Who lives, who dies? Doctors may have to decide

 

I’m alarmed over news that chronic patients in Kedah considered to have no hope of recovery will no longer be placed in the Intensive Care Unit (ICU) at hospitals.

Kedah health and local government committee chairman Dr Mohd Hayati Othman was reported by Berita Harian as saying last night that although the number of ICU beds was adequate, these were largely needed for Covid-19 patients.

“I feel guilty, but I feel this has to be said. Some doctors have no choice but to choose which patient needs to be admitted to the ICU. If the patient’s medical condition is too chronic and has no hope of (recovery), we will not admit him or her to the ICU.

“This includes non Covid-19 cases. The doctors will have a thorough and hard assessment for some cases. However, we will try our best to treat all of them until they have recovered and are in stable condition.”

It has been reported that Kedah’s ICU wards have reached 92% capacity.

I fear we will be hearing such warnings from other states too, as the number of Covid-19 cases continues soaring in the country. Yesterday, health authorities announced there were 59 Covid-19 deaths and 6,806 new cases in the past 24 hours. That’s a record.

We now have a total of 492,302 cases, making Malaysia the country with the third highest Covid-19 cases in Southeast Asia.

But the public can help ease the situation. I have said it numerous times before and I say it again: Let’s stay home as much as possible and if we have to go out, we should wear masks, practice physical distancing and wash our hands with soap.

This morning, health director-general Noor Hisham Abdullah said ICUs in hospitals in the country have reached 83% capacity.

The health ministry has requested private hospitals to increase the number of beds to treat Covid-19 patients. In addition, it is getting the military to set up field hospitals and so far three are up.

I suggest that the government seek the cooperation of clubs and associations to use their buildings as temporary medical centres for patients suffering from non-communicable diseases and who only need medicine.

For instance, patients who have their arms or legs in casts following falls or vehicle accidents could be housed in these places until the situation improves.

However, there should be proper negotiations with the committees concerned and they should be compensated for allowing their premises to be used for this. It should be on a voluntary basis. Putrajaya should start exploring this option now and not wait for the situation to get worse before acting.

I fear that if cases continue to rise at the current rate, more and more doctors will be placed in the unenviable position of deciding who gets a bed at the ICU, as in Kedah. It may mean life or death for the patient concerned. And that will simply be tragic.

If you remember, about one year ago, Italian doctors had to make heart-wrenching decisions as to who should be treated at the ICU and who should be left to very likely die.

Patients who were took sick or too old were just put on oxygen and not given other forms of more invasive support such as continuous positive airway pressure or CPAP.

Italian doctors were given guidelines in March that year as to how they could prioritise who gets what and two of the main considerations were the age and comorbidities of patients.

I believe our doctors will refer to the set of ethical guidelines on rationing resources published in the New England Journal of Medicine on March 23, 2020 by a group of doctors and academics in making their decisions.

One of the recommendations is that, at times like this, doctors should prioritise severely ill patients who are younger and who have fewer existing health conditions. Also, the usual approach of treating patients on a “first come, first served” basis should not apply.

The main consideration, they said, should be to maximise the number of lives saved and the number of life years saved. Translated into practice, it means that as younger, healthier people have a greater chance of survival and greater life expectancy, scant resources should be diverted to them first.

Perhaps our health ministry will draw up its own guidelines. Or perhaps, it will be unspoken and doctors will have to make their own decisions according to circumstances.

It will certainly raise ethical questions and put new pressure on the health authorities, especially doctors who have pledged to save lives.

Doctors dealing with serious cases have always had to make such life-and-death decisions. Now, they will be pressured to make more of them. I feel sorry for them. That’s why I’m staying home as much as I can. You should too. - FMT

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.