Mary Black provides a powerful argument on just why doctors need to resist the current trend to give relatives too much control in end of life decisions. Relatives are there first and foremost to help in coming to the right decision in line with the preferred and wishes of the patient if appropriate . Apart from any jet lag from a recent long haul flight , the “I howled with pain” suggests that she was in a poor condition to have undue control over an urgent clinical decision and to disregard the long held views of her mother , quite possibly condemning her to a more distressing alternative death in the foreseeable future. A fear of personal loss can mean losing sight of the needs of the patiet. Many of us will have cared for patients where we have allowed ourselves to be over-influenced by relatives into going ahead with aggressive treatment but with depressing , if not disastrous , results. In these circumstances it may be even more important for the family to know the ultimate decision was a medical (or surgical) one. The impressive news here is that at least the mother had expressed her views beforehand – one has to wonder what is happening in families where this has never taken place. Do they believe their parents immune from dying or health crises ? There will often be undiagnosed (not necessarily “missed”) disease present but investigation is not always indicated. It is very different and more complex when the patient is a child as recent controversies illustrate but with elderly parents it is difficult to believe there have not been opportunities for discussion.
One of the biggest advantages – one might say a perk -in being a doctor is that we can try to ensure that when our parents approach the end-of-life we can help to ensure that this is dignified and in accord with the views of that parent. This is what I tried to achieve for both my parents – one of whom also died from exsanguination when a decision was made to stop transfusion . Perhaps having spent my working life in the front-line helped and edging referrals towards a compassionate as opposed to the “have a go” doctors came from inside knowledge. Certainly I had no real doubts about the views of each parent as periodically we had discussed these issues during family life and into old age. I have not been left with any “feelings of guilt , shame , ambivalence or regret “ about the decisions made and such contribution as I made towards their deaths.. Quite the reverse : I felt privileged to help each parent to die relatively peacefully in line with their long-held views. A time to live and a time to die – but so often the recognition of the latter is retrospective after a missed opportunity.
Rapid Response:
The patient comes first
Mary Black provides a powerful argument on just why doctors need to resist the current trend to give relatives too much control in end of life decisions. Relatives are there first and foremost to help in coming to the right decision in line with the preferred and wishes of the patient if appropriate . Apart from any jet lag from a recent long haul flight , the “I howled with pain” suggests that she was in a poor condition to have undue control over an urgent clinical decision and to disregard the long held views of her mother , quite possibly condemning her to a more distressing alternative death in the foreseeable future. A fear of personal loss can mean losing sight of the needs of the patiet. Many of us will have cared for patients where we have allowed ourselves to be over-influenced by relatives into going ahead with aggressive treatment but with depressing , if not disastrous , results. In these circumstances it may be even more important for the family to know the ultimate decision was a medical (or surgical) one. The impressive news here is that at least the mother had expressed her views beforehand – one has to wonder what is happening in families where this has never taken place. Do they believe their parents immune from dying or health crises ? There will often be undiagnosed (not necessarily “missed”) disease present but investigation is not always indicated. It is very different and more complex when the patient is a child as recent controversies illustrate but with elderly parents it is difficult to believe there have not been opportunities for discussion.
One of the biggest advantages – one might say a perk -in being a doctor is that we can try to ensure that when our parents approach the end-of-life we can help to ensure that this is dignified and in accord with the views of that parent. This is what I tried to achieve for both my parents – one of whom also died from exsanguination when a decision was made to stop transfusion . Perhaps having spent my working life in the front-line helped and edging referrals towards a compassionate as opposed to the “have a go” doctors came from inside knowledge. Certainly I had no real doubts about the views of each parent as periodically we had discussed these issues during family life and into old age. I have not been left with any “feelings of guilt , shame , ambivalence or regret “ about the decisions made and such contribution as I made towards their deaths.. Quite the reverse : I felt privileged to help each parent to die relatively peacefully in line with their long-held views. A time to live and a time to die – but so often the recognition of the latter is retrospective after a missed opportunity.
Competing interests: No competing interests