Heartbeat: Learning from deaths – making life and death decisions

January 24, 2020

Death, it’s often a taboo topic, rarely spoken about and often veiled in statistics and mortality figures. However, death is one of the unfortunate inevitabilities that colleagues across the NHS deal with regularly.

Making sure that life and death decisions that have to be made are done so respectfully, ethically and with the best interests of the patient puts a huge strain on clinical colleagues who carry the responsibility. With this in mind, Dr Alison Eastaugh in her role as Chief Registrar and Dr Sarb Clare, Deputy Medical Director and enthused colleagues from across the Trust gathered at City Hospital to learn more about what they can do when they need to make a life and death decision. The day covered acute care, challenges of the post take ward round, DNR decisions as well as great tales and anecdotes from Dr Angus Mackenzie.

Dr Sarb Clare shared her thoughts, “Whilst we hope for the best outcomes for each patient often tough decisions have to be made and difficult conversations had, whether it is talking to a family about DNACPR or advanced care planning and palliative care. The burden of these tasks falls on the shoulders of clinicians and our decisions reverberate through whole families.”

The 50 colleagues that attended the conference also had the opportunity to hear from Anna Whitehouse. Her father (Alfred) was admitted to hospital with a suspected urinary infection which later transpired to be a perianal abscess. Through a series of unfortunate events, Alfred later contracted C difficile and developed chest infections during his stay. Through her words, Anna described her father as a man who led an independent life and who through his failing health and illnesses went from someone who was very much able to do things for himself to someone who lost the ability to communicate.

Shockingly, during Alfred’s failing health, the family were unable to speak to a consultant for almost two months. When the time came to discuss DNACPR, a doctor seemingly dropped the life-changing decision in the family’s hands without any thought or feeling. Whilst most of the care Alfred received was in a neighbouring hospital, Alfred was transferred to our care when on the supportive care pathway.

“Alfred’s story was eye-opening. It highlights how a range of decisions, miscommunications and failings had a dire effect on the failing health of a man who until his hospitalisation was fit and healthy. Whilst clinicians didn’t conspire to provide poor care, a series of failings ultimately led to a significant decline in his health and ultimately to his passing.”