At first glance, the Pantelimon case seems to be about two women who, for reasons still unknown, decided to play God, choosing on their own who to „let go” and who to save, while the medical guild shields them either out of professional solidarity or because such practices might be more widespread.
But beyond the initial reading, extremely emotional and with a strong sensational touch, beyond the acute and largely indisputable specific issue, there are chronic realities.
Certainly, the two doctors in preventive detention benefit from the presumption of innocence. However, it is strongly shaken by the concrete elements of the case, which no one has denied so far.
And the essential point against the two is the discrepancy between the actual treatment administered and the one in the medical record.
I understood that the patient's condition was so severe that not only was healing out of the question, but survival was impossible without the maximum dose support of noradrenaline. His situation was incompatible with life.
I understood that noradrenaline is not a treatment drug, but a substance that forcibly maintains vital functions for a limited time necessary for the body to rebalance if it still has the resources to do so. Only the ICU doctor can know the timing and when the dose reduction should start.
If the dose reduction had been documented in the medical record, it could have been a proper medical decision, at most a medical error. The fact that the reduction was done unofficially, in disagreement with the legal medical document called the patient's record, shows that the doctors were doing something they felt they could not support as an official medical decision.
The essential difference between what actually happened, according to the syringe memory, and what was supposed to happen according to the medical record incriminates the two. What they primarily had to explain was precisely this difference, not the medical decision itself, and it seems they failed to find a convincing justification.
Why did they do this?
The question cannot be ignored, at least as long as we are talking about two mentally competent individuals.
"With or without noradrenaline, considering the comorbidities, the diseases the patient had, and the reasons for being admitted to the ICU, cirrhosis - and cirrhosis is a particular element, unfortunately, the outcome would have been the same," says Professor Dan Longrois, a renowned French ICU professor.
This means that keeping a person on immense doses of adrenaline as the sole driver of vital functions does not help them in any way.
In other countries, such as France, as explained by Prof. Longrois, it is not a single doctor, but a committee that evaluates the situation and together with the family decides that the patient is "to be let go":
"When things are in the terminal phase, which is the case with this patient, they are limited, meaning it is decided to reduce both the oxygen concentration and the noradrenaline doses. Of course, pain treatment continues.
(...) We are only talking about stopping the escalation and letting the natural progression of these very severe diseases take its course. The solution that seems honorable and humane to us is indeed for each country to have procedures for the terminal stages of diseases."
In Romania, there is no regulation for such cases. The ICU, the front line, often becomes what should be a palliative care section, dedicated precisely to terminal cases, where the person is allowed to pass away peacefully because they cannot be saved.
The effect is described by ICU doctor Elena Copaciu on Facebook.
Patients in the Emergency Room cannot be transferred, even though some of them could indeed be saved, because the ICUs are full, including with individuals who are no longer viable. For any patient refused due to lack of space, the ICU doctor must find a place in another hospital, essentially acting as a dispatcher. And the critical patient is shuttled between hospitals.
And when we talk about an ICU bed, we are not just talking about furniture, but about equipment and, most importantly, about chronically deficient medical staff.
Of course, being an election year, the temptation for politicization is very high. But it is a fact that palliative care has not been the concern of any Health Minister in the last 30 years.
Just as it is a question whether society has the necessary education to understand that sometimes, not arbitrarily, not in secret, but procedurally, with precise rules and full explanations, a patient can objectively become "to be let go" and it is even humane to let them go.
The Wave of Hatred
The two accused individuals must be fully judged and their specific case will have a conclusion. However, the widespread wave of hatred raised by this case and the opinions expressed by certain doctors in the public sphere is very risky.
Now, all the frustrations, often justified, caused by the functioning of the healthcare system are being unloaded. This has two adverse effects.
On one hand, such outbursts exhaust the subject, which then becomes uninteresting until the next crisis. Positive effects are achieved rationally and calmly, not in hysterical outbursts.
On the other hand, the collective blame on doctors and medical opinions is a breeding ground for migration. I don't know how many patients the ICU doctors have killed, but I know for sure that their absence will cause massacres.