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When patients say: Please attempt resurrection

16 August 2013

Christians need to challenge inexperience and unrealistic expectations about end-of-life care, argues Carol Backhouse

DON'T believe everything you see on Holby City. My experience of working in A&E has been more mundane. The recent debate over the care of the dying in hospital has avoided the question of what society considers to be a "good death", and shown that dying remains the last great taboo.

I hope that the Church can offer much to the debate about how the end of life is approached in hospitals, how society's fears about death can be reduced, and how people can be supported as they plan for the end of life. I have often encountered a gulf between the expectations of patients and their relatives, who have little experience of what the end of life can mean, and the reality of what medicine can offer.

As Westerners tend to die in hospital from chronic illnesses, the grim reaper has become hidden behind closed, clinical doors. I have found that this great unknown exacerbates the fear of death. The Christian message that death is part of life, but is not to be feared because of Christ's resurrection victory needs to be heard now more than ever.

Western society is changing its concept of what healing means. As medicine advances and people get older, illness is not cured; rather, symptoms are "managed" through a combination of drugs and therapies. This results in a complex web of co-morbidities which alter or impair quality of life.

Medicine often sees only the physical aspects of illness. As Christians, we try to see beyond that to what makes the whole person tick, to someone who is special in God's eyes; so "doing everything possible" to keep people alive becomes more than their tablets and tests.

The Church is often a source of help for those seeking relief from the massive changes that long-term illness brings. Be it in hospital or hospice chaplaincy, pastoral teams visiting nursing homes, or social outreach to the frail, the Church's prayer and fellowship alongside people in infirmity is a witness to the continuing importance of spiritual care.

More people in the Church's pastoral networks are trying to reconcile chronic conditions with their lives as patients and carers. A phone call, a visit, or an offer of respite for an exhausted carer are all signs of fellowship. When Christians are surrounded by a hedonistic culture that offers life at all costs, we have a duty of witness to people who seek God's healing, reconciliation, and unconditional love.

IF YOU have ever been involved in giving cardiopulmonary resuscitation (CPR, or chest compressions and defibrillation), you will know that it is an undignified, brutal, and messy business. I will also add distressing and painful to that list. If you have survived a cardiac arrest, you are extremely lucky: to be alive without any lasting damage is rare.

Medicine can, in theory, "manage" most chronic conditions - including dementia, MS, and heart, liver, and lung disease. When long-term illness deteriorates into an emergency, and when hospital staff have given every available treatment, CPR is the last possible hope that the patient will improve. Yet the public imagination, aided by the dramatic TV portrayals of medical emergencies, forgets that CPR is not resurrection. You do not get up and walk away, because the chronic conditions that may have originally caused the heart to stop beating are not miraculously cured.

Some people hope that deteriorating illness will be instantly fixed: that CPR will keep death at bay just that bit longer. Unfortunately, the medical jargon that surrounds CPR compounds this. All too often, I have been asked: "Did you get him back?" after a cardiac arrest. The hope is almost of resurrection, of coming back from the dead.

Thankfully, the pricelessness of allowing someone to embrace the end of life in peace and comfort, rather than seeing death as a failure of medicine, has been a great gift from the hospice movement to acute hospitals. For Christians, life and death are in God's hands, and so we need to call for the continuing importance of mercy and grace in clinical medicine.

It is only recently that medicine has been able to ask of patients with deteriorating medical histories "What are we bringing them back to?" This must not be an arbitrary decision about prolonging life.

As medicine becomes more invasive and demanding on the lives of patients and their families, medical staff need to have the confidence to allow patients to make their own informed choices about an acceptable quality of life, and how treatment progresses and ends. The Church can encourage honesty, compassion, and dignity in care. 

THE provision of "Do not attempt resuscitation" orders (advance documents which tell medical staff not to start CPR, after discussion between the family, patient, and doctors) have become increasingly prevalent in hospitals and long-term care facilities. To this I say: alleluia. This is because there are many other ways of "doing everything possible" for someone who is seriously ill, through the provision of pain-relief, fluids, antibiotics, and a caring, peaceful environment.

Patients (young and old) who have been battling chronic illness may not wish to face death in a haze of blue lights, pain, noise, or the loneliness of an ambulance trolley. One man described how he had refused CPR because he wanted to die on his own terms, without his family having the pain and distress of a final emergency; for him, this lessened the fear of dying.

When used well, I have found "Do not attempt resuscitation" orders help staff to begin discussions about people's wishes for their quality of life, and their preferences for what care is (and is not) provided. While a national replacement for the Liverpool Care of the Dying Pathway is sought, there remains a long way to go in changing attitudes to the end of life, to ensure that patients receive dignity and compassion alongside life-prolonging care.

We also need to ask how our Church supports those whose lives are burdened by illness. In a society that often enounters death only in the media, the Church can offer teaching and experience from its daily work in how physical and spiritual care come together in a timely, peaceful, and dignified death. This voice needs to be heard.

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