Category: Death

  Pearl harbour Anaesthesia Tragedy- Historical Significance

Up to the end of World War II, less than 10% of the general anaesthetics administered were with intravenous barbiturates. The remaining 90% of anaesthetics given in the USA were with diethyl ether. In the United Kingdom and elsewhere, chloroform was also popular. Diethyl ether administration was a relatively safe and simple procedure, often delegated to nurses or junior doctors with little or no specific training in anaesthesia. During the Japanese attack on the US bases at Pearl Harbor, with reduced stocks of diethyl ether available, intravenous Sodium Pentothal(®), a most 'sophisticated and complex' drug, was used with devastating effects in many of those hypovolaemic, anaemic and septic patients. The hazards of spinal anaesthesia too were realised very quickly. These effects were compounded by the dearth of trained anaesthetists. The anaesthesia tragedies at Pearl Harbor, and the discovery in the next few years of many other superior drugs that caused medical and other health professionals to realise that anaesthesia needed to be a specialist medical discipline in its own right. Specialist recognition, aided by the foundation of the National Health Service in the UK, the establishment of Faculties of Anaesthesia and appropriate training in pharmacology, physiology and other sciences soon followed. Modern anaesthesiology, as we understand it today, was born and a century or more of ether anaesthesia finally ceased. It was estimated that the use of sodium thiopentone (Pentothal®) anaesthesia caused 1178 perioperative deaths in the hundreds of casualties who required emergency surgery in the 24 hours following the attack.

    Up to the end of World War II, less than 10% of the general anaesthetics administered were with intravenous barbiturates. The remaining 90% of anaesthetics given in the USA were with diethyl ether. In the United Kingdom and elsewhere, chloroform was also popular. Diethyl ether administration was a relatively safe and simple procedure, often delegated to nurses or junior doctors with little or no specific training in anaesthesia. During the Japanese attack on the US bases at Pearl Harbor, with reduced stocks of diethyl ether available, intravenous Sodium Pentothal(®), a most ‘sophisticated and complex’ drug, was used with devastating effects in many of those hypovolaemic, anaemic and septic patients. The hazards of spinal anaesthesia too were realised very quickly. These effects were compounded by the dearth of trained anaesthetists.  The anaesthesia tragedies at Pearl Harbor, and the discovery in the next few years of many other superior drugs that caused medical and other health professionals to realise that anaesthesia needed to be a specialist medical discipline in its own right. Specialist recognition, aided by the foundation of the National Health Service in the UK, the establishment of Faculties of Anaesthesia and appropriate training in pharmacology, physiology and other sciences soon followed. Modern anaesthesiology, as we understand it today, was born and a century or more of ether anaesthesia finally ceased.

It was estimated that the use of sodium thiopentone (Pentothal®) anaesthesia caused 1178 perioperative deaths in the hundreds of casualties who required emergency surgery in the 24 hours following the attack.

The  World War II  medical tragedies, especially those at Pearl Harbor, were a wake-up call for surgeons and the medical profession generally throughout the world. There was a realisation that it was no longer appropriate for any junior doctors or nurses to administer ‘sophisticated’ anaesthetic drugs for many types of surgeries and to critically ill patients. This had been known for many years in thoracic surgery and neurosurgery, but in the years after the war it was clear that appropriately trained anaesthetists were required, who had the knowledge and skills to use advanced drugs such as thiopentone and the new techniques and equipment which had rapidly developed in the 1940s.

The significance of the results of attempts of nurse and doctor anaesthetists to use thiopentone anaesthesia in military casualties who were hypovolaemic was very clear. Cardiovascular collapse and respiratory arrest with a lack of oxygen supplies, resuscitative skills and knowledge of thiopentone’s pharmacology and dosage, along with the insufficient numbers of skilled anaesthetists, clearly resulted in many tragedies. Some spinal anaesthetics also contributed to the perioperative mortality. So it was not too long during that fateful day in 1941 before surgeons and others reverted to using ‘drip ether’ as the principal anaesthetic technique and restricted the use of the available local anaesthetics, procaine and tetracaine, to infiltration only—mainly in burns patients. Exactly how many anaesthetic deaths resulted from intravenous thiopentone and hexobarbital will probably never be known as there were no defined classifications of such deaths as we have today.

In summary, the greatest significance of the anaesthetic events at Pearl Harbor, and more broadly throughout World War II, was that the surgeons, the medical profession generally  and health authorities recognised the need for appropriately trained and skilled specialist practitioners of anaesthesia. Modern anaesthesia, or anaesthesiology as I believe we should refer to it, was born soon after Pearl Harbor and World War II, and the ‘ether century’ began to expire, although ether continued to be used into the 1970s for many simpler surgeries in less developed centres.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Exorbitantly expensive medical education and lowered merit

0

Two siblings mauled by  stray dogs in Delhi; An urban jungle-where animals hunt humans

