GP Stories - Difficult Decision

Doctors have to make difficult decisions. GPs generally don’t have to do so as much but occasionally a hard one comes our way.

On my ward round at the nursing home, an old 110 year old man was nearing the end of his life. He lived a storied and interesting life, in the army, seen the wars and was an actual rocket scientist. He had seen better days however. He had many comorbidities and had a poor quality of life for several months now. We were treating him for a chest infection, and he had 4 days worth of his second course of antibiotics. His daughter, herself an elderly woman, was concerned about his well-being, he looked unwell, barely conscious and breathless. She asked what we should do once the antibiotic course was finished. I explained that we could either try a third course of antibiotics which may clear up his chest or we could decide that antibiotics aren’t working for this infection and let nature take its course.

I could see the dilemma in the woman’s face. She looked so distraught about what would be the best interests of her father. She didn’t want her father to suffer but she didn’t want to be the one to say that we should let her father die. She didn’t know what to do. I understood that it was a decision that doctor should take; she didn’t want to live with this horrible decision. I said that I felt medically it wasn’t in his best interests to have further antibiotics, that all we would be doing would be prolonging the inevitable. I said that after this course of antibiotics, we would not treat with more antibiotics again but just treat his symptoms. His daughter agreed wholeheartedly, and seemed very relieved that I had made the decision that she had wanted to do, but not one that she would want to say.

He passed away 3 weeks later, surrounded by friends and family. I understand it was a peaceful death. There are no guidelines or rules regarding when you should stop treating patients, its left to the patient, family and doctors to come to a collective decision. It’s hard to go against families and their wish of forever treating patient. The fear is that families will forever hold a grudge against you for not treating their relative and ‘letting’ them die. The aim in these situations is to try to get the families to realise that physician-assisted survival is not sometimes in the best interests of the patient, and ‘allowing’ them to die is really the most kind thing to do.