Intensive care units and ethical issues

The October – December 2003 issue of IME carried two interesting articles (1, 2) that raise some interesting questions. Prolonging life at any cost in the terminal state is definitely not justified. Medical practioners have subtly practised this art of palliation where prolongation of life is abrogated, with or without legal sanctions. Withholding any supportive treatment, for example, a gastrostomy in oesophageal cancer, needs an explicit consent from the patient. Withholding nourishment in a patient with an obstructed oesophagus due to cancer and who may live for few months even without treatment, is tantamount to starvation and is bound to be construed as cruel, unethical and illegal.

Barreto (1) correctly states, ‘It is ethical to withdraw lifesustaining treatments from those unable to decide for themselves, only when the treatment can no longer achieve its intended clinical purpose and cannot provide any benefit.’ Indeed it is laudable to help patients live with dignity till the last breath. But does the law of the land permit anyone to be take off the life-supporting system even before the patient is dead? Similarly, in the article, ‘The friend’, one gets an impression that the patient’s relatives took the decision to switch the ventilator off without having the power of attorney to do so (2). The pertinent question is also about switching off the ventilator without any objective evidence of brain death. I wonder what the legal stand is on this issue of switching off ventilators at will. I hope the future issues of the journal will discuss these matters.