Barry Ashpole Media Watch (#469)

Barry Ashpole Media Watch

The latest issue of  Media Watch, compiled and annotated by Barry R. Ashpole (Ontario, Canada) can now be downloaded here. More reports can be found at IPCRC.NET

Articles from Asia Pacific Region

Australia – High number of terminal patients unnecessarily treated, study finds

AUSTRALIA | ABC News (Sydney) 2016 – Doctors have called for the public to dicuss end-of-life care (EOLC) with their loved ones after a study revealed one third of elderly patients with an advanced or terminal illnesses receive unnecessary treatment in the last six months of their lives. The global analysis of 38 studies of EOLC … found a significant number of patients received treatments that were of no benefit to them. These included chemotherapy, radiotherapy and CPR, when a person had a not-for-resuscitation order. Lead author Dr Magnolia Cardona-Morrell, a senior research fellow at the University of New South Wales, found some non-beneficial treatments prevented patients from having a comfortable death. “Some of these treatments are geared towards making the patient more comfortable, but the idea is that some of them are too aggressive to be of benefit to the patient,” she said. “For example, CPR on an elderly [person] who has a not resuscitation order, or admitting them to intensive care for over a week, or starting chemotherapy, or dialysis in the last days of life.” Non-beneficial treatments was defined in the research as medicine, procedures, or tests administered when a patient was naturally dying, but which did not improve their chances of survival or their quality of life http://goo.gl/rBeFJ2

India – Don’t torture the dying: Health ministry’s draft law confuses between euthanasia and withdrawal of life support

INDIA | The Times of India (Delhi) – 20 June 2016 – The Constitution of India guarantees life with dignity as a fundamental right. Generally speaking, we enjoy this right. But it all changes if we get an incurable disease. Or when we eventually wither and die of old age. In those circumstances, we should still have the right to live the way we want to and die where we want to. But we find that we no longer have any choice. An Economist study found that India was one of the worst 15 countries in the world to die in, coming 67th out of 80 in “quality of death.” 1 In India, as we near the end of life, we cease to be treated as human beings and become mere containers of disease. Until it is seen or experienced, it is not easy to understand the degree of assault on dignity by inappropriate medical treatment in incurable diseases. Typically, even if one is fully alert and able to take decisions for oneself, one finds oneself stripped of that privilege. Whether it is advanced cancer or some other illness, the family takes over and makes decisions, and the “patient” is bundled into a hospital. There, in turn, the family loses control; hospital protocol takes over and transfers the patient to an intensive care unit. http://goo.gl/7UiV3q

India – Palliative care standards for health care

INDIAN JOURNAL OF PALLIATIVE CARE, 2016;22(3):239-243. The Economist Intelligence Unit, in 2015, published the Quality of Death Index, which ranked the end-of-life care (or lack, thereof) across the world. Among 80 countries included in the study, India came 67th . At one look, this may seem an improvement on the 2010 report, where India had ranked 40th out of 40 countries, below Uganda, which was at 39. However, closer study of the report would inform us that India escaped from being at the very bottom, not because of better quality of death, but because there is an atmosphere conducive to growth of palliative care (PC), as created by the formation of India’s National Program in Palliative Care and the amendment of the Narcotic Drugs & Psychotropic Substances Act of India in 2014, though they are yet to be implemented. The Economist Intelligence Unit’s report, while critical of the poor attention to the dying person in India, was appreciative of the developments in the State of Kerala. Kerala has more PC than in the rest of the country put together, though only 3% of India’s population lives in this tiny state. More than 185 institutions in this state have a doctor and nurse with training in PC, stock and dispense oral morphine, and most dispense it free to patients in pain. At one glance, this would appear to be a heaven within a sea of suffering; but a closer look would tell us that Kerala has this exalted position only in comparison with the rest of the country. Things are not too rosy in Kerala, either. http://goo.gl/FweNfk

 Article highlighted to be of particular interest:

Ethics in practice: Is it futile to talk about “futility”?

EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 2016;33(7):473-474. Within current medical practice, as the lines between life and death become increasingly blurred, we, as physicians, often find ourselves facing the decision whether to continue treating a critically unwell patient. These patients have often lost decision-making capacity because of a combination of the severity of their illness and the medication used for sedation and analgesia. A point may come when we feel that ongoing life-sustaining treatment should be withdrawn, or further interventions withheld, and we may justify this decision on the grounds that ongoing treatment is “futile.” The concept of medical futility has existed for millennia. Hippocrates advised physicians “to refuse to treat those who are overmastered by their disease,” realising that in such cases medicine is powerless. The state of being “overmastered” by a disease is subjective, as what may be intolerable to one person may be acceptable to another. Owing to this inherent subjectivity in defining what constitutes a burdensome existence, defining when a patient has been “overmastered” is not straightforward. The fact that many critically unwell patients lack capacity and cannot engage in decision making (defined in legal parlance as “incapax”) with their physicians only adds to the difficulty of deciding when ongoing treatment of that patient should stop. http://goo.gl/FqxyOW