Changes to the rules on organ donation will “reframe” the way people talk about death, a top critical care doctor said today.
Dr Matt Morgan said the introduction of “deemed consent” in Wales almost four years ago – a similar system comes into effect in England next year – appeared to have increased the number of donations.
Dr Morgan, whose debut book Critical provides a fascinating insight into what happens in an intensive care unit, said: “What we have found in Wales is that it radically changes the conversations we have.
“It’s the importance of ‘nudge theory’ – it completely reframes the debate. I think that is a hugely positive move.
“It’s difficult to get robust data, but there has been an increase in donations, and an increase in successful donations.”
The Organ Donation Act became law in March and means that from 2020 adults in England will be considered potential donors unless they chose to opt out or are excluded.
Dr Morgan, 39, above, a consultant at University Hospital of Wales in Cardiff, wrote much of his book, a “blend of science, history and memoir”, at Scarfe’s bar in Holborn.
A key theme of the book is urging people to talk more about death. “I have changed what I do,” he said.
“When I meet somebody whose son or daughter has died, rather than skirt the issue I ask them about that person: What was their name? What did they enjoy doing? What was their favourite music?
“We have got better at treating people but, still today, one in five people with critical illness in ICU [intensive care unit] will die.”
He added: “What we know is that dying in critical care is becoming increasingly common. It’s not a great way, sometimes, to die.
“The questions we face on a day-to-day basis are as much about what we can do as what we should do. It’s these difficult conversations that take up a lot of our time.”
He said intensive care doctors needed to be honest with relatives of patients – especially when their prognosis was uncertain.
“For me, if ‘I love you’ are the three most important words in the English language, in medicine it’s probably ‘I don’t know’,” he said. “That is something that is incredibly hard for doctors to say. Patients want certainty. Probably one in 10 things in ICU are based on the best evidence. The rest of the time it’s ‘I don’t know’.”
He wants children to be taught how to perform CPR chest compressions to enable then to save lives. He said more research was needed to improve the treatment of sepsis.
He opposes any moves to enable doctors to help patients to die. “The Royal College of Physicians has moved from a negative stance on physician-assisted death to a neutral stance,” he said. “Talking about these issues right now is more important than ever.
“I’m personally against physician-assisted suicide or death, for lots of reasons. I think it changes intent. Your intention as a doctor should never be death, even though death is the ultimate outcome. It should be to reduce suffering.
“It’s still illegal and you will still get prosecuted. But what this does is change the debate, moving from a stance against discussing the possibility to a neutral one.”
rosslydall 