I have just finished a challenging, enlightening & captivating read. I will be referring my GP & all the Specialists on the Family Payroll to it along with my immediate family & friends. I reckon that all GNs should read it too.
"A Good Life To The End" by Ken Hillman (Professor of Intensive Care)
Oops .. edited out an error in the Authors name .. sorry ..
The comment on the book states (paraphrased by me) ...
"A huge majority of people at the end of their lives want to die at home but only a small number manage to do this. This vital book asks why.
Prof Hillman ... is appalled by the way that the ICU has become a place where the frail soon to die ... are given unnecessary operations & life prolonging treatments without their wishes being taken into account.
This book will embolden and equip us to ask about the options that Doctors in hospital should offer us but mostly dont ..... An invaluable support for the elderly & their Families and a rallying cry for anyone who has had to witness in necessary suffering of a loved one ...."
I borrowed a copy from the Brisbane Public Library. A most enlightening read.
-- Edited by Cupie on Friday 20th of April 2018 11:03:40 PM
Chapter 13, 'The Living Will' could be interesting for some.
What impressed me most was the recognition that acute hospitals must focus on keeping people alive. That is their mission and their default position.
For our part we have to understand that while we do our best to keep fit, eat right and so on and we might have a better lifestyle and independence longer than those who don't do that, the odometer never lies. Age renders all of the system increasingly fragile. That's life. Conditions such as a bladder infection, that a young person should spring back from, could be life threatening for someone 60plus. Any hiccup in recovery in hospital from a treatment does make us prone to such infections, lobbing us in an intensive care unit, where stays over a day or two will likely result in a lingering serious incapacity even if eventually discharged, or death.
To boil it all down, sort out what is a lifestyle minimum you are prepared to accept and be open with relatives, carers and doctors upfront and continuously. It is our responsibility to take the load of complex, conflicting decision off our children, doctors and carers and state in writing prior, for instance (a few options only of a number listed in the book),
"Would like to be admitted to the ICU, which is a significant step up in treatment complexity, if the illness has a good chance of recovery within a few days and the chance of returning to the community in the same state that you were in before admission was good", or
"Would like to be admitted to ICU if there was a good chance of recovery to my pre-hospital status but would like treatment limited", or
"Would like treatment in the ICU ceased and to be made comfortable and have adequate pain relief if improvement was not occurring or the condition was becoming worse after about five days or more"
As I recall, the author saw Advanced Care Planning (ACP) as a defence against ICUs becoming modern torture chambers for the frail old who could not be guaranteed strong hope of emerging from the assistance quickly and be independent. But wind that back to the proposed treatment that the older person volunteered for in the first place. That is where we should be very cautious, at the starting point. That possible few extra years from having the lung cancer removed might appear possible to the surgeon and urging relatives, but balance that against the suffering and possible complications for the frail old, eg kidney failure through slow recovery.
I am a lay person and struggling with the issues like others.
