FROM DEATH'S JAWS.

NZ Truth, Issue 1031, 29 August 1925, Page 5

FROM DEATH'S JAWS.

SURGICAL KEENNESS— AND^

INQUESTS.

"There" are occasions (writes "Observer") when the public is informed through the press of wonderful operations that have been performed at

i public hospitals; of lives that have been snatched from the jaws of death; of doctors who have risked everything m a final attempt to save the life of a patient. More often such | stories remain untold, for the medical fraternity, and particularly those engaged m public institutions, are not apt to prate about their work. "There v are, too, occasions — fortunately few — when the public learns of a death under anaesthetic. It is to the credit of the service that investigations into such deaths have almost invariably revealed the fact that every proper precaution has been taken. "If, however, the district coroners throughout the Dominion are going to take the same stand as one we have heard of, then one of two things must inevitably happen — either there will be more cases of deaths under anaesthetic reported, or else there will be fewer instances of the recovery of patients whose deaths have been regarded as certain. "Under the laws of this country an inquest is required to be held m all cases where death occurs under anaesthetic. Like other legislation, this particular law is frequently administered m the spirit rather than m ' the letter, and it can safely be claimed that there are many deaths under anaesthetic that are not the subject of a coroner's inquiry. There are at times patients m hospitals who are on the verge of death, and for whom the one chance of recovery lies m an immediate operation. It has been the practice of medical superintendents m some hospials to advise the .district coroner ! m such an ' event, and for him to agree, should the operation not succeed, to accept an ordinary certificate of death. Now, however, things m one of the hospitals have changed. The present coroner has adopted the attitude that m the event of death, under the circumstances referred to, an inquest must be held. "Whether he is right or wrong is not under consideration, but it will be seen that the decision may have a serious effect. I . ■ - Incentive to Refuse Risks. "There are, as m all cases, two sides to the question, and much might be said m favor of either side. The coroner who decides to dispense with an inquest adopts the line of reasoning that the patient was as good as dead before the anaesthetic was administered. If the 'patient is brought back to life, so much the better; if he .dies during the operation, there is the satisfaction of knowing that everything possible has been done. The alternative course is m strict accordance with the law. > But the coroner who refuses to waive the formality of an inquest m these cases N is giving a direct incentive to the surgeon to refuse to accept the risk incurred m the operation, and to certify that the patient has died m the ordinary way from some particular disease.

Under such circumstances, can a surgeon be blamed? If he does take the responsibility, and the operation is successful, he is not credited with doing anything more than his duty. If, on the other hand, death occurs despite every possible care, despite every possible precaution, and despite the exercise of the greatest possible skill, what happens? An inquest is insisted upon, full publicity is given to the fact •that the patient died on the operating table, and the surgeon may be required to undergo a searching examination, very often at the hands of a layman. His name is broadcasted throughout the Dominion, and he may be censured by people who have not sufficient intelligence to appreciate the true facts of the 1 case. "Should a medical man be called upon to have his name besmirched, if not sacrificed, or should the law be administered with discretion? "It would be futile to attempt to dismiss the matter by remaining with Mr. Bumble: 'The law's a hass.' The law is not an ass, and every measure which has as its object, and its result, the protection of the health and the lives of the community has everything to commend it. Already Abused. "The point which does require consideration is how the law should be administered. It would seem that there is some argument m favor of a little elasticity m the class of case under review, and an amendment to make the holding of an inquest discretionary on the part of the coroner might meet the difficulty. It might, of. course, be suggested that the amendment would lend itself to abuse, but the, law, as it at present stands, is abused. It would be better, surely, to make the present practice legal than to condone actions that are, strictly speaking, illegal. "The present regulations are open to question, any way. If the patient dies . on the operating table half a minute before -the anaesthetic is administered no inquest is compulsory. If the patient lives for half a minute after coming out of the anaesthetic no inquest is compulsory. But if the heart stops beating m between the two stages an inquiry is demanded, with all the attendant publicity and the cost to the country. Some discretion should, surely, be pei-mitted. If the coroner was advised of the position before the operation, this, m itself, would provide evidence of the critical condition of the patient. "For the purpose of this article it is not necessary to refer to the enviable reputation enjoyed by the hospitals of the Dominion. "Does not the district coroner •who insists on inquests ' when patients are virtually dead before they reach the operating table, lay himself open to a retort? Might not the medical superintendent decline to shoulder" the responsibility entailed m attempting to save the life of a patient, if the coroner will not take the responsibility of waiving the formality of an inquest in v the event of the attempt not being a success? The surgeon, m facing an inquest, is risking his reputation, for how can the public be made to realise that the greatest possible care and skill have been brought to bear on the case?". . • »