Fear of death
From Dr Andrew D. Lawson Sir: Richard Comber is right to point out the inappropriateness of some care offered to the elderly ('It could be you'. 28 June), and I am sure that he will get some flak for doing so from the age lobby. Nowadays it seems well nigh impossible to suggest to some that aggressive interventions might not always be a good thing. In my experience, this is less to do with avoiding litigation and more to do with assuaging relatives who insist on 'something' being done to stave off death, which in our post-modernist secular society is the ultimate failure.
There is a huge discrepancy between the sort of survival rates people expect and real-life survival rates. This may be related to the fact that the public gets its information from television.
A good example of this is survival following cardiac arrest. American researchers looked at medical dramas such as ER and Chicago Hope and found that on television up to 70 per cent of cardiacarrest survivors leave hospital, none with any brain damage. In the UK media the percentage is more realistic — about 50
per cent — but still way off the mark. The truth is that about 15 per cent of cardiacarrest patients survive at best, many with brain damage. In those over the age of 80, with significant illness, survival after cardiac arrest approaches 0 per cent.
Medical dramas are also littered with phrases such as ' it's a miracle', when sadly, at least in my experience, miracles are rather uncommon. This all leads to an expectation of success in cases where the medical and nursing attendants have quite the opposite expectation, a situation bound to produce conflict. Interestingly, medics and paramedics have been found to be quite selective when it comes to the circumstances under which they would wish to be resuscitated.
It will take a sea change in society to accept that there are times when the most moral and correct thing to do for a dying patient is to let them die.
Dr Andrew D. Lawson Royal Berkshire Hospital, Reading
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