BMA calls for changes to end of life care

Doctors should not pursue aggressive but non-beneficial attempts to prolong life, says a report from the BMA on end of life care and physician assisted dying.1

The report said that more should be done to identify patients who are likely to be approaching the end of life—in particular, frail older patients with multiple comorbidities—which should then trigger a review of the goals of different medical interventions and the patient’s medicines.

It said that people nearing the end of life should receive only appropriate and proportionate treatment. The report called for more training to help doctors identify when patients may be approaching the end of life and to equip doctors with the necessary communication skills to handle difficult conversations with dying patients and their relatives.

The report said it was equally important that patients are not abandoned or denied treatment for reversible conditions or to relieve symptoms simply because they seem to be approaching the end of life or have a terminal condition. It recommended individual assessments so that, while a decision may have been made to stop chemotherapy because a patient’s cancer is incurable, antibiotics for a chest infection may be appropriate.

The final part of three volumes, the report is based on a series of consultation events held across the United Kingdom in 2015 that canvassed 237 doctors and 269 members of the public. In January the BMA published the second volume, which found that doctors and the public were concerned at the prospect of legalising physician assisted dying.2

The new report cited pockets of excellence around the UK but found considerable variation in the quality of care provided to patients across the country, as well as variation between medical conditions. End of life care for patients with cancer tends to be good, it said, but improvements are needed for people with conditions such as chronic obstructive pulmonary disease or heart failure.

Some families spoke of long delays in getting appropriate pain medicine out of hours when relatives were cared for at home. Busy health professionals do not always treat patients’ relatives with kindness, the report found, and supporting bereaved family members can often seem a low priority for overstretched staff.

The report urged hospital staff to do more to discharge patients so that they can die at home if they wish. It found that, where delays in putting together a package of care are unavoidable, many patients would be happy to be discharged from hospital despite a less than ideal care package being in place.

It said that, if a patient is approaching the end of life and has expressed a desire to die at home, appropriate planning should be made for future medical episodes. It found that many inappropriate hospital admissions occur because a patient’s family members are concerned about a sudden deterioration in the patient’s health, do not know what to do, and call an ambulance.

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