Value of informed choice
A doctor’s viewpoint on why given the futility and risks involved, he would decline consent for the use of a ventilator if and when n-Coronavirus strikes him
Into the seventieth year of life and having survived a life-threatening heart attack in January 2017, I'm fit as a fiddle and do my bit as an activist along with co-workers in Delhi. Were n-Coronavirus to affect me with mild symptoms, I would self-quarantine at home. Presently 1.25 billion people in India are anyway under lockdown but are allowed to visit the market place for buying essential items; though of course I'll have to stop these visits once flu-like symptoms appear.
I do not underestimate the reach of the watchful eyes of the Big Brother; a District Magistrate can — under cover of the 'Epidemic Diseases Act, 1897' — dispatch a policeman to get me forcibly admitted in a hospital for 'treatment'. This Act is a Draconian Law which takes away the civil liberties and democratic rights of a citizen. The Indian Higher Judiciary takes up Constitutional validity cases in the presence of a real-life case, which I would have become by then.
After testing for COVID-19 would be done, were I to develop breathing problems, then an x-ray of my chest would be done to confirm the presence of pneumonia. If prescribed antibiotics for pneumonia, I'll discuss this with the treating physician since existing antibiotics cannot tackle pneumonia due to n-Coronavirus. I see no point in consuming medicines which are useless or harmful by way of side-effects. I won't consent to untested drugs even if it has the tacit backing of WHO.
As for relief to my breathing problem, I'll consent to medication like steroids, bronchodilators for opening up my respiratory passages keeping in mind my underlying heart condition. When breathlessness becomes severe and need arises for a ventilator, I'll deny the consent for two reasons.
Firstly, ventilators are difficult to be sterilised properly and actually give patients another type of pneumonia which may be impossible to treat. Ventilators notoriously often become vehicles of introducing drug-resistant, hospital-borne infection against which existing antibiotics have become ineffective. My second reasoning is this: I see no logic in this exercise. I'll explain. True, ventilators could be of use in patients with severe pneumonia in which the causative organism is known and antibiotics — tested and duly approved — exist. These antibiotics could clear away pneumonia in a week or two, meaning the patient is eventually weaned off the ventilator. However, in the case of COVID-19 pneumonia, no time-tested and duly approved medicine exists.
Even as the families of patients emotionally suffer, it is the patient who truly suffers the ordeal; with the ventilator in place, the patient has to be sedated 24x7. As the nurse regularly sucks the fluid out of the respiratory passage, a perceptive person can observe the patient's body twitch. Pneumonia caused by COVID-19 will not resolve itself since medicines don't exist as of now and the doctors will not remove the ventilator on their own; these doctors would quote the Hippocrates oath in their defence. The immediate family members, likewise, won't have the courage to ask for the ventilator to be switched off.
Finally, Mother Nature resolves the dilemma created between the doctor and patient by a machine called the ventilator. The weakened flesh of the patient succumbs to multi-organ failure after days of 'avoidable medical torture.' At that point in time, the philosophical question remains unanswered. Whose life is it anyway?
After not consenting for a ventilator, I'll request the medical staff to consider administering me oxygen through a nasal tube and intravenous fluids in case I'm not able to eat anything orally. That done, I will thank the medical staff and request them to leave me alone. Every human being has a right to a peaceful and graceful exit from planet earth.
To conclude I would like to note a few things. First, this piece is clearly not an advisory and patients should follow the advice of their attending doctor. Second, ventilators have a role in many conditions as a temporary aid and should be considered in such cases. Third, it is understandable if patients consent to untested drugs. Finally, the mortality rate for n-Coronavirus infection is under four per cent. Over 96 per cent of patients recover.
The writer is a member of AIDS Bhedbhav Virodhi Andolan (ABVA) and has worked through six epidemics