TW: death/injury When is it kinder to let someone die?

This is such a difficult subject. I work in primary care. I’ve seen complaints against a GP because they gently suggested that offering antibiotics for their demented, bed ridden, incontinent, frail 88 year old mother may not be in her best interests. Apparently the GPs were trying to kill her.

And we give Covid and flu vaccines to similar patients in the nursing home, because the family request it and give consent on their behalf. I’ve vaccinated 98 year olds, and I frankly wonder what I’m doing as dying from flu or Covid would be the kindest thing for them.

As a clinician I can only sympathise with the doctors as it’s horrific having to make those decisions.

It's such a difficult area. It seems to fall into two broad areas: how we deal with catastrophic injuries, and how we handle the elderly or others coming to the ends of their lives.

With catastrophic injuries, it can be so difficult to tell. A friend's baby had a birth injury, and she was told that her child would never walk or talk and would need to be tube fed. None of that turned out to be true: yes, ongoing health issues, but also rides a bike and did (and passed) GCSEs.

With the elderly it often seems that some treatment isn't necessarily in the best interest of the patient. It doesn't help that people's stated wishes aren't always take into account. MIL, with advanced Alzheimer's, was supposed to be on palliative care only, but when she got a chest infection, the nursing home doctor pumped her full of antibiotics and she lived, miserable, frightened and in pain (arthritis), for another year.

Life for the very elderly who would have been dead long ago without modern medicine is another can of worms. I know at least one who is sitting there just willing the Grim Reaper to come knocking; but I knew another who loved life right up until a few weeks prior to his death in his mis-90s.

I was the one that told them to remove my DDad’s oxygen. He died very (shockingly) soon after.

It felt like a huge thing to do, but it was so pointless making him suffer.

You are right, it was selfless.

My MiL developed a chest infection when she was in the late stages of Alzheimers. We had to take the decision that it was better to make her comfortable and allow the disease to take her.

Not one person thought we'd made the wrong decision.

91% YANBU - which is the way I voted. Let me go, I don’t want to prolong things.

It’s so personal though- my aunt wanted to live any which way how, unless she was in pain.

That’s good to know. Although I would probably be categorised as non compliant with medication. So not sure what they would think of me!

Unfortunately doctors and other medical have to provide the best care possible to keep patients alive, even if it will result in life changing complications. There are many that would rather this didn't happen but also plenty who would rather be alive no matter what. Doctors can't make that decision for you.

I watch a family of a friend living through this.
Their sibling was involved in a catastrophic accident in their late teens, now mid 30’s. They have been totally paralysed ever since, non verbal, totally dependent on two carers 24hrs a day. No one is really sure if they have any awareness of what’s going on around them. In the first few years there was hope that they would improve, that there would be new treatments, but nothing has helped. No one ever expected them to live this long.
It’s very hard on their family, and I often wonder how they do it.

I think fear of litigation is a strong driving force.
There was a recent case of someone with a do not attempt resuscitation order who choked.
They were not resuscitated when they had cardiac arrest due to choking.
The team were successfully sued ( by patients family)for not resuscitating as it was argued to be a potentially reversible situation.
The problem is, any cardiac arrest could be potentially reversible, even though highly unlikely most of the time. How could you know at the time
The solicitors I see say to approach all of this with caution, even the dnar orders.

If the person doesn't have capacity to consent then you have a meeting of all concerned and discuss what is in their best interests. This is sometimes difficult to decide. Best interests doesn't always mean treatment, especially if they are likely to not cooperate or the treatment will be distressing, risky or futile. In serious cases where there is a difference of opinion at the best interests meeting, a court can decide.

V impressive! Ive not meet any that can communicate/eat/tracheostomy and not totally dependent on others for everything. Always have to have hope

I'm afraid I agree. There are people I know who have been kept alive after severe illnesses, or severe disability from birth. They have no quality of life at all - dependent on oxygen etc, one of them has been kept alive and cannot walk, talk, sit up, is tube fed etc. I do not believe in keeping someone alive at all costs.

My husband had a huge bleed. This saved his life and despite warnings of terrible outcome. He is back playing in his squash tournaments, back at work running his business, going on holiday. I thank those people making those decisions every day that I have my husband back. He is "almost" the same as before

Decompression cranie or something else?

I haven't been involved with them if I am honest.

Some units have follow up clinics whereby patients are invited back to the unit to see where there bed was, meet the staff etc. It can help with their recovery.
As a member of staff I rarely recognise the pt ( the relative yes ) as they look so different.

From Wikipedia on hemicorpectomies:

7]
Emergency rooms and ambulance service policies advise against the resuscitation of such patients. The UK's National Health Service, for example, in its "Policy and Procedures for the Recognition of Life Extinct" describes traumatic hemicorporectomy (along with decapitation) as "unequivocally associated with death" and that such injuries should be considered "incompatible with life" in patients under 18.[8] The National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (COT) have also released similar position statements and policy allowing on-scene personnel to determine if patients are to be considered unresuscitatable.[9]

So presumably there will be other conditions that have been deemed as incompatible with life, unless the patient is conscious and can express a wish.

Not exactly the same but I was the one to say to the ICU doctor that we did not wish them to attempt to resuscitate ventilated DF (covid) - the doctor asked what our wishes were and i said he absolutely would not want to live with life changing disability ie being permanently reliant on oxygen. She confirmed this would certainly be the case if he survived. He was 66. It honestly feels like the most selfless thing I've ever done- i adored my DF and wanted to keep him around forever - but not at the expense of his quality of life and happiness 💔

Both my children have told me they would not want to live if they had to be hooked up to machines to be kept alive, with no awareness and no quality of life.

I also see those videos. Especially of the pro lifers with extremely disabled babies and children.

my opinion is if the person is still mentally competent it is their choice. But bringing some of these babies into the world to suffer and less than exist is cruel. When someone has an accident and can no longer function with no meaningful brain activity, keeping them alive with no hope of recovery can be cruel. It’s just keeping a shell in existence for the benefit of others.

I'm so sorry to hear this It's exactly what we were afraid of happening to my mum