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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

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

132 replies

En0ufh1sEn0ugh39 · 21/01/2025 21:33

I recently started watching Facebook videos and haven’t yet adjusted my preferences for content I want to see. I’ve been bombarded by videos of “feel good” stories. It’s largely about people in the US who have had life changing injuries. So for example, a shot gun wound where they lost most of their face, or someone who has had all of his body below the torso removed because of an accident. In all these cases the person nearly died but was saved by modern medicine.

I want to be clear I am disabled myself (and have a not great quality of life) and I think if people want to have surgeries/treatment they should have them on the NHS and be fully supported by the welfare state if needed. But, is it always ethical to
intervene? And is consent always needed?

I’d be really interested to hear from any medical professionals or people with firsthand experience what they think. Is it possible to put in place something on medical records to say in advance when we wouldn’t want treatment.

My experience is that the NHS/medicine is great at physically saving people but there is very little support for living with the impact of serious illnesses/injury. I assume it’s the same in the US.

YABU-we should always use medicine to save a life

YANBU- it’s more complicated and sometimes it’s kinder to let someone pass

OP posts:
Destiny123 · 23/01/2025 12:58

En0ufh1sEn0ugh39 · 23/01/2025 11:10

That makes sense about the difference thanks for explaining that.

what would happen if a patient was stabilised and then their NOK presented a directive which said the patient wouldn’t want to be treated? Just a hypothetical, let’s say they were not elderly but had decided in advance that whatever the injuries were was something they didn’t want to live with?

If its valid and correctly signed it should be followed and active treatment stopped. The difficulty is many injuries aren't imminently life threatening and if the initial event isn't fatal can often have a normal "length" of life. Is what I really struggled with when doing my stroke job

I've had it on icu where they've got circulation back post cpr and the family were like he would never have wanted this etc. We dnar'd him then in case he rearrested, but explained that as he was now alive normally we wait 72h to prognosticate to see the impact on brain function to decide if to withdraw treatment or not. They were accepting of that. It was unsurvivable so was paillated then

Destiny123 · 23/01/2025 13:00

En0ufh1sEn0ugh39 · 22/01/2025 19:46

It sounded from PPs that this isn’t practical for emergency cases (e.g. car accident) where decisions have to be taken very quickly?

Yep I've had many horrific car accidents/stabbings at work that if don't get to theatre with massive blood transfusion within about 15m of arrival they'll arrest

Destiny123 · 23/01/2025 13:03

En0ufh1sEn0ugh39 · 22/01/2025 20:33

Yes it sounds very hard, especially as the family of the person might have a very different preference to the person. Also sounds like even if people make their wishes explicitly known these may be overridden, as the experiences PPs have talked about show. I wonder if anyone who has had their explicit written wishes overriden has ever sued.

Tbh advanced directives are vanishingly rare, hence why i recommended earlier in the thread people get them. The only ones I've ever seen in 10y qualified 5y med school have been jehovahs witnesses blood refusal, and they're 100% respected, and they can be petrifying to anaesthetise. I've witnessed one die when would be saved with blood and its really common in haematology if they get blood cancers as they're basically untreatable as chemo = blood transfusion or die :(

Destiny123 · 23/01/2025 13:09

BlueSilverCats · 22/01/2025 21:48

I might be mistaken but as far as I understand it DNR is about no resuscitation/CPR rather than treatment. So if he had a cardiac arrest due to his illness that would be a no CPR /resuscitation, but antibiotics to treat the infection would be ok. That’s without an advanced directive that describes what treatment is refused and in what circumstances or no NOK available to advocate for the patient.

Happy to be corrected.

Yup dnar is literally cpr only isn't performed everything up to that point is performed, if deemed appropriate. Respect forms are becoming more widely used now which covers invasive ventilation dialysis etc and has a space for patients wishes

En0ufh1sEn0ugh39 · 23/01/2025 13:16

Destiny123 · 23/01/2025 12:58

If its valid and correctly signed it should be followed and active treatment stopped. The difficulty is many injuries aren't imminently life threatening and if the initial event isn't fatal can often have a normal "length" of life. Is what I really struggled with when doing my stroke job

I've had it on icu where they've got circulation back post cpr and the family were like he would never have wanted this etc. We dnar'd him then in case he rearrested, but explained that as he was now alive normally we wait 72h to prognosticate to see the impact on brain function to decide if to withdraw treatment or not. They were accepting of that. It was unsurvivable so was paillated then

So difficult. Thanks for sharing. I think it’s for in situations like this that some PPs suggest people should be able to request euthanasia in cases of unbearable suffering

OP posts:
MistressoftheDarkSide · 23/01/2025 14:08

Ironic to come across this thread today.