In an horrifying and frightening incident, mauled and hunted two siblings, aged 7 & 5, killed in stray dog attack in Delhi's Vasant Kunj NEW DELHI: Two siblings, aged seven and five, were killed allegedly in stray dog attack in two separate incidents in the Vasant Kunj area of Delhi. The police said that the 7-year-old boy went missing on March 10 and his body was recovered later with animal bite like injuries. They needed some shield to protect himself which society, government, courts and so called “dog-lovers” failed to provide. Courts have also upheld animal rights but failed to formulate and implement policies to ensure safety of humans from these violent strays. Government has not made out any policy to safeguard public from such attacks nor have courts come up with any solid guidelines, which can save public, children, women and older people from such bites. Danger of stray dogs is increasing every day around us. As the strays population in increasing, now they are grouped and see vulnerable humans as easy prey. Packs of dogs have become dangerous and difficult to control. Protected by Dog lovers and animal right laws, the danger to normal people of being hunted even around their homes is real. Human right of being in a safe environment is being ignored. Is it not hypocritical that you care for a violent stray that is a threat to the society? Problem is not about loving and feeding dogs, but simultaneous

In an  horrifying and frightening  incident,  mauled and   hunted  two siblings, aged 7 & 5, killed in stray dog attack in Delhi’s Vasant Kunj

NEW DELHI: Two siblings, aged seven and five, were killed allegedly in stray dog attack in two separate incidents in the Vasant Kunj area of Delhi. The police said that the 7-year-old boy went missing on March 10 and his body was recovered later with animal bite like injuries.

They  needed some shield to protect himself which society, government, courts and so called “dog-lovers” failed to provide. 

4-year-old mauled to death by stray dogs in Amberpet

An urban jungle-where animals hunt humans

Dog Lover but not for human child

        Courts have also upheld animal rights but failed to formulate and implement policies to ensure safety of humans from these violent strays. Government has not made out any policy to safeguard public from such attacks nor have courts come up with any solid guidelines, which can save public, children, women and older people from such bites.

 Danger of stray dogs is increasing every day around us. As the strays population in increasing, now they are grouped and see vulnerable humans as easy prey. Packs of dogs have become dangerous and difficult to control. Protected by Dog lovers and animal right laws, the danger to normal people of being hunted even around their homes is real. Human right of being in a safe environment is being ignored. Is it not hypocritical that you care for a violent stray that is a threat to the society? Problem is not about loving and feeding dogs, but simultaneous apathy towards safety of humans. Such dog lovers most of the time, totally ignore the fact that these dogs are a threat to children and older people. An immediate sense of hatred towards such dog lovers is a consequence and a natural thought.

Animal lovers while pretending of “dog love” have formed NGOs and have donations and accumulate money. But have failed to create shelters for stray dogs. Neither have any steps been taken to save people from dog bites. So consequently, people especially vulnerable are children and older people who are mauled and eaten alive by stray dogs. What responsibility and accountability these animal lovers and NGO bear towards such incidents? Why people who collect money in name of animals do not take care and form shelters for these strays? every single death from such preventable cause raise a question on this issue.

Apathy of these so called dog lovers towards humans is appalling.

SUGGESTION: the Government, NGOs and people who claim to be “animal lovers” should create shelters to save strays “as well as people”. It should be mandatory that all the dog and animal (stray or pet) droppings are properly collected and disposed off. This single step can do wonders as it will reduce infections, people’s suffering, save lives and eventually reduce use of antibiotics. A rationale mind will definitely appreciate the danger due to strays, and can initiate proper steps rather criticizing above said facts in the name of animal rights. An animal has no sense of responsibility, so rights should be limited accordingly.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Exorbitantly expensive medical education and lowered merit

0

End of Life issues-  ‘Hold on’ or ‘Let go’ #Tom-Sizemore

The eternal human wish is to fight hard against age, illness, and death and holding on to life, to our loved ones, is indeed a basic human instinct. However, as an illness advances, “raging against the dying of the light” often begins to cause undue suffering, and “letting go” may instead feel like the next stage. Tom Sizemore has no hope of recovery after he suffered a brain aneurysm, his family has said, confirming they are making an end-of-life decision for the Saving Private Ryan actor. The 61-year-old has been in a coma in the intensive care unit of Providence Saint Joseph Medical Center in Los Angeles since he was hospitalised on 18 February. On Monday night, Sizemore’s representative, Charles Lago, issued a statement revealing that there was no chance for his recovery. “Today doctors informed his family that there is no further hope and have recommended end of life decision. The family is now deciding end of life matters and a further statement will be issued on Wednesday,” Lago said.

A difficult decision near death- try to ‘hold on’ or ‘let go’

The eternal human wish is to fight hard against age, illness, and death and holding on to life, to our loved ones, is indeed a basic human instinct. However, as an illness advances, “raging against the dying of the light” often begins to cause undue suffering, and “letting go” may instead feel like the next stage.

