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You are the SHO on a gastro ward where you are caring for Mr Dafinil (DOB 21/7/1951, NHS# 412 751 0839, address 55 Stembridge Avenue, Blackhill Moor). He has been admitted with decompensated cirrhosis due to NAFLD and has a DNACPR in place due to his liver disease and other co-morbidities (Stage 3 CKD, poorly controlled diabetes mellitus and prostate cancer). He says he would like to go home to die, and doesn’t want to be brought back to hospital. He has capacity to make these decisions at this time, has no legal representatives or directives but a daughter who he includes in the discussions.
You discuss with him things which may happen as his liver fails further; his ascites may worsen, spontaneous bacterial peritonitis, and he may have bleeding from varices in his oesophagus which could cause him to vomit blood. You warn that he may become confused due to build up of toxins in the blood. He says he does not want to come back to hospital under any circumstances, but would take tablets at home.
