Home 
Contact 
Profile 
Videos 
Material by Professor Omar Hasan Kasule Sr. for PBL for Year 2 Semester 1 Med PPSD on 20th August 2008
Background
Rosli was at home attending a family festival, kenduri, when he suddenly felt weak and collapsed falling on the ground. He lost consciousness. Family members gathered around him and tried to revive him by shouting at him or moving his arms and legs. They tried pouring cold water on his face with no response. They concluded that he was dead and they started offering prayers for the dead. A distant cousin who had retired from nursing 20 years ago tried to feel Rosli’s pulse and she said she was not sure whether he was dead and advised that he be taken to the hospital just in case.
Q1. What is your opinion about the criteria used for determining death in this situation
Q2. What is your opinion about determination of death by a person who is not medically qualified?
Emergency room evaluation
Initial examination at the hospital revealed the following:
Measurement | Rosli Hj Jumaat | Average normal value |
Mean Arterial Pressure in mmHg | 90 | 96 |
Heart rate beats per minute | 110 | 70 |
Cardiac output in liters per minute | 3.0 | 5 |
Arterial oxygen content in milliliters per liter | 150 | 200 |
Global oxygen delivery in milliliters per minute | 500 | 1000 |
Q3. What conclusion can you make from the above results
Intensive care unit
The attending medical officer decided to send him to ICU and to start all available life support measures. Several members of the family were not happy with life support they wanted to take Rosli away and prepare for burial they were however afraid to oppose the doctor. After 12 hours on life support without any sign of life visible to them, the whole family was united in asking the physician to discontinue life support. The ICU physician supported by the hospital director insisted that Rosli was living and that he could not discontinue life support. Relations between the family and the hospital staff were bad over the next weeks with frequent quarrels and arguments.
Q4. What do you think are the criteria for initiating life support?
Q5. What do you think are the criteria for stopping life support?
The family was tired of waiting in the hospital for all this time. They had come to accept that Rosli has some life in him but were convinced his fate was already sealed and that all the life support given was a waste of time. Suddenly at the start of the 4th week Rosli while still on life support made some spontaneous movements. The whole family was overjoyed. Their joy was however dampened by the ICU medical officer who castigated them: ‘ I told you he was alive and you did not believe me! Did you want me to withdraw life support so that he would die quicker! Were you after his inheritance and could not wait!’
Q6. What do you think about the conduct of the physicians and the family?
Rosli made quick recovery over the next 4 days. Most of the life support equipment was withdrawn and he started some oral feeding. He was able to recognize his family and to talk to them. The consultant surgeon visited Rosli to discuss options for further treatment. He suggested a major surgical intervention. Rosli refused the surgery. He said that he did not want his family to suffer any more. His case was terminal and he wanted to die in peace. He also did not want to exhaust all his savings paying for the surgery leaving his grandchildren with little to live on.
Q7. Discuss the cost-benefit considerations in artificial life support