Understanding the critical role of planning for end-of-life care can transform the experience for patients and families alike.
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Working in Accident and Emergency (A&E), the reality hits hard: we witness both the pinnacle of healthcare and its stark failures. Recently, I encountered an 89-year-old man whose care fell tragically short—an outcome that was entirely preventable and devastating for everyone involved.
Death is the only certainty in life, yet when it approached this gentleman, we faltered. A proud family man, he dedicated his life to serving his country as a soldier and a policeman. Until a stroke six months prior, he enjoyed a vibrant life, caring for his cherished grandchildren.
His decline was swift, leading to a situation where he required constant care.
His last months were a far cry from what he would have wished. On the day he arrived at A&E, he was struggling to breathe. His son, seeking help, assumed a district nurse would provide a home visit. Instead, a blue-light ambulance whisked him away to the hospital, where pre-planning for his deteriorating condition was sorely lacking.
Failure to communicate leads to chaos
Upon arriving at the hospital, a junior A&E doctor recognized the signs of sepsis stemming from a chest infection. Treatment began with fluids and antibiotics, but what he truly required was palliative care. Unfortunately, he was left in a busy corridor, with no cubicle available—an all too familiar scene for many. His son, understandably distressed, approached the nursing staff for clarity.
It became evident that this man, amid his suffering, wanted nothing more than a peaceful death at home, not an extended ordeal in a hospital setting. When I intervened, his condition had worsened; he was semi-conscious and in discomfort. I made the decision to halt unnecessary treatments and refocus on comfort care, ultimately allowing him to pass in dignity, albeit in an environment filled with chaos.
Planning can change outcomes
In stark contrast, I recall a friend’s father who passed away recently. This frail man, battling heart and kidney failure, had taken proactive steps six months prior. He sat down with his GP and family, clearly outlining his wishes: no hospital interventions, no CPR, just the comfort of home, his dog, and jazz music in the background.
This foresight meant that when the moment came, everything was in place. Medications were prescribed in advance, and district nurses were prepared to assist. The family experienced a peaceful farewell, free of panic or hasty decisions. This is the power of planning—a stark reminder that without it, families can find themselves at the mercy of an overwhelmed healthcare system.
Conversations we avoid
We seldom discuss death, let alone our preferences for how we wish to die. As medical advancements increase longevity, especially for those with chronic conditions, the focus should not solely be on prolonging life but also on how to facilitate a dignified exit. Too often, when a patient suddenly deteriorates, healthcare professionals scramble to make critical decisions without knowing the patient’s wishes.
The introduction of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form in 2016 aimed to alleviate such crises by documenting pre-established wishes regarding treatment preferences. This form should ideally be filled out in a calm setting, involving the patient and their family, and it encourages meaningful discussions about care options.
Understanding DNR and treatment options
One of the crucial aspects of ReSPECT is clarifying misunderstandings around Do Not Resuscitate (DNR) orders. Many believe that a DNR means no treatment at all, but that is not the case. Patients can still receive active care, including oxygen and fluids, while stipulating that they do not want aggressive interventions like CPR, which often leads to poor outcomes for the elderly.
This planning is not just a formality; it allows patients and families to have peace of mind, knowing that their desires are documented and respected. Regrettably, many GPs do not utilize this form, leading to rushed decisions in times of crisis, like what happened with the 89-year-old gentleman.
The role of legal documents
In situations where patients cannot express their wishes due to conditions like dementia, having a lasting power of attorney for health can be invaluable. These legal documents allow trusted individuals to make healthcare decisions on behalf of the patient, ensuring that their values and preferences are honored.
Getting proactive about end-of-life care
It’s imperative to have these conversations before a health crisis arises. We meticulously plan weddings, careers, and retirements, yet we neglect the most inevitable event in life: death. Completing a ReSPECT form won’t prevent death, but it will help ensure we can face it with dignity, surrounded by loved ones, just as we lived.
People often say, ‘I don’t want to think about that yet.’ But when is the right time? When you’re already incapacitated? The time is now. Good deaths are not left to chance; they require preparation, understanding, and the courage to have tough conversations.
