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Vanessa Bourne explores the resuscitation minefield

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VOL: 98, ISSUE: 25, PAGE NO: 35

Vanessa Bourne is chair of the Patients Association

In this week's clinical section, we debate the ethical minefield of resuscitation. Dingwall and Shuttleworth (p36) suggest that it is a cruel intervention in most cases, and the Patients Association questions why patients, who are without doubt the most important people involved in this issue, rarely take part in the final decision-making process.

In this week's clinical section, we debate the ethical minefield of resuscitation. Dingwall and Shuttleworth (p36) suggest that it is a cruel intervention in most cases, and the Patients Association questions why patients, who are without doubt the most important people involved in this issue, rarely take part in the final decision-making process.

The Patients Association regards resuscitation as modern medicine's equivalent of the primitive fear of being buried alive. As patients, we fear we would not be able to speak out even if we wanted to especially if we had changed our minds about a statement-of-intent or 'living will', which we may have signed without fully appreciating its implications.

Elderly people who are in reasonably good health often have no wish to be resuscitated or kept alive in the event of having a heart attack or other serious illness. At the other end of the scale, there are people who may be in the prime of life but have been reduced to paralysis or a permanent vegetative state through illness or injury.

Regardless of whether or not they have made their views clear beforehand, decisions to resuscitate should not be taken lightly by staff.

Resuscitation should be carefully considered. If possible, the issues should be documented in writing to assist family or health professionals who may have to make decisions on our behalf. This is an emotive issue and, though many people discuss it, most do not take it any further.

The media attention given to Miss B - a quadriplegic woman who won a legal battle to come off the ventilator that was keeping her alive - emphasised both her bravery and her capacity to make her views known despite her disability.

If patients are to make their views on resuscitation known, there should be two things in place. First, each patient must be regarded as an individual with an absolute right to an honest assessment of the risks involved in resuscitation. Problems begin when patients are not treated as individuals.

Second, if patients are encouraged to sign resuscitation-consent forms, the 'sign here and let's get on with it' approach will only increase their fears that they will be powerless to change their minds. These forms could be displayed in GP surgeries so that patients can reflect on them and discuss them with their GP.

Above all, patients facing a nurse or a doctor must have absolute trust that they will do their best for them as an individual. If nurses can resuscitate trust, then patients will happily discuss resuscitation.

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