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'Do doctors and nurses sometimes try to prolong life too far?'

  • Comments (5)

Having had some prior experience on a care of the elderly ward, sometimes I’ve noticed parts of the medical profession trying to sustain a patient’s life at what seems to be all costs.

I have seen terminally ill patients slipping in and out of consciousness that have been prescribed antibiotics and a blood transfusion.

I have been in meetings where doctors discussed the option of using a tube feed on a frail 93-year-old lady who just wanted to be comfortable.

I have seen junior doctors eager to impress consultants trying to prolong the life of a patient at seemingly any cost. I tried to understand the rationale behind the decisions as the nursing staff clearly felt uncomfortable.

Is this too much? Does nursing see the death of a patient as a failure? Do individual nurses feel it as a personal failure?

The first time that a patient that you’ve cared for passes away might be distressing and leave you with a lot of questions, but that’s a normal part of becoming a nurse.

Do some doctors think of preservation of life as a challenge? And the dignity of the patient takes a back seat?

Do you think that doctors and nurses sometimes try to prolong life at the expense of quality-of-life?

Let me know your thoughts.

  • Comments (5)

Readers' comments (5)

  • Anonymous

    nurses have a better understanding about end of life care but our hands are tied if medical staff are hell bent on prolonging life. I have seen first hand on a few occasions were patient dignity and families wishes have been ignored. I sometimes think medics are scared to deal with a dying patient and their family.

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  • George Kuchanny

    The best indicator here is to note down the client's wishes and MAKE SURE that they are in the notes. I deliberately say 'client' to give us all a slightly different perspective on the whole issue of care that may not have informed consent or may not even be wanted by a patient.

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  • Anonymous

    The 'Time to Intervene ?' about CPR in hospitals report came out a few days ago, and the lawyer who wrote a foreword is somewhat scathing about the apparent resuscitate first think later attitude.

    George has hinted at the legal issues around treating patients without their consent, and somehow the need to obtain consent for eol treatments appears to be sidelined for many patients.

    The problem is partly that the issues become legal, and not clinical, and clinicians are not lawyers.

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  • michael stone

    Hi Adam,

    Another very good question.

    The NCEPOD report 'Time to Intervene ?', mentioned by 'Dim', collected data for cardiopulmonary arrests in hospitals, about 500. The report highlights two main areas: were signs of approaching arrests ignored, when the arrests could have been prevented if the yhad been picked up and acted on?; and, was resuscitation often attempted when it seemed inappropriate to the reports assessors ?

    The Chair of NCEPOD, Bertie Leigh, is a lawyer, and in his foreword to the full report he wrote:

    '.. as I read these pages I wondered how many of these interventions would be defensible if charged as assaults before the criminal courts,'.

    'In the overwhelming majority of cases the question of CPR was not raised with the patient before the arrest, which suggests that this may be cultural rather than the product of a deliberate decision in each case. Some case reports said this happened because there was no opportunity, a proposition our advisors struggled to reconcile with some of the intervals that elapsed between admission and the arrest. '

    The report is limited to CPR, but in a wider context it, and especially Bertie's Foreword (not the Introduction - there is a Foreword and also a separate Introduction) addresses issues around death and who controls decisions about treatment for dying patients (the question is, do patients make those decisions {about refusals of treatment}, or can clinicians legally make judgements about a patient's quality of life ?) – the link to the report is:

    http://www.ncepod.org.uk/2012cap.htm

    and the one you want is View/Save Report (1.6Mb), because the Summary does not have the Foreword by Mr Leigh.



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  • Sin to Heal Me ?

    I have tracked down that NCEPOD report, and the following is included in the foreword, and seems relevant to Adam’s question:

    ‘This report suggests that today we stand at a crossroads. To the left lies a destiny familiar from America where 60% of us will die in an ICU and we will spend 50% of NHS expenditure in the last six months of life, much of it seeking to postpone the inevitable. This will happen, not because the patient has asked for it or because someone has taken a calculated decision that it is in the patient’s interest to make the attempt, but because the doctors think that they have a duty to do everything that they can to prolong the process of dying.’

    The report, which was about resuscitation, also included this comment in the foreword:

    ‘Alas, the results are profoundly disappointing and as I read these pages I wondered how many of these interventions would be defensible if charged as assaults before the criminal courts, or as professional misconduct before the GMC.’

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