Guest Blogger Day - Allow Natural Death?

Let me introduce to you a dear friend, Karen Brombley, Kal to those who know her well.  We met many years ago when she moved into my neighborhood and it has been one of those precious and sustaining friendships.  We had our first babies together, now those babies are 22 and have 19 year old siblings.  Kal works as  Nurse Consultant for Children and Young People's Palliative Care, currently working on Masters in Clinical Leadership in Palliative Care. She has  been a children's Nurse for 25 years, the last 14 of which have been in the community. Her piece is part of a very topical and important debate, end of life issues. I often think there are worse things than dying when I see my patient caseload.  Thanks so much Kal, for joining the conversation.

Allow Natural Death?

I work in Paediatric Palliative Care and, as you can imagine, one of the most debated issue is that of DNR/DNAR/DNAPCR (there seems to be no limit to the permutations of the initials that can be used). Basically, to resuscitate or not?

 Part of my job, as well supporting children and their families through this process, is to support the teams that are looking after them. Many struggle with this decision, and I try and help them.

How? I believe it’s about understanding the disease progression that the child is suffering from. Understanding that the medical consensus is that the child has reached the point in their life when their death is fast approaching, and nothing will prevent this. Because resuscitating a child at this point is futile, and at worst results in them being intubated on intensive care, having to have treatment withdrawn. This is not a good way to die.

Obviously the most significant conversations are with the child and their parents. I believe that it is our job to work with them, enable them to somehow come to terms with what is happening. They are the only people who will live with these decisions for the rest of their lives. We, the professionals, will remember them occasionally; some children will impact us more than others. But for those parents it’s every day. And we need to enable them to walk the tightrope of choices about care, ensuring that what is right for the child is not lost in the sea of their parents’ grief.

So once such a decision is made it is vital that everyone supports it. Which brings me to lots and lots of teaching sessions, workshops, meetings, working through the issues.

Which is where ‘allow natural death’ comes in. It’s an alternative phrase, rarely used outside of hospices. It’s a very powerful phrase, it changes the perspective from something negative, that implies a denial of something the child is entitled to, to something positive, something natural. It can transform a person’s view, I’ve literally seen that light bulb moment in people when they see that this time can be seen another way. That death is part of a natural process, and sometimes it is right and proper that we leave nature alone.