Journal of Medical Law and Ethics (JMLE)

​Reflective Student Summary: Ventilation and when to stop this life preserving measure: how are the UK and developing countries, such as Nepal different in their ethical approaches to decision making in this area?

Fraser Wright

Mechanical ventilation in the intensive care unit poses many difficult questions for health care professionals in the UK, particularly regarding futility, despite guidelines produced on the matter. However, in countries such as Nepal where there are no available guidelines, how do clinicians make these life or death decisions and what are the important factors when deciding to discontinue a patient’s life support?


Here, I present an interesting case involving prolonged mechanical ventilation in a gentleman with Amyotrophic Lateral Sclerosis seen during my medical elective in Nepal. There are significant differences in attitude to end of life care in developing countries such as Nepal, compared to the UK. In the UK, we follow accepted guidelines and practices in order to make difficult decisions surrounding end of life care and withdrawal of treatment. Financial issues appear to be the greatest influence on decision making in Nepal. However, a lack of a legal protocol for end of life care that considers capacity, overall benefit to the patient and best interests is also lacking. The massive disparity in health beliefs of their population compared with our own also plays a notable role. By understanding what drives these decisions, especially with regard to peoples’ health beliefs, we can change our own practice in order to benefit ethnic minorities in our own country and give them a better experience of healthcare. 

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