Doctors need law to turn off life support

Moch. N. Kurniawan, The Jakarta Post, Jakarta

A number of doctors are urging the government to resize Health Law No. 22/1999 to provide doctors with legal protection when declaring a patient clinically brain dead.

Dr. Iqbal Mustafa from the Harapan Kita Cardiac Hospital in Jakarta and Dr. Tri Wahyu from the Hasan Sadikin Hospital in Bandung, West Java said here on Monday that under the Criminal Code, a doctor could be charged with murder if they switched off life-support for a patient who was diagnosed as brain dead.

"What will doctors do if a patient's brain no longer functions although his heart is still beating? Should we declare him dead? In medical science they are dead already," Iqbal said.

"But if we declare them dead we will be punished as a murderer. A doctor is not a killer, therefore he or she needs protection."

To date, Tri said doctors must reach a consensus with the family to ensure there is no lawsuit if they switch off life- support.

Without such a consensus, doctors here would not dare to announce the patient deceased, she added.

Iqbal and Tri are the president and secretary general of the Association of Indonesian Critical Care Medicine (PKGDI) respectively.

Under normal circumstances, a person whose breathing and heartbeat has stopped is considered dead. But today doctors sometimes prolong the functioning of the lungs and heart by artificial means, even if a patient's brain is already damaged.

Developments in life support machines have led to a new definition of death called brainstem death.

A brainstem death diagnosis is reached only after repeated medical tests confirm that the brain is no longer functioning.

Iqbal said a decision to declare such a patient dead had to be taken by at least two doctors: a neurologist and an intensive care unit (ICU) doctor.

Tri said several countries, such as the Netherlands, had legally allowed doctors to announce the brain dead as dead.

Tri went on to say that the government should establish a special team to review the law and include the brain-dead issue in the revision.

Should the revision be approved, a doctor could refuse to treat a brain-dead patient even if family members attempt to force the doctors to continue with medical treatment.

Furthermore, Tri suggested brain-dead patients donate their hearts, livers, eyes and other organs to those in need.

Meanwhile, Iqbal said that his organization would host the 12th meeting of the Western Pacific Association of Critical Care Medicine in Bali from Aug. 22 to Aug. 25.

He said 1,300 participants from Indonesia, Singapore, Malaysia, Thailand, Vietnam, Philippines, South Korea, Taiwan, Japan, China, Hong Kong and Australia would attend the biannual congress.

"We'll mainly talk about a comprehensive approach from pre- hospital treatment to the hospital," he said.

Other issues, including brain death and bioterrorism, particularly anthrax attacks, would also be discussed, he added.