THE tragedy of Li Liyun, a 22-year-old pregnant woman who died in a Beijing hospital after her husband refused to consent to a Caesarean operation last week, has shocked the public.

But who should be held responsible for the deaths of the mother and the baby in her womb? It is a question with more than one answer, the Beijing Times said in an editorial Friday.

The husband was the first to bear responsibility, the editorial said. Xiao seemed extremely unreasonable in the three-hour standoff with doctors when his wife was in a very critical condition. Xiao, a migrant worker who was financially strapped, had even refused 10,000 yuan (US$1,351) offered by an onlooker who promised to give him the money if he signed off on the operation. He was so persistent because he wrongly believed that a Caesarean section would have negative impact on his wife if she tried to have a second child. Xiao stands accused by the public of ignorance. But there are reasons behind it, the editorial said.

Xiao and his wife had been at the bottom of the social ladder. He was introverted and had no friends in such a big city. He might have been on the verge of a breakdown and lack the ability to deal with emergencies.

The editorial called for early intervention for socially disadvantaged groups to prevent more tragedies in the future.

The hospital should also take some resposibility for the incident, the editorial said.

It seemed the hospital had fulfilled its responsibility by informing the patient's family members about her condition and reporting the case to the supervisor for instructions to abide by the law. But, it was not the best solution when a life was waiting to be saved, the editorial said.

Some netizens point the finger at the nation's existing management system in medical institutions, saying it was ridiculous to obey the rigid rule "no permission, no operation" at the expense of a human life. They stressed that doctors were obligated to help the sick or dying and the law should always be humanitarian, otherwise there was no point in observing it.

Sun Dongdong, a professor with Beijing University indicated that the real problem did not come from flawed laws and regulations. It is related government departments who should rethink their perception of a doctor's rights and obligation to save human life.

Management regulations at medical institutions state that a hospital should perform an operation on a patient after the treatment proposed has been either approved by people in charge of the medical institution when it cannot get consent from the patient or relative or in the case of an emergency.

The regulations also say that any measures to save a dying person in an emergency cannot be considered a medical accident.

(Li Jing)

The last 3 hours in Li's life

On Nov. 21

4 p.m.

Pregnant woman Li Yunli is taken to Chaoyang Hospital Jingxi branch in Beijing. She shows symptoms of respiratory and heart failure and is critically ill. The fetus is found to be healthy.

4:20 p.m.

Li's condition worsens and doctors decide an immediate Caesarean section is needed urgently. The hospital prepares for the surgery and an anaesthetist stands by.

4:30 p.m.

Li's husband Xiao Zhijun refuses to sign a consent form for the operation. The hospital reports the incident to the district and municipal health authorities for instructions.

4:40 p.m.

The hospital again tries to persuade Xiao to sign the consent form, but he refuses again.

4:45 p.m.

The woman's condition deteriorates and she begins to lose consciousness.

5 p.m.

The heartbeat of the fetus cannot be detected. Doctors brief Xiao on his wife's condition.

5:05 p.m.

Xiao again refuses to consent to the operation.

5:15 p.m.

The woman's condition further deteriorates and doctors advise an immediate C-section, but Xiao again refuses.

5: 30 p.m.

The woman's heart stops and doctors attempt resuscitation.

5:47 p.m.

The patient is placed on a respirator. Her husband still refuses to gives his consent.

6 p.m.

Doctors insist the woman needs an immediate operation, but are turned down again.

6:24 p.m.

Doctors diagnose the fetus as deceased.

6:55 p.m.

The mother's heartbeat stops and attempts to revive her fail.

7:25 p.m.

She is confirmed deceaseed.

(Claudia Wei)