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David Oliver: Sepsis—what’s behind the “hype”?

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6327 (Published 07 November 2019) Cite this as: BMJ 2019;367:l6327

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Death preventable or inevitable ?

One of the enduring mysteries of the human psyche is the belief that death is preventable and not inevitable. Survival is the default expectation, contrary to the transient nature of life all around, even in those people whose professional life deals with death on a regular basis. Campaigns such as Surviving sepsis taps into this belief of the human psyche at a broader population level.[1].

Infection is often an associated event during the dying process due to deranged immune systems, disrupted mucosal barriers and multi-organ dysfunction. Treating sepsis in a person with impending death is as futile as performing cardiopulmonary resuscitation because antibiotics merely delay the inevitable. [2] [3].

Semantics employed by healthcare systems do perpetuate this myth. The label “terminal” is often deployed by professionals and readily accepted by advanced cancer patients even when the prognosis is typically in terms of many months. But the word “terminal” is not readily used in elderly frail bed-bound patients with advanced dementia and multiple co-morbidities. Semantics have adverse consequences and do inhibit compassionate care, promote futile interventions and needlessly raise unrealistic expectations. Unnecessary interventions not only can cause an undignified death but also emotionally burden family and friends. [4].

The BMJ 2011 Christmas editorial philosophically argued in favour of embracing death as a friend. Events since 2011 indicate that this philosophy is a long way from getting embedded in the human psyche. [5].

References
1 David Oliver: Sepsis—what’s behind the “hype”? | The BMJ. https://www.bmj.com/content/367/bmj.l6327 (accessed 11 Nov 2019).

2 Geijteman ECT, Graaf M van der, Witkamp FE, et al. Interventions in hospitalised patients with cancer: the importance of impending death awareness. BMJ Support Palliat Care 2018;8:278–81. doi:10.1136/bmjspcare-2017-001466

3 D’Agata E, Mitchell SL. Patterns of antimicrobial use among nursing home residents with advanced dementia. Arch Intern Med 2008;168:357–62. doi:10.1001/archinternmed.2007.104

4 Swarte NB, van der Lee ML, van der Bom JG, et al. Effects of euthanasia on the bereaved family and friends: a cross sectional study. BMJ 2003;327:189. doi:10.1136/bmj.327.7408.189

5 Enkin M, Jadad AR, Smith R. Death can be our friend. BMJ 2011;343:d8008. doi:10.1136/bmj.d8008

Competing interests: No competing interests

11 November 2019
Santhanam Sundar
Consultant Oncologist
Nottingham University Hospital NHS Trust
Hucknall Road, Nottingham