The article by Ram and colleagues (1) concernng the management of
patients with COPD is timely, being followed as it is by the publication
of NICE guidance on the same subject.
Disappointingly, Ram’s article does not mention at all the role of
the multidisciplinary team in approaching end of life care decisions in
the chronically sick. It has been suggested at least since 1998 that there
is a specific need for specialist palliative care in non malignanat
disease ( 2), and yet still, all too often, the decision as to whether to
institute invasive treatment or palliative care in patients with chronic
illnesses who may be in the terminal rather than reversible stages of
disease, is left until the crisis admission in the early hours of the
morning when neither relatives nor patient are in a fit state to
participate in such planning. The American Thoracic society guidelines,
for example, specifically stress the importance of targeted early
planning of so called “living wills” (3)
The Leslie Burke case (4) illustrates how clearly patients wish to
be autonomously involved in these decisions. It is up to health care
professionals to ensure that their future care pathways address these
issues.
1. Hospital at home for patients with acute exacerbations of COPD Ram
FS Wedzicha JA Wright J Greenstone BMJ 2004 329 315
2. Addlington Hall J Fakhoury W McCarthy M Palliat Med 1998 12 (6) 417-27
3. (www.thoracic.org/COPD).
4. “Man wins battle to keep receiving life support” BMJ 2004
Competing interests:
None declared
Competing interests:
No competing interests
17 August 2004
James Watts
Consultant in Anaesthesia and intensive Care Medicine
Rapid Response:
The place of end of life care
Editor
The article by Ram and colleagues (1) concernng the management of
patients with COPD is timely, being followed as it is by the publication
of NICE guidance on the same subject.
Disappointingly, Ram’s article does not mention at all the role of
the multidisciplinary team in approaching end of life care decisions in
the chronically sick. It has been suggested at least since 1998 that there
is a specific need for specialist palliative care in non malignanat
disease ( 2), and yet still, all too often, the decision as to whether to
institute invasive treatment or palliative care in patients with chronic
illnesses who may be in the terminal rather than reversible stages of
disease, is left until the crisis admission in the early hours of the
morning when neither relatives nor patient are in a fit state to
participate in such planning. The American Thoracic society guidelines,
for example, specifically stress the importance of targeted early
planning of so called “living wills” (3)
The Leslie Burke case (4) illustrates how clearly patients wish to
be autonomously involved in these decisions. It is up to health care
professionals to ensure that their future care pathways address these
issues.
1. Hospital at home for patients with acute exacerbations of COPD Ram
FS Wedzicha JA Wright J Greenstone BMJ 2004 329 315
2. Addlington Hall J Fakhoury W McCarthy M Palliat Med 1998 12 (6) 417-27
3. (www.thoracic.org/COPD).
4. “Man wins battle to keep receiving life support” BMJ 2004
Competing interests:
None declared
Competing interests: No competing interests