Poor communication meant dying man's wishes were not heard

What happened

Mr J had terminal cancer and his legs had been gradually weakening. One morning Mrs J was unable to get her husband to the toilet so she requested the assistance of a Hospice at Home nurse. The nurse believed that Mr J was dying and she inserted a catheter and gave him a sedative. The nurse arranged for him to be admitted into a private hospital as it was felt that Mrs J needed help caring for her husband in his last few days. Once admitted to the hospital Mr J was declared to be approaching the end of his life and he was started on an end–of–life pathway. Days later he died in the private hospital.

Mrs J did not believe that her husband was dying and felt the nurse did not do a thorough examination to make that decision. She did not believe that her husband required a sedative and said the nurse did not discuss her opinion that Mr J was dying or the options with Mrs J. Mr and Mrs J wanted Mr J to die at home. Mrs J believed that the nurse influenced the consultant's decision at the private hospital that Mr J was dying and this in turn led him to be put on the end–of–life pathway when he was not in fact dying.

What we found

There were no failings in the treatment provided to Mr J because the use of the catheter and the sedative were appropriate. The nurse's judgment that Mr J was dying was reasonable and this did not influence the consultant's opinion because he stated that he made his own decision based on his own examination of Mr J. We did find failings with the communication between the nurse and Mrs J because she should have made it clearer that she believed that Mr J was dying and then had a discussion with Mrs J as to how they wanted it to happen. The wishes of the dying person should always be sought and complied with if possible, which did not happen here. However, the Hospice, which had provided the Hospice at Home nurse, had already apologised to Mrs J and put systems in place to make sure that communication was improved for future patients. We therefore, did not uphold the complaint.