Why do you say that? (Also addressing others who have said this is what they expected / no other outcome would’ve been possible).
A woman died of malnutrition. She died of not getting enough nutrition into her. She died of this malnutrition despite being admitted to hospital 3 times, precisely to help with her malnutrition and to get her fed. She died despite wanting to be fed. Despite going into hospital those 3 times, and despite constantly asking, she did not actually get any feeding support except a small trial of an NG tube (while being asked to sit upright which she could not do). She also was not given NJ, PEG, TPN despite wanting further help. She also was not given the *conditions* to be able to cope in hospital without deteriorating.
How can people come to the conclusion that this was not the fault of any one doctor or that there’s nothing they could have done? Every doctor who passed through her care and who made the decision not to help her, could have done something. As someone else said, people don’t (or shouldn’t) die of malnutrition in a first world country. They each made that decision (either through their own dodgy risk assessment, or because they didn’t want to “medicalise” a “functional” illness), not to help her.
No one should die of malnourishment and starvation in any land or country at all.
But all the rest of it yes
@lunarainbows. This was preventable. There is ample evidence of this plain fact. The coroner could have reached a different conclusion.
What Maeve’s parents were trying to avoid was asking questions that might be allowed to hit one doctor or other HCP which could allow the hospital the healthcare commissioners the NHS and the medical culture off the hook. So they carefully targeting the system as a whole.
Systems protect themselves coroners are of the establishment and tend to back it even while pointing to specific failures within it. Through constraints that the process puts on them, which favour the establishment, of course, and through their framework for viewing the world based on establishment values.
The victim & family have no legal representation. The institutional parties questioned over their involvement in the death have. They also have institutional knowledge of the process. The bar for pointing out failure is set very high indeed.
The bereaved individuals are at multiple disadvantages.
However coroners can and do find institutional failures and point out systemic issues. So this may have been expected by many, given our history of poor treatment within and by the state, but it wasn’t inevitable.
A different coroner would have come to different conclusions, might have been even worse, could have been much more humane.
