Much end of life treatment . Is not everything thats possible is necessary. So am i acting in the patients interest so it should not be anyone elses interest, and definitely not for economic interests. How much health should we expect from doctors and how much to the patients own wishes count and thoughts in and a patient system most can depending upon life support. What 20 years of staring at the ceiling adult on these without being able to speak . Im a drama tie to have to accept box of tea and our hospitals actually profiting from end of life treatment. The dying is often a taboo subject and one with much potential for conflict. Data to edit, 1st to earth shoots ashes to ashes, dust to dust. News, [000 00 00;00] the around half of the population in germany will take their last breath in a hospital for a better look at death and dying with tubes and ventilator. Weve come to an intensive care wing to the doctors are on their morning rounds. With them all good, good morning. Good. As to how are you . Youre all you have a serious circulation problem in your heart muscle at the moment. Were not happy with how things are looking for and this will move. So were going to take care of you a bit longer. Okay, and ill see, ill see. Yeah. So why does so many people die in hospital beds and not peacefully at home . Does any ill have to of identity because if you dont either on our rounds, we see very many elderly patients fees and they often have many different illnesses coming done plus, and they still come to hospital. So its kind of caused some of the voting. You try to help them somehow, but as we see in this case, in front of these co morbidities are so extensive, hope a talk that in conjunction with the results we got yesterday on the home phone, there is not a lot you can do. Thats one in its influenced, hasnt come over young since wants to switch to Palliative Care preparing one for end of life. But like so many peoples a man hasnt loved a patients decree, young since tries without success, to reach the mans relatives, to find out how much more treatment the man should be given. This public. Yeah. I spend about 2 hours a day on the phone. It feels like because i think its him for him to talk to the gps, but its incredibly difficult for us. Hold on there should we have. So he has a serious non treatable coronary heart condition for now. And and yes. So thats why its uh that was really very important. Now since attentive the doctor knows him well, he also told the gp that if there were to be great complications, he didnt want to be put in intensive care. But thats important because now we have a clear path to take, even if it wasnt specifically written out and was this the out the door. That means that we wont be able to help him stay alive then. But well try to ensure that he can depart this world peacefully and painlessly said that its driving me many weeks. Ill take the backpack, i dont know whether its down there like im going downstairs. Okay. But life threatening situations on the intensive care. We arent always the slow and steady intensive care medic, elise neu, decor is on her way to an emergency one floor down. A woman has been recessive, dated, and needs to be taken to intensive care. Now for further treatment, its unclear whether shell survive the system and then again quickly once in intensive care, shes immediately attached to every live sustaining machine possible. Of course, medics want to hear people like many who come to the intensive care unit dont survive. Of the 20 minutes have passed the least. Could you describe whats happening . You asked me to push buttons in this and ask i said the patient has been on a hard catheter. They did everything they could to help her, but unfortunately nothing was working and she died again. Were waiting for the family now. Its what was important to us. Well, for the last step, thats what it was that we were able to be with that patient. Make sure she had no pain or fear to kinda august of to see me to come in to ok. We were with her by and were holding her hand at the last minute because we were the only ones here and for, for the relatives were still on their way here a lot of money until they can send up until the next patients coming to intensive care are getting older and older is awesome. Theyre already sick with many illnesses that prevent them from recovering. Its been up to the doctors to decide if and how long to prolong life into the for this if we took in on the song of intensive care, allows enormous opportunities, but also risks bringing that together requires cultural understanding them team as a team, you have to keep finding ways to help the patient have a dignified test and all, and also to accept that death and dying is also part of a therapeutic process. Have a fortune, puts us as a modern medicine often means the process of dying can be very drawn out. It also leaves doctors to make the decision on when to continue treatment, and when to let someone die. Moving on since is on his way to a meeting with the Ethics Commission. This is where experts from various disciplines convene to decide on whether or not to withdraw life prolonging measures. Todays the commission is discussing the fate of a gravely ill lung patient. Hes been in intensive care for several weeks. Hes been kept alive on a ventilator deep behind because of his deteriorating ability to freeze treatments requires ventilation. He is experiencing different phases of infection. Infections, the ta, healing phases of wakefulness and of confusion and cookies out his physical limits every day. Would you like to add anything between looking to types of data on so were really just trying malta and this future is not looking much better because we dont cnn. Okay, and thats the question was, what is it a this, this series to assess the fargo . How much longer can we continue doing this . You know, wheres the and what is all call inputs . Thats an issue was they have another piece for sound like weve already been trying him for a long time to get some of the ventilator. We keep reaching the 4 hour mark tournament by continuous spontaneous breathing has failed the several times the most, the most glue that has ever missed. The risk is so great. If we took them off, you would certainly suffer oregon failure, send them an authority to stays on the ventilator must, and then he will continue to live. Was what is known about his wishes before treatment. And