BMJ Case Reports 2017; doi:10.1136/bcr-2017-219320
  • Reminder of important clinical lesson

Navigating the benefits and burdens of life-saving treatment in severely decompensated cirrhosis: an illustrative, multisourced narrative

  1. Marcus Peck2
  1. 1Guy's and Saint Thomas' NHS Foundation Trust, London, UK
  2. 2Frimley Health NHS Foundation Trust, Frimley, UK
  1. Correspondence to Dr Philip Berry, philaberry{at}
  • Accepted 3 May 2017
  • Published 12 May 2017


Severely decompensated cirrhosis presents major challenges in terms of balancing the benefits and burdens of life-extending treatment. Using accounts and interviews with a patient, her mother, consultant hepatologists and a consultant intensivist, this article explores the decision making around a 43-year-old woman with alcoholic liver disease who died after 100 days in a hospital. Particular focus is given to decisions on escalation, recognition of futility, distress associated with therapy and how messages given during end-of-life discussions are processed. Without suggesting that the case is an example of ideal practice, the importance of frequent multidisciplinary discussion, clinical re-evaluation and continuity of care is emphasised.


  • Contributors PB conceived the article and is responsible for the final version. KC, HL and MP contributed sections and reviewed draft versions.

  • Competing interests None declared.

  • Patient consent Consent obtained from next of kin.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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