treatment will cost, I will answer truthfully." Uesugi Muneyuki said simply: "And this is the very reason I have come to testify today."

"From a medical perspective, Professor Zaizen's diagnosis had no issues whatsoever. From a doctor's perspective, Professor Zaizen's surgery could be called perfect, and the treatment plan he provided at the time was undoubtedly the optimal one. Furthermore, considering that CT scans cannot accurately identify 【the condition】 and the risks of a lung biopsy, the deceased had neither the physical strength nor sufficient time to wait for further examination results."

"However..." Uesugi Muneyuki said: "However, Professor Zaizen, in the situation you faced at the time, were there any other treatment methods?"

"............" Professor Zaizen stopped speaking.

"Let me say it: yes." Uesugi Muneyuki said: "Besides surgery, one could also proceed with conservative treatment, chemotherapy, or radiation therapy."

"Admittedly, conservative treatment would at most only extend the life of the deceased by a year or two, but... the reason I am standing here today is because of this." Uesugi Muneyuki said: "Did you truthfully tell the family of the deceased about the patient's condition and the different treatment options? When the family of the deceased asked questions, did you answer their doubts truthfully?"

"The answer is, you did not." Uesugi Muneyuki held up the medical report in his hand: "Just like this modified medical report, you must have told the family of the deceased at the time that surgery was mandatory, right?"

"Before you performed the surgery, Dr. Satomi and your subordinate, Dr. Yanagihara, and others had already warned you that there was a risk of cancer in the patient's lungs. And when faced with the questions from the family of the deceased, you must have forced the family of the deceased to undergo esophageal surgery, right?"

"This is the reason I am standing here today." Uesugi Muneyuki said: "You did not allow the family of the deceased to exercise their right to informed consent; you did not give the family of the deceased the opportunity to consider multiple options. You didn't even deign to tell the family of the deceased what your judgment of the condition was; you directly demanded surgery, right?"

"Objection!" Attorney Guoping said hurriedly: "This is a fallacy, assuming things that did not happen! Your Honor, our side has the surgical consent form as evidence; signing the surgical consent form is equivalent to informed consent!"

"No need." Professor Zaizen signaled for Attorney Guoping not to act out of turn. He coughed twice and looked at his former disciple, his eyes filled with fighting spirit: "Let me answer this question."

"Uesugi-kun, you are also a doctor, so you must know that our profession is a highly specialized field. Cancer, while a broad category, can actually consist of thousands of variations based on the lesion, symptoms, and progression."

"The deceased's case was very special. Making this decision was a judgment I made based on my professional knowledge and professional ability. And just as your judgment and the medical appraisal state, this was the optimal plan. Medicine is a profound field; it was a precise judgment I made based on all my past experience and a comprehensive consideration of all possibilities."

"In other words, you felt that based on the life experience and comprehension ability of the family of the deceased, they could not understand and there was no need to provide the necessary explanations, right?" Uesugi Muneyuki asked.

"Hmm, that is what I mean." Professor Zaizen nodded quite arrogantly.

"And this is the very reason I am standing here." Uesugi Muneyuki said softly: "If my memory serves me correctly, I remember Mr. Sasaki Yohei repeatedly emphasizing before he fell into a coma that he did not accept surgery. If my memory serves me correctly, the family of the deceased also asked before the surgery if there were any other options, and your answer was: 'No, if you want to live, you must have surgery.'"

It was impossible for Uesugi Muneyuki to remember incorrectly, because when he performed the autopsy that day, the Dead Soul of Sasaki Yohei was filled with hatred and resentment, repeatedly emphasizing that he did not want surgery, emphasizing that he had refused surgery multiple times, and as a result, he had indeed died.

"Therefore, this surgical consent form was something you forced the family of the deceased to sign. You used your position of advantage in information asymmetry to deprive the family of the deceased of their right to informed consent and their right to choose!"

"This has nothing to do with medical skill, but it has everything to do with medicine!"

"............ *Cough, cough*." Professor Zaizen coughed and stopped speaking.