then vision. Have never really made any explicit statements that see that so. So we dont have any exact information of the patients wishes under William Hudson been somebody is on the east mission and to invite you for saying he can be taken off the ventilator long. Then were looking at a long term, permanent dependence on a ventilator either at home or somewhere out there. The awesome ill and then how is that something his family can perceive for him or not, or so im good. How does the stories does all of a sudden now his wishes to go home, but i dont see it as a viable option. Every few days we take a step backward carter, all students with super kids. The patient becomes full of mucus, again sly and gets really distressed, which uses up all his energy and one week. I dont see that being any different at home as well. Thank you for holding this. Im assign the size water that information i have. That means that fulfilling his wish to go home and which means hes on the ventilator. Its one in 24 hour intensive castle. And that would make things difficult for his families. And so to 250 familiar designs, all under stank office, then they didnt have on the whole, for the yes, i agree. If we can transfer mr. A back home, it would be purely palliative edition all the way mister a sees it. However, hes not seeing himself as bed bound, i would have supposed to be on this, but there is no alternative. He cannot move freely side when hes think of it, thats i think that were talking about a palliative scenario. Question honestly, we will in accordance with his wishes, send him home, but i dont think it could be for a long time in the best way to do so, i just replied and use beam per citing pastoral catch of the family and patient for a long time. So theres lots of teamwork, guidance, and all that kind of the kinds of slaves they did speak extensively about the end of his life, from a religious point of view of him with a zip for the other. His wife couldnt imagine turning the home into an intensive care room, as if, which is what being put on a ventilator at home means. When somebody says he just wants to hold on and process. Instead, she told me that in her view, we should stand humbly at the end of our lives and be thankful for the long time they had together. Since we discussed that in the last few days. Thats not a strong team. I. Yes. And then thats in time sizes in this, that means this commission has decided that that should be a transition to Palliative Care to the relatives have to be informed on the ongoing call. Do that informed me. Okay. Awesome. Youll definitely have to deal with that. The next time you speak age, thank you. Your style. Gosh, not every hospital has such an Ethics Commission because he didnt hear about element, were discussing ethical decisions that are not of a medical nature, but that concern us as humans. The name of these are still 2400. 00 and we believe that if such a structure is not in place. So then it should be mandatory english to designers, for instance, that we have left the decision of her life and death in the hands of the doctors. I wonder why is it so unusual for people to die . A natural death at home on it. So im not gonna, its going to feel like going to visit to mail to the patient now, but they have been issue. Ive been involved in the case since last week. Okay. Because she was having serious breathing problems. Actually a little skilled, unfamiliar in my mind. I thought they kept calling me, im going to say i sunday, but now she doesnt want to go to hospital and see me because she knows if she calls and im good on life and then shell end up in the clinic and gets him as a flight in the clinic. But he is turns as an anesthesiologist and palliative medic, he visits terminally ill or dying people where theyve chosen to die at home, surrounded by their families. Hello, good afternoon. Its going to be like toys. Nope. Ill head straight through. Hello everyone. Hello, hello. Can tack . Hi lou. Traffic your systems. We dont, ill sit down here again. Perfect, perfect. As estimate as soon as long as the 1st visit, you were very anxious because someone at the clinic told you you were dying feet in the knowledge that felt since youve been home to let some tab. Awfully shop or no, im not scanned. And havent had anything untoward. Any thoughts that might trouble mainly the ship to save and when did you have as many breathing episodes in the past few day in the office they stopped coming altogether middle of the table . No, no, no more shortness of breath. I would ask you havent noticed anything, have you . No, no god. Im amazed that has been going so well and wondered what to say and i feel as though you are on your deathbed. Dab. No, no, no. No. Obviously to applaud you mind to 5 and listen. Lean forward and 4, perfect, perfect teeth. 100 and a deep breath in and out of these black dish to stay in the house. Shes basically come home to die. Thats the blunt way of putting as he does for both her and us. Its how pursuit auction i can use. We can enjoy the time we have left and its nice having mama here again can be 1st lot of marketing. We all have to face this some time or rather, to be honest, so she doesnt bother me. Honestly. Yeah. Maybe im the exception because im different of my money. She, im just being older. I dont know how other people take it. Kind of just have no idea how others deal with knowing they are going to die in the next few days. Ive ordered for life next for so i think its all totally natural. Its got some cheers. Yeah. So its a strange situation there. Perhaps for you more than maintenance, but i dont mind. My worry is that it happens later. Im not young. Im not in chicago 3. C a. M plus had them. I know most. Nobody knows it. Right. Yeah, i can help her immediately as a practice. She oh, as of what is your before and youre just in the potential, hows of we want to ensure the top patients are doing well on awesome to make himself a breathing problems. Pain on nausea or vomiting any time and been dismissed unexplained. Come be helped to home. Yeah. And the only place is the clint annual the clinic. Yeah. And then im not about to how is of us hot, but if you can be treated at home and then people stay at home done, and loved dimensions. So hows almost problems can be resolved through simple medication me to come in and we only have 7 different medicines in our emergency boxes on the phone. You can treat 20 problems