Tom Sizemore has no hope of recovery after he suffered a brain aneurysm, his family has said, confirming they are making an end-of-life decision for the Saving Private Ryan actor. The 61-year-old has been in a coma in the intensive care unit of Providence Saint Joseph Medical Center in Los Angeles since he was hospitalised on 18 February. On Monday night, Sizemore’s representative, Charles Lago, issued a statement revealing that there was no chance for his recovery. “Today doctors informed his family that there is no further hope and have recommended end of life decision. The family is now deciding end of life matters and a further statement will be issued on Wednesday,” Lago said.

      Humans have an instinctive desire to go on living. We experience this as desires for food, activity, learning, etc. We feel attachments to loved ones, such as family members and friends, and even to pets, and we do not want to leave them.

     When we realize that the end of life may be approaching, other thoughts and feelings arise. Fears arise, and may be so strong that they are hard to think about or even admit to: fear of change, of the dying process, of what happens after death, of losing control, of dependency and more. Both the person who is ill and the caregiver might also experience resentment, guilt, sadness, and anger at having to do what neither wants to do, namely face death and dying.

As death nears, many people feel a lessening of their desire to live longer. This is different from depression or thoughts of suicide. Instead, they sense it is time to let go.  They may reach a point where they feel they have struggled as much as they have been called upon to do and will struggle no more. Refusing to let go can prolong dying, but it cannot prevent it. Dying, thus prolonged, can become more a time of suffering than of living.

Family members and friends who love the dying person may learn to accept a life limiting illness, and then accept the possibility of a loved one dying. They may see that dying is the better of two choices and  accept the inevitability of death.

The dying may be cause distress and  grief for those who love them. If a stage  has reached when treatments are no longer working as well as before, and everyday life maintaining activities are becoming more and more burdensome. In a sense, life is disappearing. One has to look beyond the fears and wishes.  What is really best for the one who is dying, and for the others around? Given that death is unavoidable, what is the kindest thing to do? It might be holding on or it might be letting go.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

0

Protection to Dogs but not to Human Child- Shameful Scenario

A horrifying and frightening video was recorded in Hyderabad, where a four year child was seen running and screaming for his life. 4-5 stray dogs were near him, mauled and hunted him as a prey. He needed some shield to protect himself which society, government, courts and so called “dog-lovers” failed to provide. 4-year-old mauled to death by stray dogs in Amberpet HYDERABAD: In yet another gruesome incident of its kind in Hyderabad, a four-year-old boy was mauled and killed by stray dogs in Amberpet area. Although the attack happened on Sunday, it came to light on Tuesday after CCTV footage of the dogs surrounding the boy and not letting him escape went viral. In the past year alone, the government-run fever hospital in the city has seen at least four cases of people dying after contracting rabies from dog

A horrifying and frightening video was recorded in Hyderabad, where a four year child was seen running and screaming for his life. 4-5 stray dogs were near him, mauled and   hunted him as a prey. He needed some shield to protect himself which society, government, courts and so called “dog-lovers” failed to provide. 

4-year-old mauled to death by stray dogs in Amberpet

HYDERABAD: In yet another gruesome incident of its kind in Hyderabad, a four-year-old boy was mauled and killed by stray dogs in Amberpet area. Although the attack happened on Sunday, it came to light on Tuesday after CCTV footage of the dogs surrounding the boy and not letting him escape went viral. In the past year alone, the government-run fever hospital in the city has seen at least four cases of people dying after contracting rabies from dog bites. Toddlers have been killed by strays in various parts of the state. According to data submitted in Parliament, Telangana reported about 80,000 cases of dog bite last year. Greater Hyderabad Municipal Corporation (GHMC) officials said the victim, Pradeep, accompanied his father K Gangadhar, a security guard at a car service centre, to his workplace on Sunday. The dogs attacked the boy while he was playing by himself. The 1:07-minute CCTV footage shows the child walking alone in the parking area of the service centre and three dogs rushing towards him. The boy, surrounded by the aggressive canines, looked scared and tried to run away. Soon, a dog pounced on him from the rear, resulting in him falling to the ground. The child gathered himself, got up on his feet and tried to escape, but the dogs attacked him again. Within seconds, all three canines began mauling him. The dogs tried to pull him away in different directions even as three other sub-adult dogs tried to join them. CCTV footage shows that the boy tried to fend off the attack, but gave up after being surrounded by the strays. A few seconds later, as the boy lay limp, the dogs tried dragging him away. Gangadhar, along with other staff members, rushed in and chased away the dogs. They rushed the boy to a hospital, but he succumbed to his injuries on the way and doctors pronounced him dead on arrival. Officials said the boy was carrying food in one hand, which might have attracted the dogs.

An urban jungle-where animals hunt humans

Dog Lover but not for human child

        Courts have also upheld animal rights but failed to formulate and implement policies to ensure safety of humans from these violent strays. Government has not made out any policy to safeguard public from such attacks nor have courts come up with any solid guidelines, which can save public, children, women and older people from such bites.

