A woman in the late stages of multiple sclerosis had her Advanced Care Directive ignored by a hospital that provided resuscitation against her wishes, a corononial inquest has found.
Kylie Anne Breen was 40 years old when she died at the Launceston General Hospital in 2017 after doctors were eventually persuaded by her family to take heed of her written request against further medical intervention.
She had a long history of MS from the age of 21 that had been progressively debilitating, leading to multiple fractures and chronic neuropathic pain and she was housebound and unable to drive, the inquest was told.
A year before her death, Ms Breen prepared a detailed Advanced Care Directive that she lodged with her GP and family, in which she said that she did not wish be revived or have her life prolonged if she could not speak, hear, move, or if she should have to be fed through a tube.
However when she was hospitalised after an intentional overdose of benzodiazepines and opioids, the hospital staff commenced resuscitation and medical treatment to stabilise her, including intubation and ventilation, despite a poor prognosis.
Despite the Advanced Care Directive being lodged with the hospital, it was initially not accessed by staff and, when it was seen, the treating doctor was reluctant to cease medical intervention.
The inquest heard that the medical team were treating Ms Breen according to a Medical Goals of Care (GOC) Plan which had been prepared by medical staff during a previous hospital admission for a specific medical issue three months previously. The plan made no reference to the patient’s Advanced Care Directive or any recommendations against resuscitation.
Coroner Olivia McTaggart said the treating team believed they were acting in the patient’s best interest, and noted that they withdrew treatment after several hours, when the Advanced Care Directive was brought to their attention by Ms Breen’s family.
The coroner said the inquest had highlighted the importance of an individual completing an Advanced Care Directive as well as making their wishes for end-of-life medical care known to their loved ones and treating doctors
It also highlighted “the importance of treating health professionals being alerted to the existence of an Advanced Care Directive, understanding its significance and then giving effect to the patient’s wishes expressed within it,” she said.
“I recommend that all hospitals in this state take any necessary steps to ensure that a patient’s Advanced Care Directive is readily accessible within the patient’s medical records so that timely compliance with a patient’s wishes as expressed in this document can be achieved when the circumstances arise,” she concluded.