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

BMJ Case Rep. 2017 May 12:2017:bcr2017219320. doi: 10.1136/bcr-2017-219320.

Abstract

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.

Keywords: Adult intensive care; Alcoholic liver disease; Cirrhosis; End-of-life decisions (palliative care); Portal hypertension.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Decision Making*
  • Diagnosis, Differential
  • Emergency Treatment
  • Fatal Outcome
  • Female
  • Humans
  • Liver Cirrhosis, Alcoholic / therapy*
  • Medical Futility
  • Terminal Care