     Danger of stray dogs is increasing every day around us. As the strays population in increasing, now they are grouped and see vulnerable humans as easy prey. Packs of dogs have become dangerous and difficult to control. Protected by Dog lovers and animal right laws, the danger to normal people of being hunted even around their homes is real. Human right of being in a safe environment is being ignored. Is it not hypocritical that you care for a violent stray that is a threat to the society? Problem is not about loving and feeding dogs, but simultaneous apathy towards safety of humans. Such dog lovers most of the time, totally ignore the fact that these dogs are a threat to children and older people. An immediate sense of hatred towards such dog lovers is a consequence and a natural thought.

Animal lovers while pretending of “dog love” have formed NGOs and have donations and accumulate money. But have failed to create shelters for stray dogs. Neither have any steps been taken to save people from dog bites. So consequently, people especially vulnerable are children and older people who are mauled and eaten alive by stray dogs. What responsibility and accountability these animal lovers and NGO bear towards such incidents? Why people who collect money in name of animals do not take care and form shelters for these strays? every single death from such preventable cause raise a question on this issue.

Apathy of these so called dog lovers towards humans is appalling.

SUGGESTION: the Government, NGOs and people who claim to be “animal lovers” should create shelters to save strays “as well as people”. It should be mandatory that all the dog and animal (stray or pet) droppings are properly collected and disposed off. This single step can do wonders as it will reduce infections, people’s suffering, save lives and eventually reduce use of antibiotics. A rationale mind will definitely appreciate the danger due to strays, and can initiate proper steps rather criticizing above said facts in the name of animal rights. An animal has no sense of responsibility, so rights should be limited accordingly.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

0

Singed with hot rod to ‘cure pneumonia’- the child dies: Illogical distribution of health care

BHOPAL: A newborn has died after being singed more than 50 times with a red hot iron rod in a bizarre ritual to 'cure pneumonia' in MP's Shahdol district. A local anganwadi worker saw this horror being inflicted upon the child by a quack and persuaded the parents to take her to a hospital, say sources. They did, but it was too late. The baby's body was exhumed on Friday evening for post-mortem examination. Even as police were grappling with this horror, a similar case was reported in a nearby village. This infant is in hospital. Police are yet to arrest anyone in either case and it's not yet known if the same quack, a woman, was behind singeing both babies. The Child Welfare Committee has written to police to take action under section 75 of Juvenile Justice Act, but nothing has been done. When TOI spoke with Singhpur police, they said they were taking legal opinion on how to proceed with the

         In a heart wrenching and unfortunate incident from Bhopal (Madhya Pradesh), a 2.5 month child was singed with hot iron 50 times by a quack for treatment of pneumonia.  He died and   the incident appeared in newspapers, but similar kind of  treatments must be going on at many places and  gullible patients keep on suffering .The suffering is of two types; one, that they are deprived of correct treatment and other is the tremendous suffering because of such nature of cruel practices in the garb of  treatment.    

         That brings to the fore the basic question; why such type of treatments are being practiced and allowed to be conducted in 21th century. Why people allow  and consent for such treatments by quacks?

     These incidents simply reflect that the health system has not been able to travel  the last mile and  has failed to  touch the last man.

         Most important reason for such disparity is illogical distribution of health care.  Corporatization of health care has projected medicine as a purchasable commodity and consequently resulted in an Illogical distribution of health care

 People, who can afford, spend millions in the last few days of their life, just to have only a few more days to live. Resources spent in such a futile quest are equivalent to  thousands of times the money for food and medicines for the poor who lose lives for fraction of that expense.

It seems humanity has legalized the hoarding of medical care; give it to the rich, bundled with consumerism though not necessarily the needy. It is the same as hoarding of the food that is sold to rich, letting the poor die somewhere in the world without food, which remains invisible to all.

          Another worrisome aspect of the incident is  that  avoidance of people to  seek treatment from appropriate  clinics and hospitals. Anganwadi worker was there in the village, so it was possible  to seek help from the health system. Is the mistrust and malice  generated  by media towards  doctors and  medical professionals is the reason to  avoid seeking help from them?

BHOPAL: A newborn has died after being singed more than 50 times with a red hot iron rod in a bizarre ritual to ‘cure pneumonia’ in MP’s Shahdol district. A local anganwadi worker saw this horror being inflicted upon the child by a quack and persuaded the parents to take her to a hospital, say sources. They did, but it was too late. The baby’s body was exhumed on Friday evening for post-mortem examination. Even as police were grappling with this horror, a similar case was reported in a nearby village. This infant is in hospital. Police are yet to arrest anyone in either case and it’s not yet known if the same quack, a woman, was behind singeing both babies. The Child Welfare Committee has written to police to take action under section 75 of Juvenile Justice Act, but nothing has been done. When TOI spoke with Singhpur police, they said they were taking legal opinion on how to proceed with the case. An officer said they are waiting for the autopsy report to see what charges can be pressed. The baby who died was two and a half months old and suffering from pneumonia. Her parents live in Kathotiya village, around 520km from Bhopal and close to Chhattisgarh. “The infant was ‘torched’ as a method of ‘treatment’ on January 10.” Singhpur police station in charge, MP Ahirwar told TOI. The second incident happened in Samtapur villagee. The baby’s parents deny they put the girl through the burning ritual.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

