End of Life decisions
In the media recently there has been a lot of focus on decisions at the end of life; whether this is DNACPR (Do Not Attempt Cardio-Pulmonary Resuscitation) requests or Assisted Dying legislation. The family of Mrs Janet Tracey were successful in their case against Cambridge Hospitals NHS Trust. The court found with the family that the DNACPR request was placed on Mrs Tracey unlawfully.
It is considered best practice to discuss a DNACPR request with the patient, or if that is not possible with the family. Doctors will now need to discuss it with the patient if they have mental capacity unless they can show it will cause harm. ‘Distress’ is not harm. It is distressing for doctors and patients to have these discussions; discussing the end of your own life or someone else’s can be difficult. It can be argued that as doctors and nurses we should be trained and able to do this, for the majority of the time this may be true but each conversation is different.
As patients and relatives we can help. So if you feel strongly about what you want at the end of your life have these discussions with your family so they know your wishes, you can also document your wishes in an Advance Directive. An Advance Directive is only used if you are unable to discuss it yourself at the time. Also if you or a loved one is admitted to hospital have these discussions with your doctor and let them know your wishes.
The court agreed that Cardio-Pulmonary resuscitation (CPR) is a treatment and therefore whether to offer it remains a medical decision. This means that if your doctors feel it would be futile to attempt CPR they can make that decision – they must now though have the discussion with the patient or family, unless it will cause harm.
Unfortunately, I think that what will happen is doctors will want to avoid these discussions with their patients. The result will be that for some patients who should have a DNACPR may not be given the opportunity to agree and futile attempts at CPR will be made. The result being that the family will likely be moved hurriedly out of the way whilst resuscitation is attempted. The team involved will always try to maintain the patient’s dignity but the process itself is not always dignified. When the attempt is stopped if the person is pronounced dead they are then surrounded by unknown doctors and nurses and not their family. In my opinion it’s much better to allow the person to die surrounded by their family and friends if that is what is appropriate.
The medical and nursing governing bodies along with the Resuscitation Council will produce a new joint statement and policies will be adjusted in the light of this. The Resuscitation Council have produced a statement which you can read here. However, this may take a while so in the meantime we can help ourselves and our loved ones. So please, if you or one of your family are admitted to hospital and you don’t want resuscitation attempted, should it be needed, help your doctors and nurses by initiating this conversation.
Please comment and add your views. Please also share so that others may realise that initiating the conversation ourselves can be helpful.
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