Briefing — read this before starting. The transcript will appear here once the consultation begins.
Doctor Notes
Consultation Context
Telephone consultation with Daniel Morrison (age 45), son of Mrs Ruth Morrison (age 81). He has contacted you to discuss something urgently.
Patient Information
Name: Mrs Ruth Morrison
Age: 81 years
Location: Residential care home
Next of Kin: Daniel Morrison (son)
Past Medical History
- End-stage heart failure with reduced EF (EF 20%)
- Severe aortic stenosis – not a candidate for TAVI or surgery
- Chronic kidney disease stage 4
- Advanced Parkinson's disease
- Recurrent aspiration pneumonia
- Frailty – Rockwood score 8
- Protein-calorie malnutrition
Current Medications
- Furosemide 80 mg OD
- Ramipril 2.5 mg OD
- Bisoprolol 1.25 mg OD
- Rivaroxaban 15 mg OD (AF)
- Co-beneldopa QDS
- Nutritional supplements
- Thickened fluids, pureed diet
- Anticipatory medications prescribed by community palliative care team
NKDA
Recent Medical Notes (GP Review – 1 week ago)
Care home requested review due to:
- Worsening breathlessness
- Increasing drowsiness
- Reduced oral intake
- Two recent aspiration events
- Fluid overload and general decline
On examination:
- Markedly frail
- RR 24/min, sats 88% on supplemental oxygen
- Unable to engage meaningfully in decision-making; repeatedly loses track of conversation
- Lacks capacity to make treatment decisions
DNACPR Decision
Based on:
- Severe, irreversible cardiorespiratory disease
- Extremely low likelihood of CPR success
- High risk of trauma and distress from attempted CPR
- Advanced frailty and multi-morbid decline
- Previously expressed views favouring comfort and peace at end of life ("When it's my time, I want peace.")
DNACPR was completed following clinical best-interests assessment. Multiple attempts were made to reach the son; no answer. Message left for him to contact GP.
Next of Kin
Daniel Morrison (45) — son. Works as a paramedic. No LPA for health, welfare or finance.