Harry’s condition

Harry’s condition deteriorates

Despite maximal interventions, Harry’s condition remains poor.

You are working on the ward that afternoon and note that Harry remains on highly interventional treatments, including CPR. His condition appears to be deteriorating despite the ongoing maximal medical interventions. You observe him to be confused and agitated, pulling at IV lines, and he appears distressed and in pain. You think Harry may be dying.

Around 6pm you page the on-call neurosurgical registrar to discuss Harry’s condition. The registrar who is covering the on-call page works for the other team, and does not know Harry. You convey the opinions of the consulting medical teams relating to a conservative approach, and the daughter’s objection to this.

The on-call neurosurgical registrar is frustrated by the call and says he is too busy to attend. He instructs that Harry be maintained on all active measures including continuation of the IV heparin infusion, and for escalation of care and CPR until the regular team can review on their rounds the next day.

What would you do now?

You can watch the videos below or choose to explore more of the above options.

Dr Jan Maree Davis from SESLHD Palliative Care talks about how we might recognise clinically that someone is dying.
Professor Ian Kerridge from Sydney Health Ethics discusses how we determine what is ‘best’ for a person in the clinical context, and briefly considers the complex idea of ‘best interests’.

Dr Jan Maree Davis

“How do we know when someone is dying?”

Prof Ian Kerridge

“How do we determine what is ‘best’ for a person, and what should we do where there is uncertainty or disagreement about ‘best interests’?”