Friday, August 25, 2006

Doctors versus patients - making difficult decisions in the ICU

The vast majority of the time, doctors are on the side of the patient. However, there are often difficult conditions ( which are fortunately very rare), when the doctor and the patient don't see eye to eye.
For example, consider the case of a 75 year old man who is in the ICU on a ventilator. He has led a rich and full life; and has ended up in the ICU because of a serious infection after surgery for a malignancy. He has been in the ICU for 6 days on aggressive life-support, but does not seem to be getting better. His heart functions with the medications; as do his kidneys and his brain; but it's not been possible to wean him off the ventilator - his protoplasm is not enough to keep life going on its own. The family is happy with all that has been done with him; and want him to die a peaceful death. They request the doctor to swith off the ventilator, so that he can die in peace. While the doctor understands their desires, he finds his hands are tied because he cannot comply with them. The law does not allow him to do so as long as the brain is alive ! He agrees not to perform heroic rescue measures - but this also means the patient is forced to remain on the ventilator until something bad happens. Life crawls on for the family, who are in a state of suspended animation, and are living life on a day to day basis.
This is an unfair situation - for everyone. For the patient, who is forced to survive with mechanical support he does not want; for the family, who is forced to see their father suffering; and for the doctor, who feels powerless, because he cannot do what is in the patient's best interests.
How do we resolve such issues ? The irony is that if the family could not afford to pay the medical bills, they would never have landed up in this tragic situation because they would not have been able to pay for the expensive ICU care . The reality is that this sort of "care" is really not care at all - it is an unhappy bind we are mired in, for all the wrong reasons.

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