Re: Death can be our friend (a year after)

24 December 2012

Accepting death as a friend: a year after.

The 2011 Christmas editorial, by Richard smith and colleagues, extolled the virtues of embracing death as a friend. A year on, the society has moved in the opposite direction.(1). At least, a section of the society views death as an enemy to be fought valiantly until the last moment.

The recent furore over Liverpool care pathway (LCP) is a perfect example of this alternate view point. The considerable press and public fury has forced the UK Minister to order a review of the pathway.(2).

Another example of this divergent societal attitude is the considerable public support to a family who are seeking a judicial review of the ‘Do Not resuscitate’ (DNR) policies. A terminally ill cancer patient with a broken neck was allowed to die naturally and a cardiorespiratory resuscitation (CPR) was not attempted. The family is not happy with the way ‘DNR’ decision was made.(3).

Finally, a Judge recently refused permission to a NHS trust to withhold CPR and other ‘futile’ medical interventions in a man deemed minimally conscious by clinicians.(4) This judicial decision raises the issue of ‘who defines futility’.(5).

So a year on, death remains a potent enemy that needs to be fought valiantly, using every available means, as we have done for many centuries. Judiciary would probably define ‘what is futile treatment’ and not the medical profession. Or maybe, nothing is futile in the fight against death and it is just a matter of who pays.

References
1 Enkin M, Jadad AR, Smith R. Death can be our friend. BMJ 2011;343:d8008.

2 National End of Life Care Programme. Press release. http://www.endoflifecareforadults.nhs.uk/news/all/neolcp-comment-in-resp... (accessed 24 Dec2012).

3 Eccles L. Terminally ill woman not consulted before ‘do not resuscitate’ notice was placed on her medical records, judge rules. Mail Online. 19 Dec. 2012.

4 Dyer C. Hospital is refused permission to withhold ‘futile’ treatment if patient’s condition deteriorates. BMJ 2012;345:e8404–e8404.

5 Sundar S. Accepting death: Who defines futility? Rapid response. http://www.bmj.com/rapid-response/2011/12/29/re-death-can-be-our-friend-0 (accessed 24 Dec2012).

Competing interests: Routinely prescribe chemotherapy to incurable cancer patients and regularly recruit cancer patients to clinical trials.

Santhanam Sundar, Consultant Oncologist

Nottingham University Hospitals NHS trust, Nottingham. NG5 1PB

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