Dilemma for kin of patients on ventilators

AHMEDABAD: Though the state government is incurring the medical expenses of NSG commando Surjan Singh Bhandari, who was injured in the Akshardham attack and is on a ventilator in the civil hospital ICU for a year now, it has been a painful experience for his family.
The plight is worse for those less fortunate ones who also have to incur the prohibitive cost of keeping their loved one alive with the help of a ventilator and equipment that aids artificial breathing.
Though not legal in India, euthanasia is often on the minds of families who have to see their loved ones suffering even as a ventilator keeps them alive.
In Ahmedabad, doctors say they have seen many families forced to take home their terminally-ill kin when the hope of a recovery fades.
According to medical ethics, the ventilator can be removed only after a team of doctors, including a neurosurgeon, certifies the patient to be brain dead.
Often families choose euthanasia and decide to take home their dying relatives against medical advice. While some are forced to take the tough decision when faced with the prohibitive cost of ventilators, others would rather see their loved one die peacefully at home.
The per day cost of keeping a patient on the ventilator ranges between Rs 4,000 to 10,000, depending on the type of hospital. The ICU, medication and other charges are added on, and these are beyond reach for most middle-class families.
For Haresh Shah (name changed), the decision to take his uncle off the ventilator was a tough one. “He was suffering from cerebral haemorrhage. The verdict of doctors was that the damage was irreversible and he would not recover. We took a decision to take him off the ventilator rather than see him suffering on a hospital bed. He died a peaceful death at home the next day,� he says.
Apollo hospital director of medical services and cardiologist Dr Harshad Gandhi says, “A ventilator as a life-saving equipment is extremely useful. We have many patients who were saved due to timely intervention with the ventilator. But at the same time, it is very expensive to keep a patient on a ventilator. A doctor should be courageous enough to admit that his patient is sinking and the ventilator cannot help him recover. Some times relatives have to be bold enough to take the decision.�
According to Dr Joyal Shah of Sterling Hospital, while ventilators can be life saving, in some cases where the patient is dying, it becomes an economic issue too. “The cost of keeping a patient on ventilator is high. In case where it is uncertain how long a patient would remain dependent on a ventilator or when there is no improvement in his condition, many families do take a decision to take home their dying relative.�
Dr J C Panchal, cardiothoracic surgeon at the Civil Hospital, however says that it is legally wrong to shift a patient from a ventilator. “A ventilator can be removed only if a team of neurologist and cardiologist certifies a patient to be brain dead.� The civil hospital here is the only hospital that provides free ventilator services.
There are patients who have been on ventilators for a few days and recovered completely, according to Dr Animesh Choksi of Krishna Heart Institute.
“My first reaction would be that they should not be removed as efforts to save life should not stop. However, there are economic and emotional aspects involved. Many families feel that they do not want to see their loved one suffering. They choose a peaceful death at home, rather than see them dying with machines in a hospital,� he says.