Top doctor: The dying should stop treatment and take family holiday

‘Patients want less interference’

PATIENTS who are dying should be encouraged to take a final holiday with their families rather than battle on with gruelling treatment that gives scant benefit, a hospital boss claims.

Professor Marcel Levi said the NHS too often spoils the last weeks of patients’ lives by giving them unpleasant drugs and procedures that will not save them.

Instead, doctors should admit to patients that such end-of-life treatment may be of little use.

Professor Levi, who is chief executive of University College London Hospitals NHS Trust and a specialist on internal medicine, said: ‘I often think you would be better going on holiday with your family and you may have a little shorter but a lot better end of your life.’

He took over at the trust in January after a successful career in the Netherlands, where he said treatment for patients was often stopped following a discussion between them and their doctors.

But he claims such conversations rarely take place in Britain, where patients automatically receive drugs and interventions until the very end.

Professor Levi, whose trust runs five major hospitals in central London, said: ‘ They have a very short life expectancy and we are spoiling the last weeks of their lives instead of making them comfortable and them spending quality time with family and friends.’

He said 85-year-olds on kidney dialysis, for example, ‘do not have to expect a lot of gain – but they still go there three times a week’.

He added: ‘They feel terrible on the day of dialysis, they feel terrible the day after dialysis. That is six out of seven days of the week.

‘Somebody should discuss with them, “Is this useful for you? Are you really having any gain of quality of life by doing this?”

‘I do not find the discussion “Which patients should we not treat any more at the end of their lives?” very well developed in the UK. Patients get anti- cancer treatment when the oncologist, probably the patient and his or her family know it is not going to contribute a lot and may cause a lot of safety problems and harm.’

Professor Levi told The Sunday Times it was up to physicians to broach the subject – and patients and their families often welcomed their honesty when they do.

He admitted ‘it was a bit tricky’ when it was tried in the Netherlands, but added: ‘It turned out that many patients and their families were extremely supportive.

‘Many families of patients who died of cancer said, “If I knew this was going to happen, we would not have done this operation or this chemotherapy”.’

The NHS has faced criticism in recent years over how it dealt with patients at the end of their lives – most severely over the Liverpool Care Pathway in which fluids and food were withdrawn, sometimes without their knowledge.

The system was axed in July 2015 after a Daily Mail campaign.

Experts also warned that hospitals were ‘conveyor belts’ for dying patients – focusing on their illness until they die rather than treating them as individuals. Dr Gordon Caldwell, a consultant at Worthing Hospital in West Sussex, admitted many doctors avoided frank discussions, adding: ‘We hold on to hopes of marginal benefits – “You could live 30 days longer, perhaps three months” – but omit, “This will involve 60 days attending hospital”. I suspect many patients want less medical interference.

‘A day spent having chemotherapy is a day not with the family.’

But palliative care consultant Baroness Finlay said patients must be offered treatment that could give them more time, adding: ‘Sweeping judgments about quality of life are dangerous.’