Thu, Apr 17, 2025 page8

• ‘Sudden death’ hides system failure

  • By Chu Jou-juo 朱柔若
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  In critical care settings, healthcare professionals frequently face life-and-death situations. However, in these highly monitored environments, where advanced surveillance equipment and expert clinical care are in place, are so-called “sudden deaths” truly unpredictable? When medical disputes arise and “sudden death” is cited as the cause, we must question whether these deaths were truly unforeseeable, or if they were the culmination of systemic issues that could have been identified and addressed in advance.

  Genuine sudden deaths can occur without warning. However, in many clinical scenarios, “sudden death” is not truly abrupt, but rather the result of prolonged deterioration evident hours or even days before the fatal event. Did the patient exhibit early signs of organ failure? Were there indications of sepsis? Did monitoring data signal impending danger?

  One of the core functions of critical care units is to provide continuous monitoring and timely intervention. Electrocardiograms, oxygen saturation monitoring, arterial blood pressure measurements and sophisticated biochemical indicators allow medical teams to foresee risks and take preventive measures.

  Yet, when a patient dies suddenly, the explanation often defaults to “disease progression” or “uncontrollable factors.” This raises serious concerns: Were the warning signs ignored? Did the medical team fail to utilize available monitoring tools effectively?

  If monitoring technology has become highly advanced, why do sudden deaths continue to occur so frequently? The root of the problem lies not in a lack of tools, but in the culture of medicine and systemic management flaws that prevent these tools from being effectively utilized.

  In many hospitals, monitoring systems are capable of capturing a wealth of physiological data in real time. Yet, in practice, these data are often treated more as decoration than resource. Medical teams tend to operate reactively — waiting for clear signs of deterioration rather than anticipating and preventing risks. As a result, patients might reach an irreversible stage before any meaningful intervention takes place.

  This problem is compounded by the pervasive hold of defensive medicine. In environments where medical disputes are common, hospital administrators might implicitly encourage staff to be cautious not in treating patients, but in avoiding blame. This fosters a culture where early warning signs are downplayed and high-risk conditions are managed conservatively — or not at all.

  When the fear of being wrong outweighs the urgency of being right, the medical system shifts its focus from preventing harm to minimizing liability. In such a culture, preventable deaths can too easily be dismissed as “sudden.”

  Another critical issue is the lack of transparency. Internal hospital reviews are rarely open to outside scrutiny, and death certificates often offer vague conclusions such as “cardiac arrest” or “multiple organ failure” without deeper investigation. Key details are left unmentioned. Without such details, patterns are missed, lessons are lost and similar tragedies are destined to repeat.

  Sudden deaths should be the exception, not the norm. Tackling this issue demands a fundamental shift in mindset. One key step is enhancing early warning mechanisms within critical care. Instead of relying solely on human judgement to identify obvious signs of deterioration, hospitals should adopt proactive strategies that leverage technology — such as artificial intelligence monitoring systems capable of detecting subtle, but meaningful changes in a patient’s condition. These tools could alert staff before a crisis unfolds, allowing for timely intervention that could save lives.

  Equally important is the need to transform the prevailing medical culture. Doctors and nurses must be able to act decisively and diagnose early, without the looming fear of blame. Institutions should prioritize a supportive framework that encourages active intervention and shared responsibility, moving away from defensive medicine. Only then could patient care become proactive rather than reactive.

  Transparency plays a crucial role. All “sudden deaths” should undergo mandatory, independent review — not to assign fault, but to uncover hidden systemic failures and foster continuous learning. By shining a light on these incidents, hospitals could begin to address the root causes.

  The essence of critical care is not in passively observing decline, but in acting with precision and urgency. Patients should not be allowed to slip away under watchful eyes. When we look closely, what often emerges is not the unpredictability of nature, but the failure of the system — delayed clinical decisions, neglected data and a medical culture that tolerates inaction.

  To break this cycle, Taiwan needs sweeping reforms — accountability, a culture that rewards vigilance and technology that drives timely action. Only then can we return to medicine’s core mission: to save lives.

  Chu Jou-juo is a professor in the Department of Labor Relations at National Chung Cheng University.
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