Resuscitation and end-of-life care
Sir, – I welcome your editorial (June 19th) on resuscitation of end-stage patients as it raises an interesting dilemma that needs to be openly debated in a sensible and non-sensationalist way.
When it comes to resuscitation of end-of-life patients, doctors want to do everything that’s medically appropriate, whereas a family wants the doctors to do everything that’s medically possible.
The only way to bridge that gap is by having regular meetings between the doctors and the family, discussing what is best for the patient and what is best medical practice, and agreeing a way forward.
Good communication and good science are the keys to an outcome that is acceptable to all. – Yours, etc,
Sir, – After 40 years of medical practice I understand why doctors will sometimes engage in futile attempts at resuscitation of end-stage patients. They know it will not hurt the already unconscious patient and they are under significant pressure from the next-of-kin to be seen to do something. The last thing that any doctor wants is to face allegations in the media or in the courts that he or she did not do everything possible for a dying patient.
The dilemma for doctors of whether or not to resuscitate end-stage cancer or dementia patients could easily be avoided if three measures were introduced.
First, end-stage patients should never find themselves referred to an intensive-care environment. There is almost no reason, with the exception of intractable pain, why an end-stage dementia or cancer patient should find himself transferred from his home or nursing home to the care of intensive-care doctors. The patient should be managed by general practitioners, public health nurses and palliative care doctors and nurses. Referral of an end-stage patient to the intimidating atmosphere of an acute hospital is a disorienting and frightening experience for the patient.
Second, in acute hospitals, doctors should be obliged to make a plan with all patients (or their next-of-kin if the patient is not compos mentis) as to how to deal with a critical issue such as severe breathing difficulty or a cardiac arrest.
An agreed plan, recorded in the patient’s file and implemented, would prevent the majority of incidents of inappropriate resuscitation. There would be occasional disagreement between the patient and the team of doctors on the most appropriate plan, and these cases could be resolved by a medical ethics committee.
Finally, realistic reporting of end-of-life issues in the media would be very helpful. Avoidance of sensationalism, and the encouragement of sensible reporting on life-and-death issues that is in accordance with medical science, would go a long way towards ensuring that the public has a good understanding and realistic expectations of the outcome of critical illness. – Yours, etc,
Dr TOM O’ROURKE,