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CASE REPORT
Navigating the benefits and burdens of life-saving treatment in severely decompensated cirrhosis: an illustrative, multisourced narrative
  1. Philip Berry1,
  2. Kuldeep Cheent2,
  3. Heather Lewis2,
  4. 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}hotmail.com

Summary

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.

  • Alcoholic liver disease
  • Cirrhosis
  • Portal hypertension
  • Adult intensive care
  • End-of-life decisions (palliative care)
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Footnotes

  • 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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