0

Supreme Court simplifies  rules on passive euthanasia& Living Will

NEW DELHI: The Supreme Court on Tuesday modified its 2018 order on passive euthanasia to make the procedure of removal of (or withholding) life support from terminally ill patients less cumbersome for the patients, their families and the doctors by limiting the role played by government officials. While the requirement of setting up two medical boards — one primary and other review — to examine the medical condition of the patient has been retained, the SC has done away with the rule mandating that the district collector set up the review board. The court said both boards will be constituted by the hospital and there would be one nominee doctor of the district medical officer in the review board. The medical boards must take a decision on such cases preferably within 48 hours, it added. While the current rules state that the consent of the judicial magistrate is required for conducting passive euthanasia, the new order by a five-judge bench of justices K M Joseph, Ajay Rastogi, Aniruddha Bose, Hrishikesh Roy and C T Ravikumar says the magistrate just needs to be informed. While making the procedure for passive euthanasia less cumbersome, the Supreme Court on Tuesday also simplified the process of making a “living will”, an advance directive by a person wishing not to be put on artificial life support. While the earlier rule stipulated that a living will had to be made in the presence of two attesting witnesses and countersigned by the jurisdictio

NEW DELHI: The Supreme Court on Tuesday modified its 2018 order on passive euthanasia to make the procedure of removal of (or withholding) life support from terminally ill patients less cumbersome for the patients, their families and the doctors by limiting the role played by government officials. While the requirement of setting up two medical boards — one primary and other review — to examine the medical condition of the patient has been retained, the SC has done away with the rule mandating that the district collector set up the review board. The court said both boards will be constituted by the hospital and there would be one nominee doctor of the district medical officer in the review board. The medical boards must take a decision on such cases preferably within 48 hours, it added.

While the current rules state that the consent of the judicial magistrate is required for conducting passive euthanasia, the new order by a five-judge bench of justices K M Joseph, Ajay Rastogi, Aniruddha Bose, Hrishikesh Roy and C T Ravikumar says the magistrate just needs to be informed. While making the procedure for passive euthanasia less cumbersome, the Supreme Court on Tuesday also simplified the process of making a “living will”, an advance directive by a person wishing not to be put on artificial life support. While the earlier rule stipulated that a living will had to be made in the presence of two attesting witnesses and countersigned by the jurisdictional JMFC, the new order says such a will can be attested by notary or a gazetted rank officer. The process prescribed in2018 was onerous as it not only involved family members and doctors but also a judicial magistrate and collector as well as setting up of two medical boards before removal of life support systems and there was no prescribed time period for medical boards to give their opinion. As per 2018 guidelines, in the event a person became terminally ill with no hope of recovery, the treating physician had to ascertain the authenticity of the case from the JMFC. If the physician was satisfied, the hospital then constituted a medical board consisting of the head of the treating department and at least three expert doctors with 20 years of experience.

If the medical board certified that life support system could be removed, the hospital had to inform the collector who then had to constitute another medical board comprising the chief district medical officer and three expert doctors. If the review board allowed withdrawal of treatment, it had to convey the decision to the JMFC. The JMFC then had to visit the patient and, after examining all aspects, decide on whether the euthanasia directive could be implemented. Modifying the order, the bench said that medical practitioners with five year of experience can be part of the medical board. The court also agreed with the petition that there was no need to involve JMFC in the process of preparation of the living will. Times View: The new guidelines have been issued because the earlier guidelines were proving to be unworkable. It is good that the apex court has taken a relook on the subject. It is entirely possible that even these new guidelines may need to be revised in future. But the principle must be about making things easier for consent-givers without increasing the risk of misuse.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

0

 Supreme Court agrees to make Passive Euthanasia & Living Will rules workable

NEW DELHI: The Supreme Court on Tuesday decided to "tweak" its 2018 verdict on passive euthanasia to make the procedure and guidelines fixed by it workable, and said that it may fix a time frame within which medical boards would have to submit reports to remove life-support systems from a terminally ill patient. Admitting that the procedure prescribed by the apex court in 2018 was very onerous and time consuming, a five-judge constitution bench of Justices K M Joseph, Ajay Rastogi, Aniruddha Bose, Hrishikesh Roy and C T Ravikumar sought suggestions from the Centre and senior advocates Arvind Datar and Prashant Bhushan to make it workable without compromising with the safeguards put in place by the court four years ago while legalising passive euthanasia. The process prescribed in 2018 not only involves family members and doctors but also judicial magistrates and collectors. Besides, two medical boards need to be constituted before life-support system can be withdrawn. The verdict said the living will, or advance directive for not putting a person on artificial life-support system, has to be made in the presence of two attesting witnesses and countersigned by the jurisdictional judicial magistrate of first class (JMFC). In the

