1. Professor D. Robin Taylor
The diagnosis of dying
Professor D. Robin Taylor

2. The diagnosis of dying
Progressive pathological process(es), malignant or non-malignant, affecting one or more major organs whose course is unlikely to be influenced by maximal medical therapy AND
Progressively declining quality of life such that impact of disease (on ADLs) is relatively unaffected by medical interventions, but is amenable to palliative treatments
Death is envisaged as inevitable within hours, days or 6-12 months

3. The 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 recovery
Appropriate palliative treatments are given
The next of kin are cared for more appropriately

4. 2-5 years but death often seems “unexpected”
Diagnosing dying – when?
Function
Death
High
Low
Frequent admissions, self-care becomes difficult, quality of life deteriorates
2-5 years but death often seems “unexpected”
Time
Acute exacerbations or complications
Unsatisfact stories, phoning OOH, waiting about on trolleys, no benefits, much less support and info at home
Delamothe In BMJ last weekend : nobody thinks we have this half right we do not this half right

5. Ceiling 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.