Need for docs to be upfront

Star: PETALING JAYA: Doctors should inform family members of patients in intensive care unit (ICU) of a possible brain death situation to avoid any ethical dilemma, according to a pioneer in ICU.
Universiti Malaya anaesthesiology and critical care Professor Emeritus Datuk Dr Alex Delilkan said keeping brain dead patients on a ventilator and charging their families for it could be “ethically and morally wrong” and open the doctors to lawsuits.
It would also deprive other critically ill patients of hospital facilities, he said.
“Even if family members protest and refuse to let doctors remove the ventilator, they cannot decide what doctors should do professionally,” he said, adding that family members would often claim that the electrocardiogram showed the person was still alive.
This was because they did not realise that drugs kept the patient’s heart beating and mechanical support kept the lungs working but the person was actually dead.
Such a situation usually arose when doctors did not explain to the family members early enough on the possibility of brain death in intensive care, said Dr Delilkan.
When he first set up the intensive care unit in 1968 in the then-Universiti Hospital, Dr Delilkan said he had noticed that despite doctors resuscitating patients, some patients’ bodies began to stink and decompose.
He said that in Malaysia, a medical consensus on brain death had been compiled in 1993 and updated 10 years later.
In Malacca, A. L. Loh, 39, recalled that her father could not accept the sudden death of her mother two years ago from bacterial infection when the doctor told them she was brain dead.
“I did not recall the doctor explaining what brain death meant but he said she was already dead and it was useless to continue with the life support machine,” she said.
The life support system was removed six days later after family and friends talked to Loh’s father and helped him come to terms with his wife’s death, she said.
Malaysian Medical Association honorary general secretary Dr Mary Suma Cardosa said some doctors might not check if patients were brain dead because it has not yet become a routine in the profession.
However, should a patient's family protests against removing the ventilator when brain death is confirmed, doctors should let them know the cost involved and help them come to grips with the truth, she said.