SC to tweak 2018 verdict to make passive euthanasia rules workable

NEW DELHI: The Supreme Court on Tuesday decided to “tweak” its 2018 verdict on passive euthanasia to make the procedure and guidelines fixed by it workable, and said that it may fix a time frame within which medical boards would have to submit reports to remove life-support systems from a terminally ill patient. Admitting that the procedure prescribed by the apex court in 2018 was very onerous and time consuming, a five-judge constitution bench of Justices K M Joseph, Ajay Rastogi, Aniruddha Bose, Hrishikesh Roy and C T Ravikumar sought suggestions from the Centre and senior advocates Arvind Datar and Prashant Bhushan to make it workable without compromising with the safeguards put in place by the court four years ago while legalising passive euthanasia. The process prescribed in 2018 not only involves family members and doctors but also judicial magistrates and collectors. Besides, two medical boards need to be constituted before life-support system can be withdrawn. The verdict said the living will, or advance directive for not putting a person on artificial life-support system, has to be made in the presence of two attesting witnesses and countersigned by the jurisdictional judicial magistrate of first class (JMFC). In the event of a person becoming terminally ill, the treating physician shall ascertain the living will’s authenticity from the JMFC. If the physician is satisfied, the hospital shall then set up a medical board consisting of the head of the treating department and at least three expert doctors. If the medical board recommends removal of life support, the hospital shall inform the collector, who shall then constitute another medical board comprising the chief district medical officer and three expert doctors. If the board allows withdrawing treatment, it shall convey the decision to the JMFC before allowing life support to be withdrawn. JMFC shall visit the patient and, after examining all aspects, may permit implementation of the directive.

      Seeking modification in the procedure, lawyers contended that time was crucial for terminally ill patients and the whole purpose of passive euthanisa was defeated due to the time taken by the process. That was the reason why there has not been a single case of passive euthanasia in the last four years despite it being legalised, they added.

Agreeing with their contention, the bench observed that dying in peace was dying with dignity, and suffering of a patient should not be prolonged due to the lengthy process. It said that the court could set a time limit for completion of the two-tier procedure without delay and also consider that a living be prepared like normal will without the mandatory presence of a judicial officer. The bench sought response from the Centre on whether it intended to frame a law for its regulation as the court had said in 2018. Paving the way for passive euthanasia, the apex court had in 2018 said, “It has to be stated without any trace of doubt that the right to live with dignity also includes the smoothening of the process of dying in case of a terminally ill patient or a person in PVS (persistent vegetative state) with no hope of recovery. A failure to legally recognise advance medical directives may amount to non-facilitation of the right to smoothen the dying process and the right to live with dignity.”

Supreme Court agrees to not involve judicial officers, collectors in ‘living will’ process

NEW DELHI: Amidst divergent opinions evading consensus on various points to make 2018 verdict on passive euthanisa workable on ground, the Supreme Court on Wednesday agreed in principle to keep judicial officer and district collector out of the process for making living will and setting up of medical board for removing life support system for terminally ill patients. Facing the onerous task to tweak 2018 verdict without modifying it and to continue with the safeguard put in place four years back, Justices KM Joseph, Ajay Rastogi Aniruddha Bose, Hrishikesh Roy and Justice CT Ravikumar are exploring ways to build consensus among parties, including the Centre, to make the process of making and executing living will or advance directive practical and less cumbersome for the patient. As the petitioner, represented by advocate Arvind Datar and additional solicitor general KM Nataraj, agreed that there was no need to involve judicial magistrate of first class (JMFC) in the process of preparation of will, the bench agreed that the living will can be attested by notary or a gazetted rank officer. As per 2018 verdict, the living will or advance directive, for not putting on artificial life support system, has to be made in the presence of  two attesting witnesses and countersigned by the jurisdictional JMFC. The court also in principle agreed that collectors be kept out of the process and will take a call on who should be entrusted with the task to constitute secondary medical board.

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1

Disposal of the Dead after Death-Environment Impact & Carbon Cost

Disposal of the Dead after Death-Environment Impact & Carbon Cost Burning the bodies of the dead was an ancient rite and practice in India. It was observed among Buddhists, Hindus and Jains from well before the start of the Common Era, and was later adopted by Sikhs. Burning the dead historically helped demarcate these religious communities from Muslims and Christians, for whom burial was the norm, and from India’s Parsi community who exposed their dead on Towers of Silence. Burning bodies after death, originating at a time when India was still heavily forested, cremation may also have been environmentally more appropriate and sustainable than, for instance, the mummification practised in the dry desert air of ancient Egypt.

     Burning the bodies of the dead was an ancient rite and practice in India. It was observed among Buddhists, Hindus and Jains from well before the start of the Common Era, and was later adopted by Sikhs. Burning the dead historically helped demarcate these religious communities from Muslims and Christians, for whom burial was the norm, and from India’s Parsi community who exposed their dead on Towers of Silence.   Burning  bodies after death, originating at a time when India was still heavily forested, cremation may also have been environmentally more appropriate and sustainable than, for instance, the mummification practised in the dry desert air of ancient Egypt.

