This is the phrase that clinicians use for those patients stuck on a ventilator in an ICU who are without hope of recovery but pressures from families and other doctors allegedly prevent them from turning off the machine.
The familiar story of an individual beating the odds to recover had its latest outing in the BBC drama, ‘Keeping Faith’ where a young man with an inoperable brain tumour demanded treatment, got it, and was seen skipping onto the beach in the final frame. A far more realistic and heart braking account was a documentary about Great Ormond Street of a young girl with an inoperable brain tumour filmed making her way to her radiological treatment and shown to be successively more and more disabled as the radiation destroyed her tumour and her brain. How brave she was!
Although doctors can sometimes portray themselves as hopeless in the face of the inconsolable grief of families, they are, by far, the more powerful party in terms of knowledge and resources. However, families often want their relative to die peacefully and to end their suffering. From COVID survivors, we now know that time on a ventilator can result in PTSD.
The call goes out from the families to the palliative care service, the cinderella service in hospitals, perhaps disliked by some doctors as an admission of their failure to cure. Clinicians can see death as a failure, whilst, for all of us and the clinicians themselves, it is just a natural end.
But how do we develop new treatments and machines without experimenting on these marginal cases? The ICU bed has become the cutting edge of care delivery in hospitals and these expensive beds are becoming more and more widespread.
Walking whilst ill 