"Your Honor, this is what I wanted to say, and the reason I came here today." After Uesugi Muneyuki finished speaking, he said to the presiding judge: "Regarding medical issues, let me say a few more words."

"You may." The Tokyo High Court already understood Uesugi Muneyuki's meaning.

Professor Zaizen's problem was not with his medical skill—his medical skill could be called flawless—his true problem lay in depriving others of their right to informed consent and their right to choose!

"Admittedly, Professor Zaizen is correct; medicine is a profound discipline. What is the ultimate goal of medicine? Is it to pursue the continuous progress of human body research until all things decay and all living beings are immortal, or is it to pursue the analysis of diseases until one day all patients and all illnesses are completely cured? This is the eternal question of this White Tower. On this issue, Professor Zaizen, whose medical skill is better than mine, clearly has more right to speak."

"I am a Forensic Pathologist. The work of a Forensic Pathologist is to listen to the voices of the dead. No matter how cruel the truth, no matter how horrific the corpse, I must speak the truth and solve the mystery of death. Therefore, every one of my autopsies represents the passing of a life."

"So, my persistence has always been: do not hide."

"I once personally witnessed a pancreatic cancer patient who, under a doctor's 'white lie,' thought it was not a serious illness. She underwent chemotherapy and her condition improved greatly for a time, leading her to believe she had defeated the disease. However, after repeated recurrences and chemotherapy, she finally realized the severity of her condition and died in agony, blaming the doctor before she passed away for why he had lied to her."

"I have also personally witnessed a young woman who, after being told the truth about her condition by her doctor, cooperated fully with the treatment and fought hard against the disease. She underwent surgery and chemotherapy time and again until all her hair was gone, yet she refused to give up. After developing drug resistance to domestic medications, she even went to the United States and Italy to purchase targeted drugs that had not fully passed Japanese testing. In the end, she spent all 10 million in savings she had intended for her wedding, yet the treatment was ineffective. Before she died, she blamed the doctor for why he hadn't lied to her, causing her to lose both her money and her life, and finally die in agony."

"The path of medicine often has no definitive answer. It seems that as long as one is cured, everything is right, and it seems that as long as one is not cured, everything is wrong."

"Actually, personally, I also do not like the current habit of families looking for someone to blame the moment a patient dies. Actually, personally, I am also very clear that we cannot cure all diseases or admit all patients. Hospitals do not always have empty beds, just as I cannot perform an autopsy on every corpse in Tokyo."

"So, what I can do is: do not hide."

"A doctor who cannot be responsible for the patient in front of them does not have the qualifications to be a doctor. In reality, it is possible for a patient to die, and it is possible for a doctor to misdiagnose. The United States has a rule: as long as the risks of the medical procedure are formally declared and the family is allowed to decide for themselves, then even if the surgery fails, the court will not blame the doctor for medical skill issues."

"There is a saying that clinical doctors go through two stages: the first stage is the stage of striving to climb toward an ideal, and the second stage is the stage of stopping one's steps after reaching the limit, silently doing one's best to treat the patient in front of them."

"Professor Zaizen, I admire your medical skill, and I understand your efforts and ideals in climbing toward the ultimate goal of medicine. The medical system itself is a very closed system; the series of professional terms that pop out of our mouths are obscure and difficult to understand, and the judgments we make sometimes have to be based on temporary considerations in emergency situations."

"However, this world does not only consist of the White Tower leading to the ultimate goal of medicine. Just as I have performed over a thousand autopsies in over a year, every corpse has a story they want to tell me. Whether happy or unhappy, asking for help or lying, I must tell the truth. I never hide; perhaps this is precisely why I am suited to be a Forensic Pathologist."

"Without truly leaving this tower to see the world outside, there will always come a day when one kills their own patient."

"And I, Uesugi Muneyuki, also intend to resign from my position as a physician in the Forensic Pathology Department of the Tokyo Medical and Dental University Hospital, to prove that my testimony is not based on considerations of personal vendetta!"

"That is all!"

(End of chapter)