Tough conversations about end of life care can no longer be avoided as coronavirus spreads ǀ View

Europe has been declared as the new epicentre for the coronavirus pandemic, according to the World Health Organization (WHO). Continental Europe now has the most confirmed cases of COVID-19 and deaths relating to the virus outside of mainland China. The number of cases is only set to rise. Italy continues to make headlines with its hospitals overwhelmed with the number of people requiring medical attention. Other European neighbours are experiencing their own rise in cases, with some only weeks behind Italy’s crisis. Last week, British prime minister Boris Johnson said, “Many more people will lose loved ones to coronavirus.” He is sadly correct. It’s clear that this pandemic is making more of us consider our own mortality and that of our families.

The number of people dying from COVID-19 is sadly increasing on a daily basis, and the reporting of new deaths by news organisations is something that we will be seeing for some time to come. When it comes to mortality rates – in other words, the percentage of people dying as a result of the virus – these too are changing a on a daily basis. A paper published by scientific journal, the Lancet, suggested that the death rates could be between 3.6% and 5.7%30195-X/fulltext), although it makes clear that there are a number of limitations with these estimates. Now that many countries have abandoned the testing of all people showing symptoms, focusing their testing resources on those requiring hospital admissions, the ‘true’ number of cases in a country cannot be confirmed. What’s more, contextual factors in individual countries might drive the mortality rates above or below current estimates.

Something that scientists from across the world do seem to agree on, however, is that this virus is particularly challenging for older adults and those with certain pre-existing health conditions. These “at risk” groups seems to be the priority of governments across Europe. We saw Italy initially locking down whole towns and regions to protect its elderly population, while the UK’s Health Secretary has also eluded to a potential plan to put people aged 70 and above into lockdown. Unlike previous pandemics, children seem to be spared from more serious health complications associated with the virus. That being said, I think it’s also important to acknowledge that people of all age groups have died from this virus, and family members of any group will be impacted by the death of a relative.

Given that we struggle to go about our daily lives without hearing death being mentioned at least once, perhaps now is the time to start thinking more closely about death and dying. The worst case scenario would be that we will know somebody who dies during this pandemic. As Europeans, I’d say we’re not particularly good at talking about death; you might argue it’s culturally unacceptable to start having conversations about death. This pandemic, however, could change this. In the coming weeks, we may start to see more families having conversations about how they will plan for a relative being in hospital, any wishes they might have when it comes to dying, and indeed arrangement after their death.

Conversations about end of life care are had with both healthcare professionals and families as a means of ensuring the wishes of the person who is at the end of their life are carried out. Not everybody will want extraordinary measures to be taken at the end of their life. These medical interventions might include being on a ventilator, a machine that takes over a person’s breathing when their lungs are unable to breathe for them, or having chest compressions should their heart stop beating. Likewise, some people may want every measure to be taken by healthcare professionals should their organs fail. Putting aside coronavirus for a moment, these difficult conversations have been taking place in hospital intensive care units long before this novel virus showed up. I’d argue that the current situation might have brought the prospect of dying a little closer to home.

What’s more, Italian doctors expressing concerns that there are insufficient ventilators in the country, or that the intensive care capacity of European countries may not meet the demand, is of course alarming. There have also been reports that doctors are “choosing” who gets an intensive care bed, with certain media outlets implying that these decisions are being made as a consequence of this pandemic. Doctors working in these units have a wealth of experience when it comes to assessing the benefits of intensive care level treatment for individual patients. Age is not simply a benchmark of who can or cannot get a ventilator; an individual’s quality of life after receiving such treatment is taken into account.

I think the media is currently not portraying the reality of intensive care. These interventions do not “save” everyone, and can sometimes result in a poorer quality of life or greater suffering for that individual. If patients who would benefit from intensive care treatment are being denied this due to capacity issues, then of course this must be addressed. It is important to remember, however, that not everyone who dies from this virus would have survived had they have been on a ventilator in intensive care.

Conversations about death and dying are challenging and upsetting for families. The current pandemic seems to have brought to light the need to be having them, given that we know more people will die as a result of COVID-19. Most people who acquire the virus will not only survive, but be able to return to their normal lives. But let’s also take a moment to think about the small proportion of people who might die, and what they would want at the end of their life. Speaking personally, it’s oddly reassuring to know what an elderly relative would want at the end of their life, because I know that when the time comes, I’ll be able to fulfil their wishes.

  • Hadley Stewart is a London-based writer, broadcaster and medical journalist.

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Source: https://www.euronews.com/2020/03/16/tough-conversations-end-of-life-care-can-no-longer-be-avoided-as-coronavirus-spreads-view

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