The following article is based on my own interpretation of the said events. Any material borrowed from published and unpublished sources has been appropriately referenced. I will bear the sole responsibility for anything that is found to have been copied or misappropriated or misrepresented in the following post.
Saumi Mukherjee, EMBA 2015-18, Vinod Gupta School of Management, IIT Kharagpur
The death of a 62 year old liver cancer patient in India’s one of the most premier institutions, AIIMS after live surgery has raised questions over the ethics of entire procedure.
The patient, Shobha Ram, was undergoing laparoscopic surgery for liver cancer.
According to Times of India at the workshop on July 31, part of the 23rd annual conference of the Indian National Association for Study of the Liver, hosted jointly by AIIMS and the Army Research & Referral Hospital, New Delhi, over a hundred surgeons watched as Dr Goro Honda, from Japan’s Tokyo Metropolitan Cancer and Infectious Diseases Center, performed a laparoscopic liver resection at AIIMS. He was assisted by an Indian team led by Dr Sujoy Pal, an associate professor in the gastrointestinal surgery department of AIIMS.
During the laparoscopic surgery, round of questions and answers was on between medical experts and students. Everything was in place. Experts from Japan were helping the team of AIIMS doctors in this live surgery.
But even after over four hours the laparoscopy was not getting things in place. After struggling for more than four hours, the audience in the room suggested the doctors to go for an open surgery, but the doctors continued with the laparoscopy. But after an hour, the situation became serious as the patient was bleeding profusely. When the laparoscopy could not help the patient, the audience and the experts reiterated the need to opt for an open surgery to save the patient’s life. But it was too late. The open surgery continued for almost seven hours and till then the patient had lost a lot of blood. When the doctors realised that even the open surgery is not going to save the patient’s life, they immediately stitched his stomach and took him to ICU, but passed away a little over an hour later.
AIIMS released a statement in which it said that the bleeding was a known complication of the procedure and all measures had been taken to control it. However, the statement noted that because of his existing liver disease he didn’t do well and passed away, reported the Hindustan Times. The statement also said that the patient’s family had been kept informed of his condition after the surgery.
And while the Times report raised questions over the live telecast of the surgery and whether the patient’s consent had been taken for an audience to view it, a doctor from AIIMS told Hindustan Times that live surgery had nothing to with the death.
Having an audience for a surgery is hardly new. As this detailed piece on live telecast by Slate noted, it’s been around since the first surgeries where an audience stood around to watch a surgeon and medical students are present in operation theatres to study techniques they’ve learnt about.
And this has become a lot easier in laparoscopic surgeries since the use of a camera is involved anyway, it becomes much easier. In May 2014, a UK surgeon operated and had the surgery telecast live through Google Glass, even as students and other doctors could ask him questions. The Telegraph report pointed out that 90 percent of the students who watched the live broadcast even wanted such telecasts to be part of the teaching process.
The past surveys of US physicians had shown that they weren’t in favour of surgeries on them being broadcast live. It questioned then whether it was right for them to subject their patients to it. And given they have the option of recording the surgery and then analysing it later, the question isn’t entirely wrong.
This incident has raised question on the entire procedure, is it true only the blood loss caused the death and the live streaming had no impact on the surgery? If not, where any distraction can create problem during any surgery, then for a high risk surgery, where surgery is the last hope for the patient , how the surgeon from Japan allowed for live telecast of the surgery? Was the patient or his family really informed by the hospital authority about the live telecast prior to the surgery? During the question-answer session the surgical team could get nervous and make mistakes that they may not have done if there weren’t on live telecast. More over may be watching and learning from an expert during a surgery is an age-old procedure through which a young doctor can learn better but for this serious case the training session could have been done offline with recorded video of the surgery. That way the surgeon was not distracted and the patient’s life could be saved.