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.

Chief executive officer of the QEH Dr Dexter James
Chief executive officer of the QEH Dr Dexter James

“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.


8 Responses to Dilemma

  1. Sharon Woolley
    Sharon Woolley February 27, 2015 at 4:24 am

    Exactly how do you determine who gets the chance of living life longer and who doesn’t ? seems amazing you let murderers live the life in hotel Dodds yet honest people are sent to die without trying to let them have a longer life

  2. Tara Inniss-Gibbs
    Tara Inniss-Gibbs February 27, 2015 at 6:21 am

    Lawmakers should consider how there could be provisons for advanced directives or living wills so that families can make these decisions with the advanced guidance of their loved ones.

  3. Tony Webster February 27, 2015 at 8:52 am

    Sir, I sympatgise with what you-and our medical professionals-face routinely. I really do. However, all governments the civilised world over, face similar agonising choices.
    I posit to you however, that the crux of the matter..and its solution, lies in establishing sound policies…and thereafter, being guided accordingly.
    The same applies to other routine functioning of health insitutions in general ,like Q.E.H., and our polyclinics. Having recently had all manner of admissions from on high as to the un-sustainabilty of the current policy…all we now need, is a clear statement of the New Health Policy. You Sir, are expected to implement policy,, effectively and efficiently. It is grossly unfair and iniquitous that you carry the can for poor policy and a broken system. Tell your bosses to just get with the new policy…and let us all move on!

  4. Mac10 February 27, 2015 at 9:58 am

    This is truly offensive. I am in favour of a family’s or personal right to euthanasia if their quality of life is at such a level as they see no option and that is their choice. But to do it on the basis of “it saves money for the State” is beyond reprehensible. People are not animals who are put down because the bills too high.

    Also Dr James, your references to Down’s syndrome are equally offensive.

    As CEO, you should be fired immediately!

  5. corrine boxill February 27, 2015 at 10:24 am

    Sorry to sound so abrupt… but this man thinking straight or what ( he sound as if he have heartless syndrome) stupse !!!

  6. jr smith February 27, 2015 at 11:24 am

    Where do Barbados find these people, the levels of logic thinking is very very low and this seems to be rampant among so call high levell management.
    It seems better to employ foreigners, who must prove they worth, in Barbados persons must not be employed because they are bajans.

  7. Maxine Hutchinson February 27, 2015 at 2:52 pm

    Mr Dexter James, as a St Lucian, let me ask you straight up – do you like others hate Barbadians?

    I understand situation ethics also and its “bottom line” is: as long as love prevails and no one is hurt”.

    Many people like are coming here for work and medical attention, They afterwards slip out of the island leaving bogus address and big bills unpaid. Many of them who are employed take their wages/salaries at the end of every week and month and send home to their families. The money that they send out of Barbados cannot circulate in Barbados, then you wonder why we do not have enough money on hand to do our business.

    In addition, let me ask you: are you making room for non-nationals to come to Barbados and “get a bed” in order that they can receive care? Who do you think you are?

    Could it be that as a result of your line of thinking that the situation at the hospital prevails in order for you to point to the patients that are on life support? How many are there? If they are taken off the care, how much money are you proposing that our government would save? Can you put it in figures for us?

    Mr James, your vibrations are full of anger and hate. You could not care one bit about the patients and you want to overshadow your feelings with the “carrot” that to take the route which you have suggested would save the government money. Let me tell you something, the DLP administration will carefully examine what you have posited and believe me, they are no fools. They do not wear blinkers.

    Trust me, you have offended us as Barbadians and you may have offended the doctors. Am I to believe that your contract is close to its expiry date and could be the main reason that you have decided to vent your feelings?

  8. Charles Worrell February 27, 2015 at 10:10 pm

    I continue to find much disease in what is happening in Barbados. I am from one of the used to be poorer parts of the country and was a recipient of school clothes etc. I keep recalling how a man’s vision for his people was the ONLY propelling force for him and because of this, there was education. FREE education. It leveled the playing field of economics among our people and many of us sat next to the “BOWrings” (older folk know who those were) at graduations and walked the aisle and corridor of every significant place in Ba-ba-dos. Many said it couldn’t be done; many questioned where the money would come from and in the end Mr. Errol Barrow showed us and today, 95% of all of us in any place of leadership, management etc. can attest to this bold decision by this great Barbadian.
    The QEH came and was opened by the Queen of England; beautiful and effective to MOST bajans. Doctors GAVE of their talents as public servants and nurses nursed and mothered many of us along with a healthy dose of chastisement regarding our health. Again, where did the money come from? How was it to be done? Far less develop than we are today (a bloody deception) and yet, we were able to do it because Barbados was about Bajans..a loving and happy people, having no visible stress (as the tourist used to say for we were a smiling people).
    Today, that love for people and country have become more difficult to see as we had the misfortune of fourteen years during which we were brainwashed in the view that we were ’01st world as a third world country”. We opened our doors to everyone and cared little about the benefit of so doing; we sold our land and homes on the basis of the extra dollar and ignored the lost to our children; people came in and took contracts and huge checks only to repatriate them after paying off a few facilitators for the favor; we allowed business to come and set up with a twenty-five year Insurance plan that they could exploit us even if they leave when it was time to truly play their part in our society; we allowed loop holes in agreements that guaranteed that these people will not be bound to deal with our locals in supplying them with produce; we allow the Muslims to build their mosque and consolidate their position in bajan society while their connections go undetected or unchecked even as they remain outside the fabric of bajan society; we took away the joy of learning from our children as we implemented an American system (under the guise of CXC), full of stress, anger and the consequent violence against school property, teachers, principals and themselves; we did this ignoring that what we were doing did not work in the Americas and so, it has little chance of working here, but the proponents had their day; drugs and stealing continued almost unabated largely because the wigs involved are too big; hotels were allowed that saw no reason to give back to us anything more than a pittance for wages while the cost of living continues at a blistering pace; most of our local bodies too, are now headed by people from other lands; and even as Mr. Joel Garner, a noted cricketer and administrator aspires to appointment to the Board, there is a cry in Jamaica that he should not be so appointed while we forget Patsy Callender and others to make room for Mr. Bolt from the same Ja. With all of our spineless wisdom, why should we wonder that Mr. James is now showing the ugliest side of a person sworn to keep life going? Barbados has lost its way and until another able group arises, full of love for country and all that it USED to stand for, we will continue to see people come here and treat us as we have become..LESS THAN SECOND CLASS CITIZENS, even as we shout otherwise!


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