Scots expert says doctors must learn to ‘diagnose death’

Doctors need to be trained in the art of “diagnosing death” to prevent unnecessary distress at the end of life, a top academic has warned.

Dr Erna Haraldsdottir, a senior lecturer at Queen Margaret’s University, in Musselburgh, has called for a more holistic approach to treating older people after watching her elderly father-in-law die in hospital.

The 84-year-old had been diagnosed with dementia five years previously and his family watched his gradual decline until he was admitted to hospital.

Although he was elderly and very frail, doctors attempted to discharge him at one point and tried to resuscitate him as a ‘do not resuscitate’ note had not been arranged.

Doctors were also reluctant to issue a death certificate as they were unsure of his cause of death, Dr Haraldsdottir said.

Writing in the European Journal of Palliative Care, Dr Haraldsdottir said doctors need to change their mindsets over when patients need medical intervention.

She said: “The death of a loved one is most often incredibly hard for the person’s family and friends and so it’s really important that where possible, people have a good death.

“What we mean by this is that the person does not experience medical intervention for the sake of it; the person is helped to be as pain-free as possible; and that the person’s family and friends can be with the person if they wish.”

Prioritising a good death for patients and their families is increasingly important at a time when there are more pressures than ever before on the NHS, an ageing population, and more people needing end of their life care.

Ministers unveiled a five-year plan to put palliative care at the heart of the NHS in December and to ensure a greater openness around death and dying.

It comes after a Glasgow researchers found falling numbers of Scots were dying at home, despite many saying it was what they wanted.

The views of the family and of other professionals involved in the patient’s care should not be overlooked, said Dr Haraldsdottir, who leads a pioneering research programme at St Columba’s Hospice in Edinburgh.

She said: “In my own experience, our family believed my father-in-law had a good death, however what was noticeable was the staff’s lack of insight into the situation and understanding of what was happening.

“This caused the family unnecessary upset and distress – which could have been avoided if the medical team had applied the principles of palliative care to the assessment and care in this situation.

“As such, it’s vitally important that palliative care providers such as St Columba’s Hospice continue to provide teaching and learning opportunities to health and social care practitioners both in Scotland and globally, to ensure that patients and their families are able to experience a good death.”

It is more important than ever for hospices to be leading the way when it comes to developing care around death and dying, said Dr Duncan Brown, medical director at St Columba’s Hospice.

He said: “The art of diagnosing dying is one that can take many years of practice to develop.

“At the Hospice, we provide training to both specialist palliative care and generalist health care professionals so that the provision of palliative care for patients is appropriate for the patient’s needs.

“For patients staying in the Hospice’s Inpatient Unit, our multidisciplinary team provides round-the-clock care, and for the patients we look after in the community, we work with the families, GPs and care providers to ensure patients receive the very best care wherever they are staying.

“For all of our patients we work closely with their families and those close to them, to make sure they are supported both before and after the patient’s death.”