Quite often these days one comes across screaming media headlines about hospitals keeping dead patients alive on ventilators and other life-support paraphernalia. The headlines almost always accuse hospitals and doctors trying to make more money by keeping the patients in the hospital, even when the chances of their survival are minimal. Strangely, they always mention that the patient is already dead and the hospital is treating them unnecessarily.
This has always left me wondering as to how the journalists filing these reports and the media-houses publishing such drivel know that the patient is alive or dead. Since when have we handed over the responsibility of declaring people dead to journalists? Many of these worthies wouldn’t even know how to record a pulse, leave alone pronounce people dead. Yet, the media-houses carry these stories with aplomb, merrily destroying reputations and widening the gulf between the patients and the hospitals.
The laws in India on this are clear enough. Hospitals cannot withdraw life-support from a patient, howsoever sick he might be just because the patient’s families believe that there is no further chance of the patient’s recovery. The patient’s families often find themselves in a difficult situation wherein the patient remains alive on life-support in an ICU, with very slim chances of survival and the hospital bills keeps mounting. I can understand their dilemma well, to them it may appear that spending large amounts of money, when the patient has a very poor prognosis is futile. The attendants start pressurizing the hospital to hasten the inevitable. This is of course completely illegal and hospitals usually do not comply with these requests. This leads to bad blood between patients and hospitals, media gets called and accusations of making money by keeping the dead alive fly thick and fast.
With the media pressure mounting, the hospitals are forced to waive-off their charges and suddenly, hospitals find themselves in a better place. Patient’s angry relatives are no longer as difficult, they suddenly have a better ”understanding” of the hospital’s compulsions and they now urge the hospital to do whatever they can to ensure that the patient’s suffering is minimized. This drama plays out in our hospital corridors quite often.
Media’s role in this is quite suspect. They deliberately publish inflammatory and baseless reports of the dead continuing to receive treatment. They rarely carry statements from the treating doctor, even if they do, these are tucked away or played out in a manner that does little justice to the treating clinicians. The only objective is to put pressure on the hospitals and get the concessions for the patient and paint the hospital as the devil incarnate.
Hospitals can avoid this by taking a view that when patients are so sick that they have no chance of survival, they would on their own waive off their charges till the inevitable happens. This, of course, hurts their revenues and it isn’t really fair to them to continue providing a service free, but there is hardly a choice here. The inevitable media hoopla, which is far more unfair and even damaging can perhaps be avoided in this manner. They also have an opportunity of earning goodwill from the relatives of the patients, who one assumes would be grateful for this help in difficult times.
The other alternative is really a change in the laws of the country, which in a manner of speaking is underway. Do Not Resuscitate (DNR) guidelines have been given legal form through a judicial pronouncement. These though still remain nebulous and much more needs to be done to publicise the new laws, at least a good beginning has been made. Laws regarding the end of life care need to be framed with complete clarity and any loopholes regarding potential misuse must be plugged.
Till such time, this happens, doctors and hospitals will continue to be at the receiving end of a biased media in search of lurid stories and patient attendants, who see little point in continuing to pay for a relative who is unlikely to make it.
The views expressed are personal