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Anonymous | 6-Dec-2011 11:47 am
You are right about the lack of joined-up thinking, and especially of joined-up behaviour (especially for patients who are at home). To compound the problem, clinical guidance is simply not in line with the law. And the 'emotional aspects' are used as excuses to avoid proper discussions about 'the death part' of EoLC.
I just sent an e-mail to a group of people, and (I'm just pasting, so this might de-format) I get annoyed by the lack of clear understanding about CPR:
Guardian today, pages 1 and 10 – I am very ‘grumpy bear’ ! Doctors train for years, and nursing is becoming all-graduate – it cannot be too much to ask, that the medical profession understands Bland ! And Bland says, to be clear about this, that if a patient has not refused CPR, there is an obligation to try and preserve life. It does not get beyond those two things, but the in-between bit logically follows from the existence of NICE and things such as section 14 of last year’s GMC guidance, and the fact that we all have different tolerances, expectations and enjoyment from life, as individuals.
I briefly touched on this (highly misunderstood) area in my DNAR/RITE/RIP e-mail, but as Scotland has pointed out ‘patients are the judges of quality of life issues’.
Although the report in the Guardian is both over-simplified and ‘confused’, the section at the bottom of page 10 states:
‘The law on resuscitation suggests the final word lies with doctors. Their regulator, the General Medical Council, says there is no obligation to prolong life if doctors think treatment is not in the best interests of a patient’ is rubbish – doctors can legitimately not offer CPR if they are ‘certain it would fail to restore life’, but doctors do not ‘judge the quality of any (potentially) restored life’. Patients make that judgement !
‘…says the patient “must be regarded as absolutely central to considerations on DNR notices’ (UHB guidance) is an absurdity (if not the patient, what else could be ‘central’ ?).
And as for ‘It must be stated that relatives and friends cannot make a decision on behalf of a competent adult’ well, nobody except the patient can, so neither relatives nor doctors can do that !
Why does CPR cause so many problems, emotional issues apart ?
Leave the decisions where they are supposed to be:
If CPR might work – ie if it might restore ‘life’ of whatever quality – a patient can forbid CPR;
If CPR can be ‘argued/shown’ (how, I cannot fathom !) to ‘definitely be non-viable as a clinical procedure – ie ‘even if we tried it, the heart would not be re-started’ – doctors can decide to not offer CPR (but it does not automatically follow that you also have the right to not tell patients of the decision);
‘The system’ – whoever is paying for healthcare – can impose a ‘blanket’ decision of ‘We will not offer you CPR, because we do not offer CPR to any patient in your condition, as the ‘outcome costs’ of any resuscitation, are too high': this is exactly what NICE does with other treatments, so it logically can be extended to CPR !
I am very ‘miffed’ about this, best wishes Grumpy
PS You cannot prevent arguments by getting the rules right - but you can introduce clarity ! You will not be able to remove 'the NHS deliberately killed my wife' as an opinion, when patients and relatives do not agree with 'clincial' DNACPRs (although you could simply agree to try, resouce issues apart - sort out 'RITE' and put it squarely where it rests, with 'the system' as opposed to with clinicians).
6 December, 2011
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