Burning Issues: Cremation and Incineration

    In India, one estimate reveals that funeral pyres consume 6 crore trees annually and play a huge role in deforesting the country. Air pollution and deforestation are not the only environmental threats of cremation. They also generate large quantities of ash – around 50 lakh tonnes each year – which is later thrown into rivers, adding to their waters’ toxicity.  The prolonged burning of fossil fuels for cremation results in around 80 lakh tonnes of carbon dioxide or greenhouse gas emissions per year, according to one estimate. It creates different hazardous gases, including dental mercury, which is vaporised and released into the environment leading to health hazards in the surrounding area. Many of these toxins can bio-accumulate in humans, including mercury – often from dental amalgams, but also from general bioaccumulation in the body. Cremation results in various other toxic emissions including persistent pollutants such as volatile organic compounds, particulate matter, sulphur dioxide, nitrogen oxides and heavy metals. An IIT Kanpur study in 2016 found that open-air cremations contribute 4% of Delhi’s carbon monoxide emissions. There are concerns for crematorium workers as well, who may be exposed to nuclear medicine treatments (chemotherapeutics/radiation), orthopaedic (implants) and pacemaker explosions, and nanoparticles.

. In order to tackle the environmental problems stemming from these sites, the Indian government and environmental groups have over the years tried to promote the use of electric crematoriums as an alternative way of cremation. Electric crematoriums largely unsuccessful, are expensive to run, and crucially, traditional rituals are made impossible.

   Carbon Cost estimation -When people are cremated after death, the burning releases carbon into the air. Alkaline hydrolysis, in which the body is dissolved, has about a seventh of the carbon footprint of cremation, and the resulting fluid can be used as fertiliser. A Dutch study of the disposal of bodies found that the lowest amount of money that it would theoretically cost to compensate in terms of the carbon footprint per body was €63·66 for traditional burial, €48·47 for cremation, and €2·59 for alkaline hydrolysis. Composting or natural burial are alternatives.

New Delhi: The National Green Tribunal (NGT) has questioned the centuries-old tradition practised by Hindus to cremate dead bodies at the river banks, saying the method of burning wood leads to air pollution and also effects natural water resources.

Keeping in mind the growing level of pollution, the NGT said that there was a need to adopt environment-friendly methods like electric crematoriums and use of CNG and change the ‘mindset of the people’.

The NGT bench headed by Justice UD Salvi also directed the Union Environment Ministry and the Delhi government to initiate programmes to provide alternative modes of cremation of human remains, saying the traditional emitted hazardous pollutants in the environment.

  “It is also the responsibility of the government to facilitate the making of the mindset of the citizens as well as to provide environment-friendly alternatives for cremation to its citizenry,” the bench further said.

   The green panel said the traditional means of cremation caused adverse impact on environment and dispersal of ashes in the river led to water pollution.

   If we are to survive the climate crisis then almost everything will have to change, including health care, end-of-life care, and how we dispose of the dead.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

0

Compare Reaction to  Death of “Hundreds of healthy people” to  single “perceived negligence” in Hospital  #Morbi-Gujarat

Compare Reaction to Death of “Hundreds of healthy people” to single “perceived negligence” in Hospital #Morbi-Gujarat Reaction to ‘Death’ in this new era of consumerism has become a story of paradox. Massive civil negligence and 141 deaths but there are no punching bags as are doctors for revenge in case of a hospitalized death. Just Compare the media projection, burden of negligence and accountability of hundreds of healthy deaths by civic negligence to the one hospital death by disease. Death is the inevitable conclusion of life, a universal destiny that all living creatures share. Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. Multiple Deaths in healthy people by civic negligence:

Reaction to ‘Death’ in this  new era  of consumerism has become a story of paradox. Massive civil negligence  and 141 deaths but there are no punching bags  as are  doctors  for revenge in case of a hospitalized death.     Just Compare the media  projection, burden of negligence and accountability of  hundreds of healthy deaths by civic negligence   to the  one hospital death by disease. 

     Death is the inevitable conclusion of life, a universal destiny that all living creatures share.   Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. 

Multiple Deaths in healthy people by civic negligence:

Large numbers of death and morbidity happen amongst absolutely healthy population due to preventable causes like open manholes, drains, live electric wires, water contamination, dengue, malaria, recurring floods  etc. The number of   people dying are in hundreds and thousands, and are almost entirely of healthy people, who otherwise were not at risk of death. In fact the burden of   negligence here is massive and these deaths are unpardonable.  Timely action could have prevented these normal people from death. 

Collapse of a pedestrian bridge that killed at least 141 people. #Morbi-Gujarat.

Police in the Indian state of Gujarat have arrested nine people in connection with the collapse of a pedestrian bridge that killed at least 141 people. Four of those detained are employees of a firm contracted to maintain the bridge in the town of Morbi.

Hundreds were on the structure when it gave way, sending people screaming for help into the river below in the dark.

Hopes of finding more survivors are fading. Many children, women and elderly people are among the dead.

The 140-year-old suspension bridge – a major local tourist attraction – had been reopened only last week after being repaired.

