Missed opportunities

I do realize that the article “Management of painful wounds in advanced disease” in the September issue of Canadian Family Physician1 was meant as a means to present innovative options for pain management in wound care; however, I had difficulty getting past the description of K.C., the elderly woman with advanced dementia and multiorgan failure. I feel saddened that K.C.’s case was likely not fictional and illustrates a number of key end-organ failures of our medical system, which include but are certainly not limited to the following: 1) the debate between length and quality of life, 2) truly informed versus passive consent with active treatments (including antibiotics), 3) the ability of loved ones, family members, and powers of attorney to make truly informed choices around goals of care, 4) the prioritization of financial and staff resources in an arguably unsustainable medical system, 5) the overall well-being of the patient, including issues of pain and suffering, and 6) the ambiguous definition of “do no harm.”

One has to think that K.C. suffered a great deal throughout her hospitalization. Even with optimal wound management, K.C. must have experienced ongoing suffering. Was the chance to treat her sepsis with comfort measures only a missed opportunity to ease her burden?

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