The Korean telenovela series Ghost Doctor portrayed a genius surgeon in a coma whose spirit was able to possess another surgeon’s body. The genius surgeon thought of patients in persistent vegetative states as space-occupying bodies, since the beds could be used for other patients with better prognosis.
In the Philippines, the families of patients in private hospitals decide to bring their patients home to allow natural death when the resources are not sufficient to support the growing hospital bills. Further medical intervention would be considered extraordinary measures. Government hospitals are usually inundated with patients so there is an urgency to discharge patients as soon as they are more stable in order to provide more beds for incoming patients.
Last week our hospital celebrated the 5th anniversary of the Malasakit Center – a one-stop shop for government funding agencies in one geographic location so that patients can be discharged with out having to pay a single peso of their hospital bill. In Philhealth, this is known as the NO BALANCE BILLING. However there are big bills that reach millions of pesos, but the outcome of patients still end in death. It’s a difficult call for the doctors handling patients in the ICU to decide on prognosis, quality of life and health outcomes. Moreso, patients in persistent vegetative state, more commonly known as “comatose”.
Last Wednesday, we organized our hospital’s first bioethics conference. The lecturer discussed the four (4) basic principles of ethics: autonomy, non-maleficence, beneficence and justice. A case of persistent vegetative state was discussed and concepts such as respect for autonomy, paternalism, common good, distributive justice, motivation, quality of life, futility, advanced directives, and allowing natural death.
The parents did not want to bring the patient home. They didn’t have the resources to take care of him while they worked, whereas if the patient remained admitted, his care would be at no cost to the family. However, with the poor prognosis, he would be depriving another patient of the same resources that were afforded to him.
Join us tonight on #HealthXPH at 9PM MLA time to discuss this complex topic:
T1. In your opinion, should the government pay for the care of patients in persistent vegetative state?
T2. When and how should healthcare workers bring up discussions of allowing natural death?
T3. If you were the healthcare worker assigned to pull out the ET tube and withdraw life support, how would you feel?
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