Letter: Computers do not decide to stop life support

Sir: I would like to set the record straight concerning our attempts to use a piece of computer software - the Riyadh Intensive Care Program (RIP) - to help us identify those hopelessly ill patients who are inevitably going to die despite the very best intensive care ('Death by computer proposition dismissed', 25 August).

Computers do not make decisions - doctors and families make decisions about the withdrawal of life support in the Intensive Care Unit (ICU). Well- informed decisions require objective information from many sources - clinical examination of the patient, X-rays, blood tests and a careful discussion with all those involved. A computerised information system that identifies those patients with a 95 per cent mortality rate (recognising that a prediction of death given by the RIP is not 100 per cent accurate, one in 20 patients predicted to die surviving to leave hospital) can help doctors and relatives considerably in their attempts to assess whether or not it is appropriate to continue with the life support.

When life cannot be preserved, suffering must be alleviated. Anyone who has watched a patient die in the ICU recognises that this experience is associated with tremendous suffering and indignity, both for the patient and their family. In my opinion, this is only worthwhile when there is a reasonable chance of recovery.

There is an acute shortage of ICU beds in this country so that many patients referred (perhaps one in four) are refused admission. This is rationing on a grand scale and if no more resources are available (personally, I doubt this to be the case), intensive care specialists must take difficult decisions to maximise the use of their beds. It makes little sense prolonging the treatment of hopelessly ill patients when major surgery is being cancelled and other patients with a reversible illness are denied access.

For these reasons, I believe it is unethical to ignore the information that can be obtained from a computerised system such as the RIP. That the BMA Ethical Committee and the Guy's and St Thomas's Hospitals Trust are unable to countenance such a system suggests that these bodies do not understand, and therefore should not comment on, the wider issues involved. Finally, I have not been instructed by the trust to close down the system.

Yours sincerely,

DAVID J. BIHARI

Director of Intensive Care

Guy's Hospital

London, SE1

29 August