Doctor's Dilemma (Sujatha)

A fascinating article and discussion in The New England Journal of Medicine.

Comments

[Norman Costa]

Yes, it is a fascinating article. DON'T forget to read the discussion. It's what gives perspective to the story and fills in the blanks you didn't know were there.

[Ruchira]

Sujatha, I see no link. I don't know how Norman read it.

[Sujatha]

I don't know why you couldn't get to the article, Ruchira. Try cutting and pasting this in your browser:
http://www.nejm.org/doi/full/10.1056/NEJMp1006331?query=TOC

[Dean C. Rowan]

Can't say I understand the full extent of the problem. The medical doctors, including the spouse, understood their protocol. They failed to comply with it, not because they reasoned that medical circumstances demanded an exceptional response, but because of a "practical concern" that if they gave up the crew would necessarily take over, to the detriment of the rest of the passengers. How so? Why couldn't two of the four attendants perform the ordinary work of an attendant while the other two, merely to comply with their own industry rules, performed the useless CPR?

The doctor seems a little resentful that he and his colleagues had been relegated to "acting less as physicians than as skilled passengers assisting a flight crew." He believes the rules should be revised to prioritize a doctor's opinion as to "the good of the patient," trumping the crew's opinion as to the good of their passenger. In particular circumstances, such as this one, it seems sensible to permit flight crew to defer to the judgment of the attending physician. But then how does he arrive at this prescription? "We should ensure that our medical policies and protocols exclude considerations such as mitigation of liability or the exclusive interests of third parties from playing a role in resuscitative decisions." His solution, by recommending the establishment of an industry standard relieving flight crew of the duty to intervene after a doctor deems further treatment futile, is precisely such a consideration.

[Sujatha]

On the difficulties of having the flight attendants continue the 'ineffective CPR', if they were using both Chest compressions and an Ambu bag (being compressed 12 times a minute, holding mask to face) , it would possibly have required at least 3 attendants' combined efforts, and probably a violation of the airline emergency landing protocols.
Incidentally, one of those raising her voice in the discussion is the deceased patient's wife,a physician herself (Elma Lou Roda) giving her perspective on the whole issue.