- Dr Christopher Wright
End of life support
End of life decisions are common in intensive care units. Dr Christopher Wright explains how some of these decisions are made and the practical issues around reaching them.
Most of our patients aren’t able to tell us their wishes, so we rely on family and friends (and, sometimes, ministers of religion!) to understand what the patient would want. We combine this with the clinical opinion of those looking after the patient – the doctors, nurses and allied health staff. It is essential that individual family members do not “carry the load” of having to make these decisions. Usually, families don’t have the technical background to fully understand the clinical situation, and the building up of trust between the family and the treating team is an essential part of our work.
Decisions are not made quickly and all the useful evidence is collected and weighed. A team approach to these decisions provides valuable reassurance for us. Ultimately, these decisions are made by the clinical staff, with the support of the patient’s family.
There are occasions when conflicts within families arise. We deal with these by allowing more time for exploration and explanation of the issues; it is most uncommon for us to need to seek recourse through other means (such as the Guardianship Board).
Information is the key, using simple, unambiguous language. Words like “he might die” are often more useful to families than euphemisms and false optimism. It’s not always easy to speak the truth simply and clearly, but it’s essential.
Positions, such as “I am sure your son’s death was part of God’s great plan”, really irritate and offend me; oleaginous hand-wringing of this kind seems to offers little comfort, and much difficulty.
These sad occasions are marathons as often as they are sprints and family members need to look after themselves physically. They need to get enough sleep and tell their GP what they are going through, so that they can cope emotionally.
Since working in Intensive Care medicine, I am more convinced than ever of the importance of clarity of thought and expression, genuine empathy, and expertise. One or more of these are often missing from public debates on euthanasia.
Dr Christopher Wright is Associate Professor and Medical Director of Monash Medical Centre’s Intensive Care Unit.