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People are missing out on their perfect death because doctors do not know their wishes

4 1 0
28.07.2019

‘Billy* is 87. He was playing bridge with friends, and suddenly collapsed in cardiac arrest.’

I could be describing the perfect death. Old, doing what you enjoy. Surrounded by friends. Quick, very quick. But it doesn’t end there, and I continue the night-shift handover to my intensive care colleagues.

‘Paramedics resuscitated for 10 minutes, got him back. He had his own circulation on arrival here, but he remained barely conscious.’ My colleagues stare down hard at their patient lists. I hear mumbled a well-repeated adage. ‘Is anyone allowed to die these days?’

As the UK population ages, these situations are increasingly common. We’re seeing greater numbers of elderly patients admitted to intensive care and high dependency units – wards that cater for the very sickest patients and support whole organ systems when they fail. We’ve an armament of procedures and tools at our disposal, poised to save lives, but always at risk of merely prolonging them.

As the intensive care doctor, I’d been pre-warned of Billy’s arrival. It was late when he arrived into the resuscitation room. He looked thin and old, and deserving of peace and comfort, not heroics.

I want to ask him what he wants us to do for him, but as I said, he’s hardly conscious. The paramedics have done a great job and should be proud of themselves, but they don’t look it. ‘Any family with him?’ I asked. She shakes her head gravely.

We have to decide Billy’s outcome in minutes, or he’ll decide his own. I know what we probably should do, yet I know what we will be duty-bound to do. I phone my consultant. They probe the situation for some enlightenment.

No family about? I explain I couldn’t get hold of his son by phone. None of his wishes previously in the notes? Nope.

‘The paramedics said he has a stairlift’ I........

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