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Meeting death on our own terms | DW Documentary – Transcript
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- Around half of the population in Germany will take their last breath in a hospital.
- A local judge ruled on what she believed are the wishes of Ingred Lender, and palliative care began with immediate effect.
- Ingred Lender died five days after her treatment was switched to end of life care at the hospital.
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Most people spend their final days here in a hospital. Although most of us would prefer to die at home, only very few do so. Is there too much end of life treatment? Not everything that's possible is necessary. Am I acting in the patient's interest? It should not be anyone else's interest and definitely not for economic interests.
How much help should we expect from doctors? And how much do the patients own wishes count? When a patient says they're more scared of ending up on life support with 20 years of staring at the ceiling ahead of them without being able to speak and would rather die, you have to accept that.
Are hospitals actually profiting from end of life treatment? Dying is often a taboo subject and one with much potential for conflict.
Earth to earth, ashes to ashes, and dust to dust.
Around half of the population in Germany will take their last breath in a hospital. For a better look at death and dying with tubes and ventilators, we've come to an intensive care wing. The doctors are on their morning rounds.
Good morning. How are you? You have a serious circulation problem in your heart muscle at the moment. We're not happy with how things are looking. So, we're going to take care of you a bit longer. Okay.
Why does so many people die in hospital beds and not peacefully at home? On our rounds, we see very many elderly patients and they often have many different illnesses and they still come to hospital.
You try to help them somehow, but as we see in this case, these co-orbidities are so extensive that in conjunction with the results we got yesterday, there's not a lot you can do. Uva Jansen's wants to switch to paliotative care, preparing one for end of life. But like so many people, the man hasn't left a patient's degree.
Jansen's tries without success to reach the man's relatives to find out how much more treatment the man should be given. I spend about two hours a day on the phone, it feels like, because I think it's important to talk to the GPS, but it's incredibly difficult.
He has a serious non-treatable coronary heart condition. Yes, that was really very important. The doctor knows him well. He also told the GP that if there were to be grave complications, he didn't want to be put in intensive care. That's important because now we have a clear path to
take, even if it wasn't specifically written out. It means that we won't be able to help him stay alive. But we'll try to ensure that he can depart this world peacefully and painlessly.
I'll take the backpack. I don't know whether it's down there. I'm going downstairs. Okay. But life-threatening situations on the intensive care wing aren't always this slow. and steady. Intensive care medic Alis Noker is on her way to an emergency one floor down.
A woman has been resuscitated and needs to be taken to intensive care now for further treatment. It's unclear whether she'll survive. Okay.
Okay. Let's move this and then again quickly. Okay. Once in intensive care, she's immediately attached to every life sustaining machine possible.
Of course, medics want to heal people, but many who come to the intensive care unit don't survive. Okay.
20 minutes have passed. Alise, could you describe what's happening? The patient has been on a heart catheter. They did everything they could to help her, but unfortunately, nothing was working and she died. We're waiting for the family now. What was important
to us for the last step. was that we were able to be with that patient, make sure she had no pain or fear. We were with her and were holding her hand at the last minute because we were the only ones here.
The relatives were still on their way. Patients coming to intensive care are getting older and older. Often, they're already sick with many illnesses that prevent them from recovering. It's then up to the doctors to decide if and how long to prolong life.
Intensive care allows enormous opportunities but also risks. Bringing that together requires cultural understanding. As a team, you have to keep finding ways to help the patient have a dignified death and also to accept that death and dying is also part of a therapeutic process.
Modern medicine often means the process of dying can be very drawn out. It often leaves doctors to make the decision on when to continue treatment and when to let someone die. Uva Jansen is on his way to a meeting with the ethics commission. This is where experts from various disciplines convene to decide on whether or not to withdraw lifep prolonging measures.
Today the commission is discussing the fate of a gravely ill lung patient. He's been in intensive care for several weeks. He's being kept alive on a ventilator. Because of his deteriorating ability to breathe, treatment requires ventilation.
He is experiencing different phases of infection, infections that are healing, phases of wakefulness, and of confusion. He's at his physical limit every day. Would you like to add anything? We're really just treading water and his future is not looking much better. We don't see an end game. That's the question.
How much longer can we continue doing this? Where is the end? What is our goal? We have already been trying for a long time to get him off the ventilator. We keep reaching the 4hour mark and continuous spontaneous breathing has failed several times.
The risk is so great that if we took him off, he would certainly suffer organ failure. If he stays on the ventilator, then he will continue to live.
What is known about his wishes before treatment? He never really made any explicit statements. So, we don't have any exact information about the patient's wishes. If we're saying he can't be taken off the ventilator, then we're looking at a long-term permanent dependence on a ventilator either at home or somewhere
else. Is that something his family can foresee or not? His wish is to go home, but I don't see it as a viable option. Every few days, we take a step backward.
The patient becomes full of mucus again, gets really distressed, which uses up all his energy. I don't see that being any different at home. That means that fulfilling his wish to go home would mean that he's on a ventilator in 24-hour intensive care and
that would make things difficult for his family. Yes, I agree. If we can transfer Mr. A back home it would be purely paliotative. The way Mr. A sees it however he's not seeing himself as bedbound but there is no alternative. He cannot move freely.
I think that we're talking about a paliotative scenario. We will in accordance with his wishes send him home but I don't think it could be for long. and you've been providing pastoral care to the family and patient for a long time.
They did speak extensively about the end of his life from a religious point of view. His wife couldn't imagine turning the home into an intensive care room, which is what being put on a ventilator at home means. instead. She told me that in her view, we should stand humbly at the end of our lives and be thankful for the long time they had together.