Presentation on theme: "Professor D. Robin Taylor"— Presentation transcript:
1Professor D. Robin Taylor The diagnosis of dyingProfessor D. Robin Taylor
2The diagnosis of dyingProgressive pathological process(es), malignant or non-malignant, affecting one or more major organs whose course is unlikely to be influenced by maximal medical therapy ANDProgressively declining quality of life such that impact of disease (on ADLs) is relatively unaffected by medical interventions, but is amenable to palliative treatmentsDeath is envisaged as inevitable within hours, days or 6-12 months
3The diagnosis of dying: other aspects Establishes appropriate truthfulness in the minds of patients, their families and health care professionals. Hope is not extinguished. The diagnosis of dying does not imply abandonment.Futile and burdensome treatments are avoided:- no meaningful benefit- adverse effects- wasteful of resources- illusions of potential recoveryAppropriate palliative treatments are givenThe next of kin are cared for more appropriately
42-5 years but death often seems “unexpected” Diagnosing dying – when?FunctionDeathHighLowFrequent admissions, self-care becomes difficult, quality of life deteriorates2-5 years but death often seems “unexpected”TimeAcute exacerbations or complicationsUnsatisfact stories, phoning OOH, waiting about on trolleys, no benefits, much less support and info at homeDelamothe In BMJ last weekend : nobody thinks we have this half right we do not this half right
5Ceiling of treatment: respiratory Assuming that other immediately reversible problems have been Addressed (e.g. pneumothorax), management of the patient’s acute respiratory distress SHOULD ALWAYS INCLUDE SYMPTOM RELIEF e.g. low flow oxygen, opiates, haloperidol, benzodiazepine. Thereafter, the patient’s ACUTE MANAGEMENT MAY INCLUDE THE FOLLOWING: (Circle YES or NO. Changes can be at any time later if necessary). ARTERIAL BLOOD GAS ANALYSIS YES / NO ANTIBIOTICS YES / NO PREDNISOLONE YES / NO NON-INVASIVE VENTILATION (BiPAP) YES / NO TRANFER TO HIGH DEPENDENCY UNIT YES / NO ICU / POSSIBLE MECHANICAL VENTILATION YES / NO CPR IN THE EVENT OF CARDIO-RESPIRATORY ARREST YES / NO Active consideration should be given to the need for spiritual care.