End of life strategy needed for terminally ill patients in Northern Ireland, says A&E doctor
A leading doctor in Northern Ireland is today calling for an overhaul of the treatment of terminally ill patients.
Sean McGovern said it is time for people to face up to the reality of death, which he said will better allow doctors to meet their wishes when it comes to end of life care.
Dr McGovern, who is the former vice president of the Royal College of Emergency Medicine in Northern Ireland, wants a formal 'end of life' strategy put in place for people living with a range of chronic life-limiting conditions, including dementia and COPD.
"Health care has been a success and as a result, people are living longer and better quality lives," he said.
"However, as a result we are also seeing more people develop age-related chronic life-limiting conditions and we need to react to that to ensure that patients are getting the best and most appropriate care in the final weeks and days of their lives.
"This is not about withdrawing treatment, this is about providing better end of life care and that may not involve jumping up and down on a patient's chest if they go into cardiac arrest."
Dr McGovern, who runs the A&E unit at the Ulster Hospital, said an end of life strategy is also necessary because of constant advances in technology, meaning clinicians are able to provide interventions that were not previously available.
"Just because we can do something doesn't mean that we should," he continued.
"Must patients get every last thing going to keep them alive, even if it means they have a very poor quality of life?
"The question we need to ask is whether we throw everything we have at someone when it may be their wish to die naturally.
"It's about making sure we respect the wishes of someone who is at a very advanced stage of a life-limiting illness.
"If they want everything then fine, but we may find the answer is different if we take the time to ask the question. We need to give the autonomy to choose.
"For example, I had a patient in her 80s and I asked her what she wanted and it was to go home to her dog and not be admitted to hospital."
Dr McGovern said patients and their families must also be realistic about the outcome of particular diseases.
"It has to be recognised that despite throwing everything at patients, people do die," he said.
"Death is a reality, yet for some people it seems to come as a surprise, so it's almost a surprise to some people that a patient who is 95 years-old and is bed bound and at the end stages of a very debilitating condition, that they do not survive."
Dr McGovern said that while the patient pathway for terminally ill cancer patients typically deals well with the issue of end of life care, he would also like to see improvements for other conditions, including dementia and COPD.
"There has been inadequate attention given to end of life strategies and that is something that needs to be addressed," he said.
"We need a debate that is about improving end of life care and we need an end of life strategy that puts patients first and talks honestly about quality of life care and the value of interventions."
Dr McGovern's comments have been made to coincide with Dying Matters Awareness Week, which begins today.
Dying Matters is a coalition of individual and organisational members which aims to help people talk more openly about dying, death and bereavement, and to make plans for the end of life.
Health service officials are looking at ways of improving end of life care in Northern Ireland, including a research project to develop a care plan that will allow people with dementia to remain at home for as long as possible.