Death eclipsed

  Finding the right balance between active treatment, which may include surgical or semi-surgical interventions, and palliative care, can be difficult. The two can go on in parallel, of course, but often a full palliative care assessment and plan takes place when the primary medical or surgical team have drawn a line under their management.... Continue Reading →

Reputations: the light and the dark

  A recent thread on Twitter brought up a subject that is really spoken about. Elin Roddy kicked it off with a comment that patients admitted to nursing homes should routinely be engaged in conversation about their preferences towards end of life. With habitual frankness, she later commented that there is a danger that those... Continue Reading →

‘I wouldn’t want it but…’ – commentary on an important paper

  This study, published by the open access journal PLOS1 last week, approaches but does not solve two important questions: Why do doctors provide intensive treatment at the end of life when they would never accept it themselves? And how can they propose such treatments when evidence suggests that patients do not want it? The... Continue Reading →

5 days: a tale of escalation creep

Day 1 A 90 year old lady, Mrs V, is admitted to hospital with symptoms of pneumonia. She was managing at home 6 months ago but has become increasingly dependent on her family; the plan was to employ or arrange carers soon. She always said she never wanted strangers around – the words ‘fiercely independent’ are... Continue Reading →

Futility redux, and reset

The futility debate has had its day, hasn't it? At its height between during the 1980's and late 1990’s there were hundreds of publications on the subject, but a NEJM ‘sounding board’ article by Helft et al, 'The rise and fall of the futility movement' appeared to bring it to a natural end. The authors... Continue Reading →

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