Case 1. Withdrawal of life support treatment in limited resource settings
Introduction
Withdrawing life support treatments presents unique ethical challenges in resource limited settings. There are unique legal, moral and cultural aspects that require to be addressed.
Case scenario
A 42 year old gentleman was knocked down by a fast moving vehicle in Kampala. He was admitted to the nation’s only trauma high dependency unit and put on mechanical ventilation. He was pronounced brain dead using standard criteria two hours after admission.
The trauma unit received two other patients with severe road trauma who needed urgent mechanical ventilation in the same period and members suggested stopping the brain dead patient’s ventilation. The attending clinicians were not comfortable with switching the machines off and sought the advice of the hospital ethics committee. The ethics committee advised that Uganda had a cardio-respiratory criterion for death and that there was no legal framework for brain death. So neither the Institution nor the clinicians could switch off the machines.
The family agreed with the option of switching off the ventilators. The ethics committee advised that the family could among themselves chose a person to do it. None of the family members could do it on moral grounds fearing blame at the funeral. They again requested the clinicians to remove the machines (“Please doctor kill the patient for us”).
The clinicians in consultation with the ethics committee decided to wait and observe the patient till he got a cardiac arrest and passed away without resuscitation ten hours after admission.
Questions
- Identify the facts in this case.
- Discuss the ethical issues posed by this case
- Are there aspects of medical futility in this case? Discuss
- What could have been done differently?