Single  Death in Hospital due to disease:

      Reaction to single “in Hospital” medicalized death  is a paradox.   The media has instead, focused on the stray and occasional incidents of perceived alleged negligence in hospital deaths which could have occurred due to critical medical condition of patient.  However an impression is created as if the doctors have killed a healthy person. It is assumed without any investigation that it was doctor’s fault. 

     In present era, the expectation of medicalized death has come to be seen as a civic right and Doctors’ responsibility. People now have less understanding and acceptance of hospital  death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event.

Point to ponder-Misplaced priorities:

Who is to be blamed for the deaths of healthy people which occur because of civic negligence?  Here relatives are actually  helpless and the vital questions may go unanswered .  There are no punching bags  as are  doctors  for revenge. Any stray incident of death of an already ill patient is blown out of proportion by media  forgetting the fact that thousands of patients are saved everyday by  Doctors.   

      It is time to check the  emotional reactions to single hospital death due to a disease as compared to hundreds of death  of healthy people due to civil negligence.

Advantages-Disadvantage of being a doctor

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Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

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NEET- Not so Neat- percentile system

4

Transition from   ‘Natural death’ to Medicalized Death- Paradox  of dying process

Death is the inevitable conclusion of life, a universal destiny that all living creatures share. It's an age-old idea that a good life and a good death go together. Death and dying have become unbalanced in high-income countries, and increasingly in low-and-middle-income countries; there is an excessive focus on clinical interventions at the end of life, to the detriment of broader inputs and contributions. The story of dying in the 21st century is a story of paradox. While many people are over-treated in hospitals, with families and communities relegated to the margins, still more remain undertreated, dying of preventable conditions and without access to basic pain relief. In this present era, process of dying represents unbalanced and contradictory picture of death. Even though medical advances continue to increase life expectancy, they have raised an entirely new set of issues associated with death and dying

Death is the inevitable conclusion of life, a universal destiny that all living creatures share.   It’s an age-old idea that a good life and a good death go together. Death and dying have become unbalanced in high-income countries, and increasingly in low-and-middle-income countries; there is an excessive focus on clinical interventions at the end of life, to the detriment of broader inputs and contributions.

      The story of dying in the 21st century is a story of paradox. While many people are over-treated in hospitals, with families and communities relegated to the margins, still more remain undertreated, dying of preventable conditions and without access to basic pain relief. In this present era, process of dying represents unbalanced and contradictory picture of death.  

Even though medical advances continue to increase life expectancy, they have raised an entirely new set of issues associated with death and dying. For example, how long should advanced medical technology be used to keep comatose people alive? How should the elderly or incapacitated be cared for? Is it reasonable for people to stop medical treatment, or even actively end their life, if that is what they wish?

          Before the 12th century he describes a period of “Tamed death,”  where death was familiar, and people knew how to die. The dying and their families accepted death calmly; they knew when death was coming and what to do; dying was a public event attended by children.

    Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. The great success with antibiotics vaccines has perhaps further fuelled the fantasy that science can defeat death. But this temporary success as only has been the result of discovery of germ theory and antibiotics.

     In true sense, Death still remains invincible.

   The fear of death also involves the fear of separation.

     As families and communities want more and more hospital care, when critically sick, health systems have occupied the centre stage in the process of dying.  Dying people are whisked away to hospitals or hospices, and whereas two generations ago most children would have seen a dead body, people may now be in their 40s or 50s without ever seeing a dead person. The language, knowledge, and confidence to support and manage dying are being lost, further fuelling a dependence on health-care services.

 

   Death systems are the means by which death and dying are understood, regulated, and managed. These systems implicitly or explicitly determine where people die, how people dying and their families should behave, how bodies are disposed of, how people mourn, and what death means for that culture or community.

Death systems are unique to societies and cultures.

    The increased number of deaths in hospital means that ever fewer people have witnessed or managed a death at home. This lack of experience and confidence causes a positive feedback loop that reinforces a dependence on institutional care of the dying.

     Medical culture, fear of litigation, and financial complexities contribute to overtreatment at the end of life, further fuelling institutional deaths and the sense that professionals must manage death. Social customs influence the conversations in clinics and in intensive care units, often maintaining the tradition of not discussing death openly. More undiscussed deaths in institutions behind closed doors further reduce social familiarity with and understanding of death and dying.

     How people die has changed radically over recent generations. Death comes later in life for many and dying is often prolonged. Futile or potentially inappropriate treatment can continue into the last hours of life. The roles of families and communities have receded as death and dying have become unfamiliar and skills, traditions, and knowledge are lost.

    At first only the rich could expect that doctors would delay death. However, by the 20th century this expectation had come to be seen as a civic right.

         ‘Natural death’ is now the point at which the human organism refuses any further input of treatment.

       Corporatization of health care has projected medicine as a purchasable commodity and consequently resulted in an illogical distribution of health care. People, who can afford, spend millions in the last few days of their life, just to have only a few more days to live. Resources spent in such a futile quest are equivalent to thousands of times the money for food and medicines for the poor who lose lives for fraction of that expense.

     Death is not so much denied but has become invisible to people. People now have less understanding and less acceptance of death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

4

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