at all. Patients often have sponsors basically giving instructions on the fine example of tabi. So how is the losing the tape of telephone is it to . It was okay and if you have any problems get in touch, otherwise ill see you again next week. Cool the best im still a step ahead of the grim reaper. I still have a little time left. Thats fine. Yeah, im a visa. Yeah. Thats in. When did you see how much a patients who come home again tend to flourish . You know, shes practically just been discharged from the hospital, death bad and that utah . Obviously, she looks like shes going to die and the next few days down here on the country here. Shes dramatically improved on the other one else of toothpaste, and thats not a di puts in a deal with a temporary di. So to the, just a lot of fun minutes company and people at the end of their lives as a renaissance, be fulfilling. Okay. I should think because you often manage to a severe pain or breathing difficulties, this kind of costs. I cant save my patients lives, a few of them are not, but for many of them, the total death is no longer the enemy. Then you starting to find managed to ensure that they have a Payment Processing system is that is a good thing. Lets go to the 92 year old in a mountain, died a month later, at home, as she had wanted. But how can one ensure that youre the one who decides how you dine the weve heard from a former intensive care worker. She says she would never want to be recessive, hated the high a. Its for the so youve taken steps to ensure that if the paramedic comes and youre unconscious that you wouldnt be resuscitated, is that right . And whatever, you know, only if my heart keeps out. When done and when the paramedics arrives to say that it, that it is when the door closes, see that the close the screen stick a test is . No, theres an emergency buckle that on the emergency. Barclays in the fridge for them. Okay, then they go to the kitchen and when they open the door, you the best, the bottle and whats in there. And the doors this and theres a document with lots of patient information in income, not feeling this got good. Okay. And here, once he written in big red letters, do not for substitute age. And why dont you want that . Well, ive seen too many things back when i was working a symbol. You mean you wouldnt want to be taken to the hospital then . It was, i didnt want to go to a hospital and i didnt want to be put on a ventilator ok to life by choose the who knows how long its always been for the bad. The 89 year old is familiar with the procedures on intensive care stations. It is. This does what us it is. Do you have the feeling that just too much is done to keep people alive . The people arent allowed to die . Yeah, and they will mindfulness . Yes. Comes from the moment you arrive in the hospital system. Know its like put the paramedics, the ash the dont exist in cameras, have to do everything in the power to keep me in line after the 1st he does have a substitute. I did my institute for me with that. So then thats exactly what i dont want to spend the 70 but here what was it that you experienced that made you say, no, i do not want that to happen. To me. It says accepted nasa ellis. Thats but thats in the i often so elderly people being resale so tiny take yeah. Even then they will put you on i these, the apartment ventilation is 12 and finally dying days, weeks lets months later talking and i dont think you need that would be that side thing. I want to know if my life the way i want until the end, thats the one i can no longer do that just makes me and then not should be the end of its end. Again. The, its rare to day that people are in control of their lives. At the end of life, the world, a former nurse, get her wish the will she encounter paramedics so wouldnt recessive teacher. In such a scenario, the, the 89 year old fears that she might end up like this patient, this terminally ill cancer patient is on life support in a coma, after being recessive hated after his heart stopped. Intensive karen, hers at least knowing decker is looking after him. Im just going to check something. Dont worry of his kidney and deliver have already filled and his brain is barely functioning. Thats it. And then we dont believe licensed. Also home patients are resuscitated usually outside their homes or they arrive here and are given every medical treatment possible calls. And then you find out like in this case that the brain is had too little oxygen during resuscitation. We often see patients not wake up and then its days or weeks before instrumental diagnostics to tell us that theyre actually not able to wake up again. Let me do a pop up to you. Theres no sticks in their brains are so terribly damage to us that we cant help them. So events associated with inputs, engine. Yeah. Mission. I heard some code and this 58 year old is also not going to wake up a lease is giving him Palliative Care and will accompany him as he dies. So this one ive got everything ready the do you always talk to your patients . Yeah, yes. Right, because i always assume that they can perhaps still hear something for us to we always do our best, especially for patients who are dying. So can you always respect your patients that affect what inputs and the mind has so what usually happens when doctors go from trying to save someones life to recognizing they will dine, then giving them its an ongoing for them to not leave me to come, we accompany Family Members into the room, the medication has already been swap to hide those pain killers and so, and other medication to protect the patient to ensure theyre not in distress. And then we switch off life support option. We always wait a little moment to him and dr. Young relatives have to adjust to the situation, so its always hard to sit next to the bed and comprehend your Family Member is about to die. One of the most frequent questions that relatives ask me is how long will it take up there . Always scared, it will happen right away, but it varies from patient to patient fun, but usually it takes around 2 days. But that is a very long time. So im showing 012 days. So and then the patient dies because theyre already very weak and also not going to come to the phone for ya. Constance. The terminally ill patient in room 3 has no relatives here to sit with him. And while death is part of the daily conversation here at the hospital in our society has increasingly become a taboo. The s