3 years ago I was in the last 48 hours of my DPs life sitting beside his death bed.

He had been in hospital for nearly 3 weeks having collapsed at home from a major brain bleed. He was operated on successfully and even regained consciousness for a few days. He had tested positive for Covid so we weren't allowed to visit for 14 days. I had one phone call and it was clear that he was thankfully high as a kite and he asked me what time it was. I told him and he said "See you at 6" which was when we'd meet after work. At that point it was clear he had some paralysis but they were already talking rehab.

Over the next few days he regressed and another scan found a second massive bleed that wasn't compatible with further surgery. The writing was on the wall. I had long conversations with his devastated father and I knew DPs wishes were not to end up like his DM who has end stage dementia. His career depended on fine motor function, and he would have hated to be dependent on anyone for intimate care, not that it seemed he had any awareness and was in a deep coma. I agreed with doctors suggestions that for the sake of comfort and dignity, we had to let him go.

Some of his close friends were really combative about it, holding out for a miracle of some sort, (as if I wouldn't feel the same) but it was medically and personally ridiculous to keep him "here" in physical terms as his body was shutting down and no miracle could have restored the damage and brought him back as the person he was and would want to be.

It took four months and two post mortems to reveal that he had cancer that had metastised to his liver, lungs and brain. Partly genetic, partly lifestyle and with symptoms that any doctor would have concluded were lifestyle related which is why he didn't seek help - he was trying to address those issues himself and only bother the doctor if they didn't resolve.

So it's a really hard and emotive subject for all concerned.

I'm currently in a position of holding H and W for his mother as he was an only child, and long divorced from his father. She is end stage Alzheimers, unresponsive to a degree, in a care home, muscle contracture in the foetal position, no recognition of people or stimulation for at least five years. In the last three months she has started suffering seizures. This weekend I'm told they are now investigating potential bowel cancer. I am making it clear that she has a DNR and that any investigation is only to determine how any palliative care is administered. Her comfort is to be the only focus, and honestly, I'm willing her to go as quickly and peacefully as she can. She already has no quality of life so if she does have cancer, and I saw what chemo did to my late DM, I will not advocate any treatment bar the highest amount of pain relief possible.

My late DM was diagnosed with ovarian cancer stage 4 after two years of doctors assuming she had IBS and dicking about with the Fodmap diet etc. It was finally picked up in a blood test for HRT to address her tiredness. The first round of chemo bought her about three years. When the tumours started to grow again she was persuaded to try more, and the first lot nearly killed her and put her in hospital for a week. The last six months of her life were devoid of pleasure in food- she couldn't taste it, and she couldn't do activities. Her last month, which I nursed her through at home, we're hell. She only had a syringe driver for the last 24 hours. She wanted to live, but not like that.

I think every case should be considered individually with more flexibility on the part of medics and family to help determine a dignified end when it is inevitable. It seems ludicrous and cruel when someone is clearly terminal and in pain to dither around worrying about "too much morphine" for example. Likewise watching my DP struggle to breathe for two days seems unnecessary when a dose of appropriate drugs might have helped him slip away more peacefully.

My thoughts about disability and premature babies etc - I don't feel I am qualified or have the right to speak for anyone but myself, as these are hypotheticals for which I have no experience or frame of reference. Legislation relating to such personal matters is a huge can of worms and I remain conflicted on assisted dying because while the three situations I have experience of do I think qualify, there are hundreds of different scenarios that are grey areas in my book, and I worry about slippery slopes.

I send love and solidarity to all those grappling with such issues. It's a shitty club to be in.

EdithStourton · 23/01/2025 14:35

It seems ludicrous and cruel when someone is clearly terminal and in pain to dither around worrying about "too much morphine" for example.
Well indeed. When my DM was dying, 'too much morphine' wasn't a concept I even considered. I just wanted her out of pain, and if that hastened the inevitable end, I thought it was a fair trade.

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