Social work and end-of-life care

Social work is important in end-of-life care

Resuscitation: hospitals need facilities for private consultations with patients and relatives

with 2 comments

I’m having a lawyers morning. Here’s another interesting comment on Do Not Resuscitate orders. These are decisions made by a doctor not to attempt to use cardio-pulmonary resuscitation with a patient, whose heart and lungs fail. The doctor generally puts a note for other staff on the patient’s records. The responsibility is the doctor’s, because a doctor cannot be requested or forced to provide treatment that is not considered to be in the best interests of their patient.  Good medical practice, however, is that they inform and consult with relatives. Doctors, particularly inexperienced junior doctors in busy general hospitals not used to handling dying people, often do not do this consultation. This happens partly, possibly, because they don’t have the competent communication skills to have what are sometimes difficult conversations. It also happens because most general hospitals do not actually know the relatives of their patients: their records call patients ‘pt’ and relatives are called ‘mum’ ‘wife’ rather than by their names, and the doctors are not often around when the relatives are to have the conversation. So it gets left.

Contrary to the fantasy of many of the supporters of assisted suicide, it is far more common for people to be upset at any recognition that a patient is dying and needs to be left free to get on with that than it is for people to be upset that health services are keeping people going when they would rather die. Consequently, unconsulted relatives often complain about DNR decisions, even though relatives generally do not have a right to make or be involved in a patient’s decisions about treatment – it is for the patient alone. And lawyers therefore have an interest in the legal sequelae of these events.

After reviewing some recent cases, Hope concludes:

It is evident that policy surrounding DNRs is inconsistent and lacks transparency. Many of those families subjected to DNRs following a unilateral medical decision seek for the law surrounding DNR notices to be clarified as they can constitute an interference with the fundamental rights of vulnerable patients. Whether they should be governed by the Department of Health following a public enquiry and ensuing national policy is one suggestion, however it is clear that the current status quo of surrendering this issue to individual Trust policy and professional guidelines is inadequate.

It seems this is another misunderstanding by someone who thinks this is a matter of policy rather than professional skill. The reality is that cardio-pulmonary resuscitation is not all-wonderful as the telly in programmes such as ‘Casualty’ would have us believe; it is often ineffective, and not appropriate for many people, in particular people at the end stage of major illnesses, and many cancers. It is not a right to receive this treatment, and it is certainly not a right for relatives to interfere with a decision that a patient wants to make. What is required, however, is a policy of training doctors to make appropriate consultations, helping them to develop the skills to do so and organising hospitals and other healthcare services so that consultation can be appropriately carried out. There are many hospital wards where there is no provision for a private discussion between doctor, patient and relatives. Now that is a matter of policy, which I don’t hear talked about much.

Link to Brendan Hope’s comment on ‘do not resuscitate’ orders.


Written by Malcolm Payne

16 January 2013 at 11:12 am

2 Responses

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  1. Interestingly, my experience in the acute sector has often been the reverse – multiple situations when families have expressed concern at the ongoing medical management plan when patient is clearly dying but no one seems to be able to say it…

    Emily Madsen

    17 May 2013 at 2:00 pm

  2. […] Link to the original post. Thanks for the comment, Emily. […]

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