49 Irrational action

The mule and his Rider: A rider was guiding his mount, a mule, along a mountain track. Suddenly the mule left the track and rushed to the edge of a precipice. The rider dismounted and tried to pull the mule back by its tail but it would not budge. Coaxing and cajoling did not help either. Finally, the rider gave up saying, "If you want to jump over the brink, have it your way. It is the quickest way to die."

Kittu, a 20-year old farm-labourer, was admitted with acute meningitis, a severe infective condition attacking the membranes covering the brain. If untreated, it is a fatal condition. He was admitted in the emergency ward and intensive antibiotic therapy was begun. From an unconscious state, he improved to a delirious state within 24 hours. His parents were upset by his delirious muttering and wanted to take him home 'before he died'.

The treating physician pleaded with them to continue treatment and said, "I can most certainly cure him within a week or two. But if you take him home, he will die within the next three days. Please give us a chance to save his life.” The parents did not agree and took him home against medical advice.

Comments

One of the strong points of modern allopathic medicine is the successful treatment of acute life-threatening infections like pneumonia, meningitis, etc. It is most disheartening for a physician to send against-medical-advice, a patient with a serious but

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highly curable infection. Such foolish behaviour by the relatives of a sick patient is not uncommon. Dependent persons like women, female children and the elderly are especially vulnerable to such acts by their domineering and boorish relatives.

I have treated a few women patients with potentially curable diseases, whose husbands will sign the against-medical-advice form and take them home. Some callous remarks from them include:

- "Why should I donate blood for her? I can have my blood and marry someone else." - "Why should I keep her here? If she dies here, I can't pay for her transport and conduct her funeral. If she dies at home, it is all right. I can manage the funeral." - "God has given her the infection. Let him decide if she would live or not. I shall take her home and pray."

When confronted with cases like Kittu, I feel that state custody for health care should be permitted even for adults who, like Kittu, are not in a position to decide for themselves what is good for them. They are at the mercy of relatives. Cynicism, fatalism, escapism, or fear of an adverse outcome in a hospital setting, are some of the reasons for the relatives making foolish decisions that can be considered as a form of 'passive homicide'.

In USA, a country that permits individual autonomy very strongly, a physician can request the State to take custody of a minor if the parents are not acting in the best interest of their child's health.

Our society needs to take a serious look at the thousands of innocent victims who die, not due to lack of quality health care but due to denial of life saving treatment. We can save many of these women, children and dependent adults from 'passive homicide'. Plugging the loopholes in health care rights would help. Let us do it soon.

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