We were very interested to read the case report in the April1 issue of the journal. It highlights the importance of patient autonomy and of allowing patients to make their own decisions regarding future care. What is concerning in the case described is that the patient's specific wishes were not followed. The patient had explicitly stated she did not wish to be hospitalised and wanted nature to take its course. However, when the patient was very unwell and became unconscious, the decision was made by the GP to hospitalise the patient (albeit not the hospital she had stated that she did not wish to be admitted to) 25 miles away from her home.
Surely, the patient could have been managed differently — was it not possible to obtain rectal diazepam from a pharmacy? Also would it not have been possible to liaise with the local palliative care and district nursing teams to arrange for a syringe driver to be set up at home to allow the patient to be managed in her place of choice? Palliative care is about forward planning and decision making. Spending a night in A&E, followed by a week on a general ward does not usually afford good palliative care and in this case the response of the GP made a mockery of this patient's desire to have some control over the last days of her life.
- © British Journal of General Practice, 2008.
