James says hospital often faced with tough decisions
The chief administrator at Barbados’ lone public hospital is suggesting that authorities may have to consider discontinuing treatment for some terminally ill patients.
Chief executive officer of the Queen Elizabeth Hospital (QEH) Dr Dexter James said today while such a move posed an ethical dilemma, it was an agonizing reality that the healthcare facility faced frequently.
He raised the controversial issue as he delivered a lecture organized by the University of the West Indies Open Campus on the topic Is Free Health Care Sustainable?
James told the gathering that packed the Grande Salle of the Central Bank that sooner or later, consideration would have to be given to taking brain-dead patients off life support, as one means of reducing spiraling health care costs that were likely to make the provision of services unsustainable.
“The question I want to ask . . . ‘is Barbados ready for a conversation and a debate around futility of care versus rationing?’,” he said, explaining that futility of care was where “medical care cannot provide the patient with the quality of life that is meaningful to the patient” and was determined through assessment by a medical team.
“We agonize every day when our treating physicians would come to us and say, ‘we have a patient on the ward who has a stroke, the prognosis is poor and is occupying the ICU bed and by the way, we have a 35-year-old in the Accident & Emergency Department . . . with a stroke [and] his condition could improve if he gets ICU support’.
“That is an ethical dilemma that we have to address if we are really serious about fixing some of these systemic problems in the system,” James added.
He said there were cases where the QEH kept patients on life support even though all the indicators pointed to them being brain-dead.Somebody had to make the call on addressing that matter, the hospital CEO insisted.
He acknowledged that there were legal implications to cutting the lifeline of that category of patient.
However, he noted: “If Joseph Fletcher was the CEO of the QEH, he would make decisions based on his understanding of situational ethics that the quality of life was more important than the mere length of life.”
James pointed out that Fletcher, an American professor who founded the theory of situational ethics in the 1960s and served as president of the Euthanasia Society of America, did not accept the cultural traditions that life had absolute value.
He also pointed to the views of one scientist who argued that parents of children with Down Syndrome should not feel guilty about putting those children away, “whether it is putting away in the sense of hidden in a sanitarium or a more responsible lethal sense”.
The hospital’s chief told the audience he had raised those controversial views to demonstrate the thinking with respect to keeping patients alive when there was no real hope of them having a meaningful life.
He said while this was one way of cutting costs, there were also additional options such as greater efficiency in deploying resources, instead of asking for more funds.
James also suggested that doctors should be paid for their outcomes instead of getting compensated in spite of their patients’ outcome.