The Murder of a dead person

About 2-3 weeks ago the nation was outraged by the story of a child with severe dengue who was treated at Fortis Hospital Gurugram for 15 days in NICU and billed Rs 18 lacs plus for the same. The father of the child had alleged on TV channels that the child who was brain dead was being kept on ventilator and treated for monetary reasons. The doctors were alleged to be wanting to do plasmapheresis costing 10 lacs against wishes of the father. It was only on parents demand that scans of brain were done to ascertain whether the child was brain dead and these showed 70-80% damage. The parents then sought to get child removed from ventilator and leave hospital against medical advice. This allegation of treating a dead or nearly dead child in ICU with bill for 2700 gloves and 660 syringes caused many of us in the medical profession also squirm with discomfort.

http://www.timesnownews.com/…/fortis-hospital-gurugr…/129955

However soon the Haryana Government got its "act" together and constituted a probe panel to inquire into the incident which has now labelled the treatment given by fortis hospital criminally negligent with the health minister declaring it as “murder”

https://www.ndtv.com/…/murder-says-anil-vij-after-probe-int…

We need to be clear whether the child was dead and was being unnecessarily treated by fortis to inflate her bill and make profits or was the child alive. If the child was alive then the parent’s request to remove the ventilator needs to be prosecuted. However If the child was already dead, then Mr Vij , it cannot be murder. There is no clear guideline for doctors who are left to make their own ethical decisions whether to prolong life saving measures or to switch off and let nature take its course. In case of a dispute it would be easy for someone to accuse the doctors of murder. The guidelines issued by the Honourable Supreme Court in Aruna Shaunbaug case carry little practical relevance since they ask for a writ petition to be filed in high court for each case and let the two judge bench decide whether to withdraw life support. In the month that the legal system will take to decide each case the bill for such a patient would reach 50 lacs. There is procedure laid down under Transplantation of Human Organs Act to declare a patient brain dead but again the process is lengthy, cumbersome and involves costs which would again be consider unnecessary by our learned media.

Though death of a young girl due to dengue is most unfortunate and there can be no words to comfort the parents but the blame for her death cannot and should not be laid at the door of those who tried to save her. Technology unfortunately is expensive specially since there is no focus to develop it indigenously. The level of supportive care needed for dengue hemorrhagic shock syndrome is available maybe in 5-6 Government hospitals all over the country. Civic authorities and public need to get their act together to prevent breeding of mosquitoes and such like unfortunate deaths. The Government on its part needs to infuse funds much more than the measly 1.2% of GDP it currently gives to the public health system to keep costs of private health care in check.

But most importantly we need to evolve specific guidelines for doctors who have to take decisions in difficult situations specially where brain is not completely dead but nearly so, irrespective of cost of such decisions or of what the press will say. If the doctors follow the guidelines then they need to be protected from the abuse of maliciously defamatory TV anchors, or the proclamations of murder sentence by politicians.

Dr Neeraj Nagpal 
Convenor,Medicos Legal Action Group, Managing Director MLAG Indemnity,
Ex President IMA Chandigarh
Director Hope Gastrointestinal Diagnostic Clinic,
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