Saturday 10 November 2012

Whose Life Is It Anyway?

A high court hearing in London is determining issues of fact before a judicial review in February. Tracey wants to clarify whether there is a legal duty to inform patients with capacity whether a DNR has been placed in their notes and whether they have any right to be consulted.
Yes, just savour that – we need a court case to decide if there’s a legal duty to inform patients whether the NHS will seek to keep them alive, or allow them to die for convenience’s sake…
"At one point, she did say they were trying to get rid of her, and I didn't believe her. I just said, 'don't be so silly', which proved to be a mistake."
What with this, and the recent allegations about the Liverpool Care Pathway, who feels safe with their elderly parents or spouse in any NHS hospital?

Shouldn't this be of more concern than who will appear of ‘Celebrity Clowns In The Jungle’ or the continuing accusations against Savile?
Tracey said: "I had rather they hadn't kept badgering her all the time. They told her she had a 1% chance of leaving the hospital. What kind of thing is that to say to someone in hospital?"
So…they can’t find the time to ensure elderly patients are properly fed but they can always find time to stick a DNR form under your nose and brandish a pen?


Dr Cromarty said...

You are absolutely right, for the vast majority of patients DNACPR should be explicitly discussed. Many people want to die peacefully without being jumped upon, many want every resuscitative effort.

The success rate of CPR is low in hospital and becomes even lower in the frail elderly. Those who are particularly enthusiastic That everyone should get CPR should try the experience of breaking the ribs of an elderly demented patient (as I have done) in their last minutes on earth in a futile CPR attempt, because the issue had never been raised even though death could have been reasonably predicted.

Doctors should be under no obligation to offer CPR to those in whom it would be futile, any more than they are under obligation to offer chemotherapy to those in whom it would cause more harm than good (or cupping, leeches or homeopathy for that matter).

They should be obliged to discuss the matter, even when families get up in arms ("How could you discuss that with my mother?" was one I had this very week)

Whose life is it anyway? Indeed.

Furor Teutonicus said...

MOMENT people.

DNR, I presume is "Do not resuscitate"?



Here it is so worded, that you have to work your way through two, or three double negatives before you come to an answer.

Now try that on a person who has just been brought to the ICU because of a suspected stroke!

One of the signs IS that they can not tell you the time of YEAR, let alone work out double, and even tripel negatives!

I Know. I have been there.

Luckily, my uncle was present, who is a doctor of law, and was, before retirement, a Judge, and the President of the Berlin Landesarbeitsgericht. (State (Berlin in this case) work court.... hmm. Better translation needed, but...)

HE had them all sewn up in a bloody teabag. But how many people have such luck?

(I am sure you can all imagine how an EXTREMLEY Prussian Judge thinks!?!? :-) )

Dr Cromarty said...

DNACPR = Do Not Attempt Cardiopulmonary Resuscitation

CPR= Cardiopulmonary Resuscitation

Anonymous said...

Call me difficult if you wish but as a nurse of 'mumble' years experience in most of the major teaching hospitals in London, as well as a couple of regional hospitals, I have yet to witness a single case of a DNR being put in place without a consultation with the patient, or in cases where that is not possible, the family.

The opposite? Happens all the time. Why? Because it is a difficult subject to broach, and because in the majority of cases it isn't thought of as an issue because of the prognosis. Part of the issue is, as mentioned above, when asked 'do you want us to do everything to maintain your life?' most patients/relatives haven't the slightest clue (despite multiple explanations) what that means (procedures, and the effects of such, or outcomes).

I've worked Resus teams in a number of areas and the immediate recovery rate runs at about 10% (that's all patients who arrest, elderly is much lower). the five year follow up ran at 0.3% survival.

It's easy to point out the failings of the service (due mostly to cost cutting, cutting qualified staff at the expense of administrators and management, etc.) but it is already seen as professional misconduct (with the attendant legal implications) for a DNR to be put in place without patient/relatives involvement.

My personal experience is more along the lines of relatives who dumped granny into a home, haven't seen her for years, then turning up and arguing the decision the totally compis mentis granny (or other family members they don't get on with) made herself (either feeling guilty or wanting the inheritance?).

Put it into law if you wish, it won't make the slightest difference in the absolute majority of cases. The few (I can't say it doesn't happen)? There should already be professional conduct questions being asked in such cases anyhow.

Oh, and in situations where there is some/any doubt at all, the requirement (professional) is to resuscitate.

JuliaM said...

"They should be obliged to discuss the matter.."

They should, yes. That we have to have this forced upon them BY LAW is worrying.

"But how many people have such luck?"

Well, indeed. How many elderly without relatives around to make a fuss have been put on this 'care' pathway?

"... I have yet to witness a single case of a DNR being put in place without a consultation with the patient.."

And yet, so many people have claimed it has happened to them or their loved ones.

Using Savile as a template, we need an inquiry! Burn some doctors! No hiding place!

"There should already be professional conduct questions being asked in such cases anyhow.

Totally agree. The worry is that this isn't happening.