In search of a good death

Editor—Ellershaw and Ward reviewed the care of dying patients.¹ Children cared for in paediatric hospitals are given specialised, curative care appropriate for their developmental level and range of acuity, but the importance of palliative care has been overlooked.² Doctors adept in pharmacotherapy should manage end of life situations in a manner that is sensitive to the needs of patients and care givers.³

Figure 1.

Sir Thomas Aston at the Deathbed of his Wife by John Souch, 1635

Credit: MANCHESTER ART GALLERY/BAL

Our paediatric critical care unit is a tertiary service with over 1200 admissions yearly. We care for children with a wide range of diagnoses, including traumatic injury, sepsis, respiratory failure, cancer, congenital heart disease, and genetic anomalies. Our service is often left with managing a life ending event or with planning and implementing a palliative care plan before discharge.

The death of a child is an emotive event for the family and a challenging time for the clinician.⁴ We work closely with the palliative care service in caring for children with terminal conditions. This multidisciplinary team includes the hospital bioethics committee, clinical social workers, child life specialists, chaplains, primary nursing teams, subspecialty doctors experienced in terminal care, and the community doctor. We try to identify an appropriate place for dying in hospital or at home. Working with home health nurses, we are able to make the transition to home easy for the patient and family. End of life with experienced care givers is surely a standard we should all strive for.