David Oliver: "Progressive dwindling," frailty, and realistic expectations.

Relatives of sick older patients have an understandable need to know why their loved ones are deteriorating or failing to recover, or exactly why they died. This can lead to misunderstandings, formal complaints, fraught meetings, or upsetting inquests. Over the years I’ve seen my share of this in my own practice. I’ve also worked on numerous cases as an independent investigator or expert witness. In some cases aspects of care were poor, sometimes indefensibly so. And even in someone with serious health problems, failings in care can worsen decline or cause avoidable harm and distress. Often, however, the medical care was good or exemplary, communication was open and frequent, but still the complaints and misunderstandings came. During my career society has become ever more high tech and “can do”—and perhaps less comfortable with death and dying. I’d say that people have become less willing to accept the very real limits of medicine. Often, no one is to blame when older, frailer people with long term conditions and acute illness deteriorate. That’s just (late) life.